Schizophrenia and other Psychotic Disorders Flashcards
Schizophrenia
characterized by: disordered thinking, emotions, and behavior
Schizophrenia: Etiology
unknown
theories include:
- genetics
- biochemical
- interaction of predisposing risk and environment
Biochemical Theories of Schizophrenia
dopamine: thought that excessive dopamine is cause as Levodopa can sometimes induce a psychotic rxn
serotonin: could be excess serotonin? not sure but clozaril is very effective (clozaril affects both dopamine and serotonin)
glutamate
neuroanatomy: enlarged ventricles, less brain tissue
Genetic Factors of Schizophrenia
identical twins have 50% risk of schizophrenia if one twin has it
children w/ one bio parent w/ schizophrenia have 15% risk and two bio parents = 35% risk
Immunovirologic Factors of Schizophrenia
virus exposure particularly in pregnancy, possibly leading to schizophrenia
cytokines > immune response
Schizophrenia: Onset
dx in late adolescence or early adulthood
onset 15-25 YO men
25-35 YO women
insidious onset
it may be debilitating functionally, economically, and emotionally for individuals and their families
- sx may impair employment, education, relationships, and impact self-care
- increased risk for suicide: early on in dx, person has more insight into what is happening to them
Phases of Schizophrenia
Prodromal: decrease in functional ability, may arise a year before 1st hospitalization
Active: psychotic symptoms
Residual: flat affect, social withdrawal
Diagnostic Criteria for Schizophrenia
HD BS Network
Hallucinations Delusions Behavior disorganization Speech/Thought Disorganization Negative Symptoms
Positive Symptoms
delusions
hallucinations
disorganized thinking or speech
disorganized behavior
Negative Symptoms
5 A’s
- Affect (blunted)
- Ambivalence/Avolition (decreased motivation)
- Alogia (reduction in speech, lacks content)
- Anhedonia (decreased ability to experience pleasure)
- Asociality (decreased social interest, difficulty relating to other people)
Schizoaffective Disorder
has a mood component to it
mood episode (mania or depression) concurrent with Criterion A of schizophrenia
delusions or hallucinations for two or more weeks in the absences of a major mood episode
Schizophrenia: Criteria A
2 or more of the following (1 month period) at lease one must be 1, 2, or 3
- delusions
- hallucinations
- disorganized speech
- disorganized behavior
- negative symptoms
Brief Psychotic Disorder
diagnostic criteria for schizophrenia but different time frame, for brief period of time (at least 1 day but less than a month)
Schizophreniform Disorder
diagnostic criteria for schizophrenia but different time frame, for brief period of time (symptoms lasting at least 1 month but less than 6 months)
Delusional Disorder
overall functioning of the individual is not impaired (one or more non-bizarre delusions)
Schizotypal Disorder
personality disorder that’s most closely related to schizophrenia
Catatonia
psychomotor disturbance - can see decreased motor function, mutism, responds well to benzos
Hallucinations
visual auditory olfactory tactile gustatory
*hallucinations related to schizophrenia are generally auditory
Schizophrenia: Tx
early onset treatment: likely respond more quickly to drug therapy
mixed modalities:
- vocational counseling
- medications
- CBT for psychosis
- psychosocial
meds: dopamine antagonists (decrease positive symptoms, help though disorders, help w/ anxiety/agitation/sleep)
Benefits of Group Therapy
socialization
develop coping skills
help with interpersonal conflicts
General SE of Dopamine Antagonists
- sedation
- anticholinergic
- orthostatic hypotension
- metabolic (obesity, DM, hyperlipidemia)
- photosensitivity
- EPS (dystonia, drug-induced parkinsonism, akathisia, TD)
Dystonia
- acute, involuntary movement disorder
- usually involving the neck
- occurs in short period of time after antipsychotic administration
tx: anticholinergic (benzotropine) or antihistamine (diphenhydramine) IM
Parkinsonism
subacute syndrome that mimics Parkinson’s disease
Akathisia
subjective as well as objective feeling of inner restlessness and inability to sit still often affecting the lower extremities
should resolve after drug discontinuation
tx = propranolol
TD
insidious onset and arises after prolonged tx (unlike EPS which is acute)
repetitive, involuntary, purposeless movements
most cases affect orofacial and lingual musculature
s/sx:
- rapid eye blinking
- tongue protrusion
- lip puckering or pursing
- rapid movements of the hands, arms, legs, or trunk
early detection is important as this can be permanent if not treated early
AIMS
abnormal involuntary movement scale
Neuroleptic Malignant Syndrome
infrequent, life-threatening
sx:
- fever
- rigid muscles
- altered consciousness
Metabolic SEs
weight gain
disturbances in cholesterol
dysregulation of glucose
Anticholinergic SEs
“dries you up”
dry mouth blurred vision constipation urinary retention orthostatic hypotension
Clozaril
most efficacious antipsychotic medication we have now
SE: agranulocytosis (low WBC with pronounced neutrophil depletion)
- sedation
- hypotension
- weight gain
- hyper-salivation
- tachycardia
- seizure
Prognosis for Schizophrenia
-suicide
-incarceration
-homelessness
-live 10-20 yrs less than their peers d/t increased risk of suicide and SE of meds (DM, high cholesterol), tobacco use disorder
-smoking
need early intervention!
