Schizophrenia and Other Psychotic Disorders Flashcards
What disorders are categorized under Schizophrenia and Other Psychotic Disorders?
- Delusional Disorder
- Brief Psychotic Disorder
- Schizophreniform Disorder
- Schizophrenia
- Catatonia
- Schizoaffective Disorder
- Substance/Medication-Induced Psychotic Disorder
- Psychotic Disorder Due to another Medical Condition
Are Schizophrenia and Other Psychotic Conditions severe in comparison to other psychiatric conditions?
Among the most disabling psychiatric conditions
What are positive symptoms in terms of Schizophrenia and Other Psychotic Conditions?
the presence of symptoms
Hallucinations- distorted sensory experiences
Delusions- fixed belief that are not held by others
What are negative symptoms in terms of Schizophrenia and Other Psychotic Conditions?
the absence
Flat affect- lack of emotional expression or response
Anhedonia- lack of experience of pleasure
What were the changes in the DSM5 for Schizophrenia and Other Psychotic Conditions?
Stronger requirement for presence of positive symptoms
Dimensional diagnostic system rating eight symptoms on a scale of severity- from 1 (least severe) to 4 (most severe)
Deletion of sub-categories of schizophrenia, such as paranoid and disorganized behavior.
Catatonia is now described as a symptom not a separate type
What is the diagnostic criteria for Schizophrenia and Other Psychotic Conditions?
Presence of one or more delusions for at least a month
Absence of all the criteria required for a diagnosis of schizophrenia
Must use caution to distinguish from accepted cultural beliefs/practices (e.g. spirit possession, visions)
What are the types of delusions?
erotomanic
grandiose
jealous
somatic
persecutory
What is an erotomanic delusion?
the individual believes that he or she is loved by someone else, usually a prominent figure whom the individual does not actually know
What is a grandiose delusion?
a belief that the individual has some special, great characteristic
What is a jealous delusion?
the individual is convinced that a spouse or lover is unfaithful
What is a somatic delusion?
a belief that the individual has some gross physical problem
What is a persecutory delusion?
a belief that the individual is being conspired against (the most common)
What is the etiology of Delusional Disorder?
Neurocognitive disorder
What is the prognosis for Delusional Disorder?
Chronic, with exacerbations and remissions
Appears best when somatic delusions are most evident, and worse in cases in which erotomanic or paranoid content is prevalent
Social impairment
Function typically unimpaired except related to delusions
What is the treatment used for Delusional Disorder?
Antipsychotic medications (limited benefit)
Psychotherapy
Cognitive-behavioral therapy
What is the diagnostic criteria for Brief Psychotic Disorder?
One or more of the symptoms associated with psychosis:
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized behavior
- Lasting more than a day but less than a month
- Often emerges in adolescence or early adulthood
- May be a precursor to a more chronic psychotic disorder
What is the differential diagnosis of Brief Psychotic Disorder?
Substance-related disorders
Mood disorders
Personality disorders
What is the comorbidities of Brief Psychotic Disorder?
Medical conditions
Substance-related disorders
Personality disorders
What is the diagnostic criteria for Schizophreniform Disorder?
Duration one to six months
Two or more of the major signs of psychosis for a significant portion of at least one month
- Delusions, hallucinations, or disorganized speech
- Disorganized or catatonic behavior
- Negative symptoms like diminished emotional expression or avolition
What is the etiology of Brief Psychotic Disorder & Schizophreniform Disorder?
Genetics
Stress is a factor in exacerbations
Poor parenting and family dysfunction
Environmental factors, psychosocial stressors, such as maladjusted family relationships
Childhood trauma
What is the prognosis of Brief Psychotic Disorder & Schizophreniform Disorder?
Variable; may becomes schizophrenia (the diagnosis if symptoms last beyond six months)
If substance abuse related, resolving substance use resolves psychosis
What are the implications for function for Brief Psychotic Disorder & Schizophreniform Disorder?
When psychotic symptoms are present, function is severely impaired
Cognition is particularly impaired, with resultant deterioration of social and vocational roles
What treatments are used for Brief Psychotic Disorder & Schizophreniform Disorder?
Psychopharmacological
What OT treatments are used for Brief Psychotic Disorder & Schizophreniform Disorder?
Monitor the effectiveness of medications (inpatient & outpatient)
Minimize damage to occupational status resulting from a period of severe disorder
What is the diagnostic criteria for Schizophrenia?
Two or more signs of psychosis for a significant portion of at least one month
- At least one: Delusions, hallucinations, or disorganized speech
- And catatonic behavior, and/ or
- Negative symptoms like diminished emotional expression or avolition
Functional limitations- self-care, work, interpersonal relations (differentiates from brief psychosis or schizophreniform disorder)
Signs of disturbance last at least six months, including prodromal and residual periods
What characteristics may be seen in those with Schizophrenia?
Disorder of thought and perception
Loose association, incoherence, or excessively concrete or abstract thought
Perception and affect are also disturbed
Peculiar psychomotor behavior: Odd mannerisms, grimacing, hyperactivity, waxy rigidity
Onset in adolescence or early adulthood
Within the DSM5 Is Catatonia a type of schizophrenia?
In DSM-5, a symptom, rather than a distinct type of schizophrenia
What is the criteria for Catatonia?
3 of more of the following:
- Catalepsy (passive induction of a posture against gravity, like an arm held in front of the face for long periods of time)
- Waxy flexibility (resistance to being positioned by the therapist)
- Mutism (absence of verbal response in the absence of aphasia)
- Negativism (opposition to or failure to respond to instructions or stimuli)
- Odd Mannerism or Grimacing
- Stereotypy (repetitive, frequent, non-goal-directed movement)
- Agitation
- Echolalia (mimicking others’ speech)
- Echopraxia (mimicking others’ movements)
What is the differential diagnosis for Schizophrenia?
Bipolar disorder
What are the comorbidities for Schizophrenia?
Depression
Bipolar disorder
Personality disorder
Substance abuse
What is the etiology for Schizophrenia?
Genetics
Stress is a factor in exacerbations
Poor parenting and family dysfunction
Environmental factors: psychosocial stressors, such as maladjusted family relationships
Childhood trauma, TBI, many other factors considered
Found in lower SES, but may be because of functional limitations
What is the prognosis for Schizophrenia?
- Poor, but this is changing as better medications are identified
- Stopping medications predicts relapse
- Higher levels of negative symptoms and greater cognitive dysfunction have worse functional outcomes
- Higher levels of education and briefer duration of untreated psychosis also predict better outcomes
- Better premorbid function predicts better outcomes
- High risk of suicide (10-13%)
What are the phases of Schizophrenia?
- prodromal phase
- active phase
- residual phase
What is the Prodromal phase of Schizophrenia?
Function begins to deteriorate
Withdrawal from friends and family
Work, self-care, and avocational activities suffer
What is the Active phase of Schizophrenia?
Delusions and hallucinations
Thought disorder, and other psychotic symptoms
Global functional deficits
This phase may occur spontaneously or as a result of stress.
Difficulty with work, social interaction, self-care, and leisure occupations.
Skills deficits in visual processing
Emotional identification
Communication skills, emotional regulation, and visual-motor perception
Processing speed and working memory are impaired
What is the Residual phase of Schizophrenia?
Function continues to be below the highest level ever achieved
Continued flat affect, peculiar behavior, and functional difficulties in self-care, work, social spheres
In all phases, symptoms vary from individual to individual
What psychotropic medications are used in the treatment of Schizophrenia?
Older antipsychotic medications effective in reducing positive symptoms, minimizing exacerbations
Newer, “atypical” medications have fewer side effects and show promise in treating negative symptoms.
Why is medication adherence a problem for those with Schizophrenia?
because of cognitive deficits and unpleasant side effects
What treatments are used for Schizophrenia?
Psychotropic medications
Cognitive-behavioral therapy
Social supports (inpatient or community)
Psychotherapy
Art and other creative therapies
Behavior therapy (addresses cognition)
Family therapy
Close monitoring of physical health
What is the most effective treatment for Schizophrenia?
Cognitive-behavioral therapy in concert with medication
Why would close monitoring of physical health be important for those with Schizophrenia?
Potential damage from medications
Inability to manage nutrition, physical activity, other health promotion strategies
High risk of cardiovascular and other health problems
What is the diagnostic criteria for Schizoaffective Disorder?
- Symptoms of schizophrenia, with at least one period of illness during with a major episode of depression or mania
- Delusions or hallucinations must be present for two or more weeks without a major mood episode at some point during the illness
- Mood episodes must be present for the majority of the duration of the illness.
What are the differential diagnoses for Schizoaffective Disorder?
Other psychotic disorders
Mood disorders
Substance-related disorders
What are the comorbidities for Schizoaffective Disorder?
Substance-related disorders
What is the etiology for Schizoaffective Disorder?
Genetic
Advanced parental age at birth
Preterm birth
What is the prognosis for Schizoaffective Disorder?
Chronic
Prognosis is better than that of schizophrenia and worse than mood disorders (major depressive or bipolar)
What are the implications for OT for Schizophrenia & Schizoaffective Disorder?
Need to find meaning/purpose in life
Must be comprehensive, with particular emphasis on occupational engagement
- Motor and praxis
- Sensory perceptual
- Visual-spatial and visual-motor coordination
- Cognitive intervention
- Communication and social skills
- Performance areas: self-care, leisure, and work
Reintegration into the community is an important emphasis for OT
What are the implications for OT for solely Schizophrenia?
Activities/IADLs training- Medication management, time & budget management
Vocational assessment and work skills training
- Work as an activity is clearly important as an intervention and as an outcome
- Match job demands to the skills of the individual
Remediating skill deficits through education, behavioral, or sensorimotor approaches
“Life skills” training
Strengths as well as weaknesses should be incorporated into treatment
Educate families/employers
Sex education (can work with social work) for adolescents and young adults
Advocacy regarding public policy
How common is Substance/Medication Induced Psychosis?
Between 7 and 25% of individuals presenting with psychosis have a substance-induced condition
How severe is Substance/Medication Induced Psychosis?
Severity and persistence of substance-induced psychosis vary
What are the cultural considerations for Psychotic Disorders?
In some cultures, hallucinations, delusions might be part of culturally sanctioned rituals
E.g. Latino cultures- religious belief: “hearing God’s voice”. Western culture- pathological delusion/ hallucination
How do health disparities in the U.S. affect those with Psychotic Disorders?
Evidence of over diagnosis of schizophrenia among African-Americans
Inaccurate and effective treatment
Stigma
How might Psychotic Disorder onset in adolescence or young adulthood affect the lifespan?
individuals may miss developmental accomplishments in education, work, leisure, and social participation
What are the lifespan considerations for older adults?
Older adults typically have endured an extended illness.
In later life, neurological components of the disorder may be prominent
Individual may have significantly lowered energy and motivation
There may be significant and permanent deficits associated with long-term antipsychotic medication use
