Schizophrenia And Psychotic Related Diaorders Flashcards
Define Psychosis
The inability to diatinguish fantasy from reality
Impaired reality testing with the creation of a new reality
Common manifestation in Schisophrenia and other psychotic related disorder dx class
Psychosis
Does cannabis (weed) increase risk of developing psychotic disorders?
Yes
Name disorders under Schizophrenia and other psychotic related disorders dx class in DSM 5
Schizophrenia
Delusional disorder
Brief psychotic disorder
Schizophreniform disorder
Schizoaffective disorder
Schizotypal personality disorder
Name other disorders under Schizophrenia and other psychotic related disorders dx class in DSM 5
Substance abd medication related psychotic disorder
Pssychotic disorders due to other medical condition
Catatonic diorder due to medical cause
Unspecified catatonia
Other specified schizophrenia spectrum and other psychotic disorder
Unspecified schizophrenia spectrum and other psychotic disorder
What is schizophrenia?
Mental disorder characterized by disintegration of thought processes and of emotional responsiveness
Brain disorder that affects how people think, feel and perceive
“Schizo”
Fragment or split”
“Phrenia”
Mind
Schizophrenia prevalence ratio in males to females
1:1 (0.3-0.7)
Schizophrenia mean age of onset in females
21-30 yrs
Schizophrenia mean age of onset in males
18-25 yrs
What are the 3 phases of Schizophrenia
- Prodormal
- Acute
- Residual
Describe prodormal phase of Schizophrenia
Lasts weeks,months or even years
Sx - loss of interest in usual persuit
- pull away from family
- easily confused
- trouble concentrating
- lethargy
- apathetic
- prefer spending time alone
Describe the Acute phase of Schizophrenia
Sx - acute psychotic episode
- negative and positive sx of Schizophrenia
- positive sx > than negative sx
Describe the residual phase of Schizophrenia
Sx similar to those in prodormal phase
- reduced positive sx
- negative sx persist
- Improved cognitive functioning
-patient is aware of their strange beliefs
Etiology of Schizophrenia
Genetic
Neurochemistry
Neuroanatomy
Neuroendocrinology
Neuropsychilogy
Enviromental
Genetic cause of Schizophrenia
Dysbindin (Chrm 6p), neurogulin(8p) and G72 (13q) are found to be susceptible
Chances of schizophrenia when sibling has it
10%
Chances of Schizophrenia when one parent has it
5%
Chances of Schizophrenia in monozygotic twin when the other twin has it (concordance)
46%
Chances of Schizophrenia in dizygotic twin when the other twin has it (concordance)
14%
Neurochemistry cause of Schizophrenia (dopamine hypothesis)
Excessive activity in mesolimbic dopamine pathway precipitates positive sx of psychosis
Decreased dopamine in the frontal cortex may mediate negative and cognitive sx of Schizophrenia
Neuroanatomy causes of Schizophrenia
Enlarged lateral ventricles
Smaller brain volume
Cortical atrophy (brain shrinking)
Widening of third ventricle
Smaller hippocampus
Neuroendocrine causes of Schizophrenia
Abnormal growth hormone
Abnormal cortisol
Abnormal prolactin
Neuropsychological cause of Schizophrenia
Global defects in attention, language and memory
Suggesting disrupted connectivity of neural pathways
Environmental causes of Schizophrenia
Drug use
Cannabis increases chances of getting Schizophrenia
Geographical variance
Winter season of birth (suggesting perinatal/prenatal exposure of child to certain microorganisms
Obstetrics complications
What are the clinical features of Schizophrenia
Positive sx - hallucinations
- delusions
Negative sx - avolition (lack of motivation)
- alogia (poverty of speech)
- flattened affect
- anhedonia (inability to experience pleasurable activities)
- Asociality (lacking capacity for social interactions)
Cognitive sx - disorganized dimension
- thought disorder (thought form and content)
- disorganized behaviour (catatonic behaviour)
Other sx - lack insight
- memory problems
- attention problems
- disturbances in sleep and sexual interest
Schneider’s first rank sx of Schizophrenia
- Delusional perception
- 3rd person auditory hallucinations (2 voices speaking in patients head)
- Thought interference
- Passivity phenomenon
What are the different typea of Schizophrenia
- Paranoid type
- Disorganized type
- Catatonic type
- Undifferent type
- Residual type
- Post schizophrenic depression
- Simple schizophrenia
The DSM 5 dx criteria of Schizophrenia
Specifiers - severity of Schizophrenia
Eaxh sx may be rated for uts current severity in the last 7 days on a 5 point scale
0 - not present
1 - present
2 - present but mild
3 - present and moderate
4 - present and severe
How do you manage Schizophrenia
** Biological tx**
Acute tx - Antipsychotics
- 1st Line
(1st generation Antipsychotics Haloperidol)
( 2nd generation Antipsychotics Risperidone and Olanzapine)
- 2nd Line
(Clozapine)
Maintanance Therapy
- Initial episode - treat for 1 - 2 years because there is high risk of relapse
- Multiple episodes - treat for 5 years
Adjunctive
- Mood stabilizers for aggression / impulsiveness- lithium, valproate and carbamazepine
- Anxiolytics Benzodiazepines with or w/o ECT
- Antidepressants - for depression
- Electroconvulsive Therapy (ECT)
- for concurrent depression and catatonic sx
Schizophrenia psychological intervention
CBT
Supportive therapy - group or family
Assertive Community Treatment
- help with medication adherence
- basic living skills
- social support
- job placement and resources
- social skills training
- vocational rehabilitation
- disability benefits
-appropriate housing
