Schizophrenia and Schizoaffective Disorder Flashcards
What key features define schizophrenia and schizoaffective disorders?
Delusions
Hallucinations
Disorganized thinking (speech)
Grossly disorganized or abnormal motor behavior
Negative symptoms
What are delusions?
Fixed beliefs that are not amenable to change considering conflicting evidence. Their content may include a variety of themes.
- Persecutory delusions: belief that one is going to be harmed, harassed, and so forth by an individual, organization, or other group.
- Referential delusions: belief that certain gestures, comments, environmental cues, and so forth are directed at oneself.
- Grandiose delusions: when an individual believes that he or she has exceptional abilities, wealth, or fame.
- Erotomanic delusions: when an individual believes falsely that another person is in love with him or her.
- Nihilistic delusions involve the conviction that a major catastrophe will occur.
- Somatic delusions focus on preoccupations regarding health and organ function.
Delusions that express a loss of control over mind or body are generally considered to be bizarre; these include the belief that one’s thoughts have been “removed” by some outside force (thought withdrawal), that alien thoughts have been put into one’s mind (thought insertion), or that one’s body or actions are being acted on or manipulated by some outside force (delusions of control).
What are hallucinations?
Hallucinations are perception-like experiences that occur without an external stimulus. They are vivid and clear, with the full force and impact of normal perceptions, and not under voluntary control.
They may occur in any sensory modality, but auditory hallucinations are the most common in schizophrenia and related disorders.
What is disorganized thinking?
Disorganized thinking (formal thought disorder) is inferred from the individual’s speech.
The individual may switch from one topic to another (derailment or loose associations).
Answers to questions may be obliquely related or completely unrelated (tangentiality).
What is grossly disorganized or abnormal motor behavior?
May manifest itself in a variety of ways, ranging from childlike “silliness” to unpredictable agitation. Problems may be noted in any form of goal-directed behavior, leading to difficulties in performing ADLs.
Catatonic behavior is a marked decrease in reactivity to the environment.
What are negative symptoms?
Negative symptoms account for a substantial portion of the morbidity associated with schizophrenia but are less prominent in other psychotic disorders.
Two negative symptoms are particularly prominent in schizophrenia: diminished emotional expression and avolition.
- Diminished emotional expression includes reductions in the expression of emotions in the face, eye contact, intonation of speech (prosody), and movements of the hand, head, and face that normally give an emotional emphasis to speech.
- Avolition is a decrease in motivated self-initiated purposeful activities. The individual may sit for long periods of time and show little interest in participating in work or social activities.
- Alogia is manifested by diminished speech output.
- Anhedonia is the decreased ability to experience pleasure from positive stimuli or a degradation in the recollection of pleasure previously experienced.
- Asociality refers to the apparent lack of interest in social interactions and may be associated with avolition, but it can also be a manifestation of limited opportunities for social interactions.
What are schizophrenia spectrum and other psychotic disorders?
Schizotypal Personality Disorder
Delusional Disorder
Brief Psychotic Disorder
Schizophreniform Disorder
Schizophrenia
Schizoaffective Disorder
Substance or medication induced psychotic disorder.
Catatonia
What is schizophrenia?
To meet the criteria for schizophrenia, an individual must exhibit at least two of the following symptoms for at least 1 month:
- delusions
- hallucinations
- disorganized speech
- disorganized or catatonic behavior
- negative symptoms.
At least one of the two symptoms must be delusions, hallucinations, or disorganized speech.
In addition, there must be a marked decline in functioning.
According to the DSM-5, the condition must persist for at least 6 months.
What are positive symptoms of schizophrenia?
Positive symptoms (Type I) reflect an increase in the presence of abnormal behaviors.
Minimal or no cognitive deficits; fluctuating course; usual onset a full-blown psychotic episode; responds well to antipsychotic meds.
- Hallucinations
- Delusions
- Disorganized thinking
- Disorganized behavior
What are negative symptoms of schizophrenia?
Negative symptoms (Type II) refer to an absence of normal behaviors found in healthy individuals. They may appear months of years before positive symptoms.
Some degree of cognitive deficits; onset insidious but identified by early adulthood; chronic course; ongoing OT for rehab and maintenance—responds poorly to typical antipsychotic meds.
- Loss of interest in everyday activities
- Appearing to lack emotion.
- Reduced ability to plan or carry out activities.
- Neglect personal hygiene
- Social withdrawal
- Loss of motivation
What are the symptom clusters for schizophrenia?
4 distinct symptom clusters:
- Psychotic: hallucinations, delusions
- Disorganized: disorganized speech, disorganized or bizarre behavior, inappropriate affect
- Negative: alogia, flat affect, avolition, anhedonia, attentional impairment
- Affective: manic, depressive
What are schizoaffective disorders?
Schizoaffective disorder is characterized by a combination of psychotic and mood symptoms. For someone to receive a diagnosis of schizoaffective disorder, criteria must be met for a mood episode as well as criteria for schizophrenia.
The mood disturbance must be present for most of the time in which the individual has experienced the illness.
What is the etiology of schizophrenia?
Research into the etiology of schizophrenia explores genetic factors, prenatal factors, structural and functional neuroanatomical differences, dopamine, stress vulnerability, and specific environmental factors. It is likely that biological and environmental factors interact to cause schizophrenia.
What is the prevalence and course of schizophrenia?
Schizophrenia can develop at any age, although it is rarely diagnosed before adolescence or after age 40. Late-onset schizophrenia is more common in women.
Before meeting the criteria for schizophrenia, most individuals have a prodromal period lasting for weeks or months in which there are nonspecific changes in behavior.
The prodromal period is the time between the emergence of early signs of the illness and the point at which the diagnostic criteria for the disorder are met. Identifying the prodrome of schizophrenia may be important for prevention.
There is a slightly higher incidence of schizophrenia in males, and schizophrenia is generally less severe for females than it is for males.
What cognitive impairments can occur with schizophrenia?
Cognitive impairments in schizophrenia may include problems with attention, memory, and executive function.
A hallmark of cognitive impairment in schizophrenia is difficulty with working memory, or the ability to manipulate information in the brain for short periods of time.
Functional outcomes were divided into three categories:
- Success in psychosocial rehabilitation programs
- Laboratory or simulated measures of social and instrumental skills
- Broader measures of community outcome.
