Schizophrenia etc DSM Diagnosis Flashcards
Criteria for Schizophrenia?
2 or more for at least 1 month
1) Delusions
2) Hallucinations
3) Disorganized Speech
4) Grossly disorganized/catatonic behavior
5) Negative symptoms (the 5 A’s)
OR
only 1 if delusions are bizarre or if hallucinations are contstant voices or 2 or more voices
But I thought schizophrenia had to be for 6 months? whats all that about?
The duration of the illness in total has to be 6 months in length… not necessarily delusions for 6 months for example…
Schizophrenia has 3 phases;
1) Prodromal - where there is a decline in functioning that precedes first psychotic episode (delusions etc). Usually pt becomes withdrawn/irritable. Often they have a new found interest in religion
2) Psychotic - perceptual disturbances, delusions, disordered thought (this is the one that has to be 1 month long)
3) Residual - occurs between episodes… marked by flat affect, socially withdrawn, and odd thinking or behavior.
What are the 5A’s of “negative symptoms” of schizophrenia
1) Anhedonia
2) Affect (flat)
3) Alogia (lack of speech)
4) Avolition (apathy)
5) Attention (poor)
What are the 5 subtypes of schizophrenia and what is one key fact about each?
1) paranoid type - pts often are higher functioning with OLDER age of onset… preoccupation with 1 or more delusions/hallucinations
2) Disorganized type - pts are often poorly functioning with an EARLY age of onset… characterized by disorganized speech, behavior, flat or inappropriate affect
3) Catatonic type - excessive purposeless activity, extreme negativism, echolalia or echopraxia (2 or more of these)
4) residual type - prominent negative symptoms… with minimal positive symptoms
5) undifferentiated - fits 1+ subtypes
What are some common findings in an interview with schizophrenics? (3)
1) disheveled appearance and flat affect
2) concrete understanding of proverbs
3) lack of insight into their disease
also key: disorganized thought process, auditory hallucinations, ideas of reference
What is the prevalance, age of onset for schizophrenia?
1% of population… men and women affected equally… but guys usually present around 20… vs girls present around 30! (also weird fun fact… those born in the winter and spring have a higher incidence of schizophrenia)
How good are we at treating schizophrenia?
40-50% remain functionally impaired after diagnosis while only 20-30% function fairly well in society with medication (downward drift hypothesis)
What are some brain findings in schizophrenic patients?
enlargement of ventricles and diffuse cortical atrophy (decreased hippocampal, temporal, and cerebral mass)
What is key to assess in a patient newly diagnosed with schizophrenia?
Suidice thoughts/attempts… 50% of patients with schizophrenia attempt suicide
Treatment for schizophrenia?
typicals and atypicals work equal for positive symptoms… but typical antipsychotics have much higher side effect profile… so atypicals are commonly used (still watch out for metabolic syndrome etc)
Schizophreniform criteria?
same as schizophrenia… except symptoms are from 1-6 months
what is a fun fact about beta blockers and digoxin?
They are known to induce psychosis in predisposed patients
What is the DSM criteria for schizoaffective disorder?
- all of the following
1) meet criteria for major depressive episode, manic episode or mixed episode
2) have has delusions, hallucinations for 2 weeks IN ABSENCE of mood disorder symptoms… aka while feeling just fine
3) have mood symptoms present for a substantial portion of psychotic illness
note - 60-80% will progress to schizophrenia
Criteria for Brief Psychotic Disorder?
same as for schizophrenia except symptoms last from 1 day to 1 month…. 50-80% recovery rate!
What are the 3 criteria for Delusional Disorder?
1) NON-bizarre, fixed delusions for at least 1 month
2) does not meet criteria for schizophrenia
3) functioning in life is NOT significantly impaired..
basically, non-bizarre beleifs in an otherwise high-functioning person (erotomania is a subtype of this like the lady in the psych unit)
