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Schizophrenia- Exam 3 Flashcards

1
Q

Give some examples of forms of psychosis. How many do you have to have?

A

Hallucinations
Delusions
Disorganized or incoherent speech
Disorganized or catatonic behavior
Abnormal emotions
Cognitive difficulties

“A disturbance in the perception of reality”
1+

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2
Q

_____ sensory perceptions in the absence of any external stimuli. What is the key word there?

A

Hallucinations

**absence

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3
Q

_____ sensory misperceptions of actual external stimuli. What is the key word there?

A

Illusions

misperceptions

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4
Q

_______ - fixed false beliefs that persist even with evidence to the contrary. What is the key word?

A

Delusions

Not shared by a defined religion, family, or subculture

fixed false beliefs

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5
Q

What is the DSM definition of schizophrenia?

A

Psychiatric disorder with chronic or recurrent psychosis that is impairing functioning/severely disabling

Must have a “characteristic symptom”: positive, negative or cognitive symptoms
PLUS
social/occupational dysfunction

for a least 6 MONTHS

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6
Q

Does schizophrenia have a specific s/s?

A

NO! No clinical sign or symptom is pathognomonic for this disease

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7
Q

What is the typical presentation for a schizophrenic pt? What are the 3 categories of schizophrenia s/s?

A

Poorly groomed, failure to bathe, and dressed too warmly for the current weather

positive, negative, cognitive

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8
Q

What are hallucinations, delusions,
disorganization of speech, thoughts, behavior classified as? How do you define it?

A

positive symptoms

Exaggeration of normal processes

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9
Q

What are amotivation, blunted affect, avolution, alogia, anhedonia, social withdrawal classified as? How do you define it?

A

negative symptoms

“Diminution or absence of normal processes

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10
Q

What are deficits in memory, attention, reasoning and problem solving, processing speed, social cognition and IQ classified as?

A

cognitive symptoms

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11
Q

Name 4 kinds of hallucinations. What are the MC form of hallucinations? Which kind are the most responsive for antipsychotic meds? Are they considered positive or negative?

A

Auditory, visual, somatic, olfactory

**auditory is MC and most responsive to meds

postive s/s

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12
Q

_____ fixed, false belief present even in the face of evidence to the contrary. These are often used to defend _____.

A

delusion

Patients often have delusional explanations for their hallucinations

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13
Q

What are some common forms of delusions? What is the MC?

A

**delusions of :persecution- MC
grandeur
cotard delusion/nihilistic delusion
erotomania
reference
control
somatic delusions

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14
Q

_____ the belief that one does not exist or has died. What type of delusion?

A

Cotard Delusion / Nihilistic Delusion

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15
Q

_____ Delusion that someone is in love with the patient. What type of delusion?

A

erotomania

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16
Q

_____ belief that insignificant remarks, events or objects in one’s environment have personal meaning or significance. What type of delusion?

A

Delusions of Reference

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17
Q

____ belief that another person, group of people, or other external force controls one’s general thoughts, feelings, or behavior. What type of delusion?

A

delusions of ocntrol

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18
Q

_____ belief regarding one’s bodily functioning, sensations, or appearance.Usually involves the body being diseased or infested. What type of delusion?

A

Somatic delusion

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19
Q

What are 8 types of disorganized speech? Which ones are more severe?

A

tangentiality, circumstantiality, neologisms, derailment, incoherence, clanging, concrete speech, perseveration of idea

More severe - derailment, neologisms, word salad

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20
Q

types of disorganized speech: _________ speech begins in a goal-directed manner, but deviates gradually and consistently off-topic such that answers to questions are not reached. Is it common or severe?

A

tangentiality

commonly observed

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21
Q

types of disorganized speech: _________ speech is goal-directed but full of unneeded detail and gets to the answer in a “roundabout” way. Is it common or severe?

A

circumstantiality

commonly observed

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22
Q

types of disorganized speech: _________ speech begins in a goal-directed manner, but topics shift rapidly between sentences with no logical connection to the topic previously discussed. Is it common or severe?

A

derailment

severe

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23
Q

types of disorganized speech: _________ creation and use of new, nonsensical words. Is it common or severe?

A

neologisms

severe

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24
Q

types of disorganized speech: _________ Incomprehensible speech due to loss of logical connections between words, phrases and sentences. ____ form - “word salad”. Is it common or severe?

A

incoherence

word salad is severe

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25
types of disorganized speech: _________ words are used on how they sound rather than what they mean. May cause excessive rhyming or alliteration.
Clanging
26
types of disorganized speech: _________ inability to use abstract thinking
concrete speech
27
types of disorganized speech: _________ consistently returning to one topic despite the conversation going in a different direction
perseveration of ideas
28
Childlike silliness Unprovoked outbursts of behavior or emotion Laughter Hyperactivity Agitation or violence Aimless, compulsive, or bizarre behavior Inappropriate social behaviors Bizarre clothing choice or general appearance Severe neglect of hygiene Catatonic behaviors What are these an example of?
positive symptoms: disorganized behavior
29
Is catatonic behavior considered a positive or negative symptom?
positive symptom but can have positive and negative categories within the positive symptom
30
Grimacing Teeth clicking Rocking Touching or tapping Speech mannerisms (robotic, foreign accent) Echolalia Echopraxia What am I? What category do I fall into?
catatonic behavior: positive schizophrenic symptom positive catatonic category due to motiveless abnormally increased movement
31
Immobility (hypokinesia, akinesia) Mutism Stupor Negativism Waxy flexibility Posturing/Catalepsy (holding a position for a long time) Staring What am I? What category do I fall into?
catatonic behavior: positive schizophrenic symptom negative catatonic category due to motiveless abnormally decreased movement
32
What is echolalia? Echopraxia? What type of symptom are they?
involuntary repetition of words or phrases that someone else says involuntary repetition or imitation of another person's actions positive catatonic behavior
33
Social withdrawal Anhedonia Flattened affect Loss of motivation Alogia (decreased verbal communication) Loss of hygiene What am I?
negative schizophrenic symptoms negative = decrease in or absence of normal psychosocial processes
34
Deficit schizophrenia affects ____ of schizophrenia pts. Mostly ____ symptoms More likely in ____; more likely to have 1st degree schizophrenic relatives. Less prone to ????
15-20% negative males addiction, suicidality, depression, and emotional delusions
35
Processing speed Attention Working memory Speech Verbal learning and memory Verbal comprehension Visual learning and memory Reasoning/executive functioning Social cognition What am I?
cognitive impairment
36
What other psych disorders are common in schizophrenic patients? What substance is most widely used? What is common in their neuro exam? What are common comorbities?
depression, anxiety and suicide** nicotine agraphesthesia and asterognesia HTN, DM, hyperlipidemia
37
What is the average age of schizophrenia onset for males and females?
Men: between 10-25 years old Women: between 25 -35 years old¹
38
What are some risk factors for schizophrenia?
1st degree relative with schizophrenia male gender OB complications or material malnutrition infections inflammation/autoimmune disorders cannabis use immigrant status
39
Schizophrenia has a strong genetic componenet. ____ chance if you identical twin has it. ____ risk if nonidenical twin has it. ____ is first degree relative. ____ chance if both parents have schizophrenia. ____ chance if NO family history
50% identical twin 10% for nonidentical twin 10% for first degree relative 40% if both parents Over 50% of patients have NO family history
40
____ and _____ are associated infections/inflammation with increased risk of schizophrenia
influenza ( winter/early spring birthdate risk) toxoplasma gondii _____ herpes simplex 2 measles antibodies
41
Inflammation/Autoimmune diseases increase risk for schizophrenia due to increased _____. What disease has a LOWER rate?
cytokines lower incidence with RA
42
_____ risk factor for psychosis. Is it dose dependent? ______ may be due to stress and social discrimination. It increases your chances by _____
cannabis dose-dependent relationship immigrant status: increases risk by 4X
43
What is the dopamine hypothesis?
Schizophrenia due to abnormal levels of dopamine Positive Symptoms → increased dopamine Negative Symptoms → decreased dopamine All antipsychotics block dopaminergic D2 receptors
44
What is the glutamate hypothesis?
due to low function of NMDA glutamate receptor NMDA antagonists → Psychosis, negative symptoms, cognitive deficits
45
What is the GABA hypothesis?
Decreased functioning of GABAergic neurons in schizophrenia Possible decreased synthesis of GABA
46
What is the actylcholine hypothesis? Treating with nicotinergic substances improves some ____ and _____
led to theory that nicotine corrects fundamental problem in schizophrenia Unclear if nicotinergic receptors are primary problem or secondary to other neurotransmitter pathophysiology eye-tracking and EEG abnormalities
47
Describe some of the structural brain abnormalities in schizophrenia. What about functional?
Decreased brain tissue overall, larger ventricle size, increased rate of brain tissue loss Cognitive defects often present before positive symptoms
48
For positive symptoms would want to treat a pt with _____. What about for negative symptoms? What drug in particular?
Positive: generally respond well to antipsychotics negative: less reponsive to antipsychotics but 2nd gen atypicals work better than 1st generation Cariprazine (Vraylar)
49
about ___ of patients with delusions or hallucinations will have a good response. How long does it take to see a response from medication?
70% 4-6 weeks: 6 weeks trial minimum per drug, no high doses until after first 6 weeks
50
What is the MOA for typical 1st generation antipsychotics? SE? What type of symptoms are they good for?
Dopamine receptor antagonists More side effects (up to 70%) Good for positive symptoms
51
What drugs are considered typical first generation antipsychotics? Which ones are lower vs higher potency?
lower: chlorpromazine (Thorazine) thioridazine (Mellaril) higher: haloperidol (Haldol) prochlorperazine (Compazine)
52
What is the MOA for atypical 2nd generation antipsychotics? SE? What type of symptoms?
Dopamine/5HT antagonists LESS SE good for both positive and negative symptoms
53
Rigidity, fever, autonomic instability, altered mental status Can lead to fatal ______ and metabolic acidosis Can happen with any antipsychotic How long does it take to show up?
Neuroleptic Malignant Syndrome (NMS) **can lead to fatal hypertensive crisis 1-3 days
54
What is the treatment for Neuroleptic Malignant Syndrome (NMS)?
cooling measures, supportive tx, dopaminergic meds
55
What are common SE of antipsychotics?
Neuroleptic Malignant Syndrome (NMS) Hyperprolactinemia Anticholinergic Sedation Extrapyramidal Symptoms (EPS) Hypotension Agranulocytosis Seizures Cardiac Arrhythmias Metabolic Syndrome
56
Hyperprolactineamia is common with what antipsychotics?
typicals: haloperidol, prochlorperazine chlorpromazine, thioridazine risperidone high dose olanzapine or ziprasidone
57
anticholinergic SE are commonly seen with what Antipsychotics?
Highly likely with low-potency typicals (chlorpromazine, thioridazine) and clozapine May also be seen with high dose olanzapine, quetiapine
58
Sedation is commonly seen with what antipsychotics?
Highly likely with low-potency typicals (chlorpromazine, thioridazine) and clozapine May also be seen with olanzapine, quetiapine
59
When are extrapyramidal symptoms commonly seen? What are some examples of s/s?
Can happen with any antipsychotic, but more common with high-potency typical (haloperidol, prochlorperazine) Pseudoparkinsonism - Parkinson-like symptoms Rigidity, bradykinesia, masked facies, shuffling gait Akathisia - inner restlessness leading to pacing or fidgeting Dystonia - spastic, uncontrollable muscle contractions Tardive Dyskinesia - involuntary movements usually involving the orofacial region that disappear during sleep
60
When are hypotension commonly seen?
Orthostatic hypotension can occur with any antipsychotic Highly likely with low-potency typicals (chlorpromazine, thioridazine) and clozapine May be seen with risperidone, quetiapine - especially with rapid titration More common in elderly, pts with hx of HTN or cardiovascular disease
61
What drug is agranulocytosis associated with? What are the risk factors? what is the monitoring?
Clozapine can cause neutropenia and agranulocytosis commonly seen in the first 3 months of tx risk: elderly, female, asian Must have CBC weekly x 6 mo, biweekly x 6 mo, then q 1 mo
62
When are seizures commonly seen?
**Can be seen with any antipsychotic because ALL antipsychotics lower seizure threshold** more sedating effect the lower the seizure threshold Most likely with low-potency typicals (chlorpromazine, thioridazine) and clozapine May consider avoiding use of depot antipsychotic
63
When are cardiac arrhythmias commonly seen?
Seen most often with thioridazine and ziprasidone dose dependent so avoid giving with other medications that also prolong the QT interval
64
What antipsychotics are WORSE for weight gain? What drugs minimize weight gain?
Worse with clozapine and olanzapine aripiprazole, brexpiprazole, cariprazine, lurasidone, ziprasidone
65
___ and _____ are the worst for glycemic abnormalities?
clozapine and olanzapine
66
What antipsychotics are worse for dyslipidemia?
low-potency typicals (chlorpromazine, thioridazine), clozapine, olanzapine, quetiapine
67
overall metabolic problems are worse with ?? intermediate with ??? least with ???
WORST: clozapine and olanzapine intermediate: low potency typicals (chlorpromazine, thioridazine) and quetiapine least: aripiprazole, brexpiprazole, cariprazine, ziprasidone, high-potency typicals (haloperidol and prochlorperazine)
68
What is the likelihood of causing SE of weight gain and sedation from greatest to least?
69
What is the treatment for acute psychosis? What do you NOT want to use?
lower antipsychotic doses Recommended not to use clozapine or olanzapine use dosing in the lower half of the recommended range consider adjunct anxiolytic or sedative meds
70
What is the maintenance treatment for schizoprenia?
antipsychotic medication **indefinitely at the lowest effective dose psychotherapy social support services close clinical follow- up
71
What are some good and poor prognosis factors for schizophrenia?
72
_____ is schizophrenia but for less than 1 month. _____ is schizophrenia but for 1-6 months
Brief Psychotic Disorder Schizophreniform Disorder
73
_____ is psychosis with another probable cause _____ is schizophrenia with a mood disorder as well _____ is delusions but no other crazy symptoms
secondary psychotic disorder schizoaffective disorder delusional disorder
74
What is the criteria for brief psychotic disorder? What is the treatment? What are some diagnostic clues?
Treatment - Not well studied May try antipsychotic medication presence of marked stressor before symptom onset, lack of negative symptoms, confusion during early course of illness, duration <1 month
75
What are the criteria for schizophreniform disorder? What is the treatment?
Antipsychotic medication - second generation preferred Generally respond much more quickly than schizophrenics psychotherapy
76
What is secondary psychotic disorder? What is the treatment?
psychotic symptoms that are caused by another condition: medical, psychological, substance use improvement in psychotic symptoms with improvement of underlying cause, presence of symptoms only when underlying disorder is active or uncontrolled correction of underlying cause
77
What is the criteria for schizoaffective disorder? What is the important timeframe to note?
Pt meets criteria for both schizophrenia and a major mood disorder, both sets of symptoms are prominent **At least one 2-wk period where hallucinations and/or delusions are present in the absence of a prominent mood episode**
78
What subtype of schizoaffective disorder has the better overall outcome? Is it better to have schizoaffective or schizophrenia? What is the tx?
bipolar has a BETTER outcome than depressive Schizoaffective has a better prognosis than schizophrenia without mood symptoms antipsychotic medication - first tx of choice Antidepressants, mood stabilizers - adjunct
79
What is the criteria for delusional disorder? What is the treatment?
Isolated delusions in an otherwise high-functioning person for at least 1 month Typically non-bizarre - followed, poisoned, infected, deceived generally there no other psychotic symptoms Antipsychotics, especially **atypical antipsychotics**
80

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