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Behavioral Dynamics > Schizophrenia- Exam 3 > Flashcards

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
Q

types of disorganized speech: _________ words are used on how they sound rather than what they mean. May cause excessive rhyming or alliteration.

A

Clanging

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26
Q

types of disorganized speech: _________ inability to use abstract thinking

A

concrete speech

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27
Q

types of disorganized speech: _________ consistently returning to one topic despite the conversation going in a different direction

A

perseveration of ideas

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28
Q

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?

A

positive symptoms: disorganized behavior

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29
Q

Is catatonic behavior considered a positive or negative symptom?

A

positive symptom

but can have positive and negative categories within the positive symptom

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30
Q

Grimacing
Teeth clicking
Rocking
Touching or tapping
Speech mannerisms (robotic, foreign accent)
Echolalia
Echopraxia

What am I?
What category do I fall into?

A

catatonic behavior: positive schizophrenic symptom

positive catatonic category due to motiveless abnormally increased movement

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31
Q

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?

A

catatonic behavior: positive schizophrenic symptom

negative catatonic category due to
motiveless abnormally decreased movement

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32
Q

What is echolalia? Echopraxia? What type of symptom are they?

A

involuntary repetition of words or phrases that someone else says

involuntary repetition or imitation of another person’s actions

positive catatonic behavior

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33
Q

Social withdrawal
Anhedonia
Flattened affect
Loss of motivation
Alogia (decreased verbal communication)
Loss of hygiene

What am I?

A

negative schizophrenic symptoms

negative = decrease in or absence of normal psychosocial processes

34
Q

Deficit schizophrenia affects ____ of schizophrenia pts. Mostly ____ symptoms
More likely in ____; more likely to have 1st degree schizophrenic relatives. Less prone to ????

A

15-20%

negative

males

addiction, suicidality, depression, and emotional delusions

35
Q

Processing speed
Attention
Working memory
Speech
Verbal learning and memory
Verbal comprehension
Visual learning and memory
Reasoning/executive functioning
Social cognition

What am I?

A

cognitive impairment

36
Q

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?

A

depression, anxiety and suicide**

nicotine

agraphesthesia and asterognesia

HTN, DM, hyperlipidemia

37
Q

What is the average age of schizophrenia onset for males and females?

A

Men: between 10-25 years old
Women: between 25 -35 years old¹

38
Q

What are some risk factors for schizophrenia?

A

1st degree relative with schizophrenia
male gender
OB complications or material malnutrition
infections
inflammation/autoimmune disorders
cannabis use
immigrant status

39
Q

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

A

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
Q

____ and _____ are associated infections/inflammation with increased risk of schizophrenia

A

influenza ( winter/early spring birthdate risk)

toxoplasma gondii
_____
herpes simplex 2
measles antibodies

41
Q

Inflammation/Autoimmune diseases increase risk for schizophrenia due to increased _____. What disease has a LOWER rate?

A

cytokines

lower incidence with RA

42
Q

_____ risk factor for psychosis. Is it dose dependent? ______ may be due to stress and social discrimination. It increases your chances by _____

A

cannabis

dose-dependent relationship

immigrant status: increases risk by 4X

43
Q

What is the dopamine hypothesis?

A

Schizophrenia due to abnormal levels of dopamine

Positive Symptoms → increased dopamine

Negative Symptoms → decreased dopamine

All antipsychotics block dopaminergic D2 receptors

44
Q

What is the glutamate hypothesis?

A

due to low function of NMDA glutamate receptor

NMDA antagonists → Psychosis, negative symptoms, cognitive deficits

45
Q

What is the GABA hypothesis?

A

Decreased functioning of GABAergic neurons in schizophrenia
Possible decreased synthesis of GABA

46
Q

What is the actylcholine hypothesis? Treating with nicotinergic substances improves some ____ and _____

A

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
Q

Describe some of the structural brain abnormalities in schizophrenia. What about functional?

A

Decreased brain tissue overall, larger ventricle size, increased rate of brain tissue loss

Cognitive defects often present before positive symptoms

48
Q

For positive symptoms would want to treat a pt with _____. What about for negative symptoms? What drug in particular?

A

Positive: generally respond well to antipsychotics

negative: less reponsive to antipsychotics but 2nd gen atypicals work better than 1st generation

Cariprazine (Vraylar)

49
Q

about ___ of patients with delusions or hallucinations will have a good response. How long does it take to see a response from medication?

A

70%

4-6 weeks: 6 weeks trial minimum per drug, no high doses until after first 6 weeks

50
Q

What is the MOA for typical 1st generation antipsychotics? SE? What type of symptoms are they good for?

A

Dopamine receptor antagonists

More side effects (up to 70%)

Good for positive symptoms

51
Q

What drugs are considered typical first generation antipsychotics? Which ones are lower vs higher potency?

A

lower:
chlorpromazine (Thorazine)
thioridazine (Mellaril)

higher:
haloperidol (Haldol)
prochlorperazine (Compazine)

52
Q

What is the MOA for atypical 2nd generation antipsychotics? SE? What type of symptoms?

A

Dopamine/5HT antagonists

LESS SE

good for both positive and negative symptoms

53
Q

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?

A

Neuroleptic Malignant Syndrome (NMS)

**can lead to fatal hypertensive crisis

1-3 days

54
Q

What is the treatment for Neuroleptic Malignant Syndrome (NMS)?

A

cooling measures, supportive tx, dopaminergic meds

55
Q

What are common SE of antipsychotics?

A

Neuroleptic Malignant Syndrome (NMS)
Hyperprolactinemia
Anticholinergic
Sedation
Extrapyramidal Symptoms (EPS)
Hypotension
Agranulocytosis
Seizures
Cardiac Arrhythmias
Metabolic Syndrome

56
Q

Hyperprolactineamia is common with what antipsychotics?

A

typicals: haloperidol, prochlorperazine chlorpromazine, thioridazine
risperidone
high dose olanzapine or ziprasidone

57
Q

anticholinergic SE are commonly seen with what Antipsychotics?

A

Highly likely with low-potency typicals (chlorpromazine, thioridazine) and clozapine

May also be seen with high dose olanzapine, quetiapine

58
Q

Sedation is commonly seen with what antipsychotics?

A

Highly likely with low-potency typicals (chlorpromazine, thioridazine) and clozapine
May also be seen with olanzapine, quetiapine

59
Q

When are extrapyramidal symptoms commonly seen? What are some examples of s/s?

A

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
Q

When are hypotension commonly seen?

A

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
Q

What drug is agranulocytosis associated with? What are the risk factors? what is the monitoring?

A

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
Q

When are seizures commonly seen?

A

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
Q

When are cardiac arrhythmias commonly seen?

A

Seen most often with thioridazine and ziprasidone

dose dependent so avoid giving with other medications that also prolong the QT interval

64
Q

What antipsychotics are WORSE for weight gain? What drugs minimize weight gain?

A

Worse with clozapine and olanzapine

aripiprazole, brexpiprazole, cariprazine, lurasidone, ziprasidone

65
Q

___ and _____ are the worst for glycemic abnormalities?

A

clozapine and olanzapine

66
Q

What antipsychotics are worse for dyslipidemia?

A

low-potency typicals (chlorpromazine, thioridazine), clozapine, olanzapine, quetiapine

67
Q

overall metabolic problems are worse with ??
intermediate with ???
least with ???

A

WORST: clozapine and olanzapine

intermediate: low potency typicals (chlorpromazine, thioridazine)
and quetiapine

least: aripiprazole, brexpiprazole, cariprazine, ziprasidone, high-potency typicals (haloperidol and prochlorperazine)

68
Q

What is the likelihood of causing SE of weight gain and sedation from greatest to least?

A
69
Q

What is the treatment for acute psychosis? What do you NOT want to use?

A

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
Q

What is the maintenance treatment for schizoprenia?

A

antipsychotic medication **indefinitely at the lowest effective dose

psychotherapy

social support services

close clinical follow- up

71
Q

What are some good and poor prognosis factors for schizophrenia?

A
72
Q

_____ is schizophrenia but for less than 1 month.

_____ is schizophrenia but for 1-6 months

A

Brief Psychotic Disorder

Schizophreniform Disorder

73
Q

_____ is psychosis with another probable cause

_____ is schizophrenia with a mood disorder as well

_____ is delusions but no other crazy symptoms

A

secondary psychotic disorder

schizoaffective disorder

delusional disorder

74
Q

What is the criteria for brief psychotic disorder? What is the treatment? What are some diagnostic clues?

A

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
Q

What are the criteria for schizophreniform disorder? What is the treatment?

A

Antipsychotic medication - second generation preferred
Generally respond much more quickly than schizophrenics

psychotherapy

76
Q

What is secondary psychotic disorder? What is the treatment?

A

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
Q

What is the criteria for schizoaffective disorder? What is the important timeframe to note?

A

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
Q

What subtype of schizoaffective disorder has the better overall outcome? Is it better to have schizoaffective or schizophrenia? What is the tx?

A

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
Q

What is the criteria for delusional disorder? What is the treatment?

A

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
Q
A

Behavioral Dynamics (16 decks)

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