Schizophrenia Spectrum Flashcards
Is psychosis a disorder?
NO
it is a defining feature in other disorders (i.e. schizophrenia, substance/med induced psychotic disorders, delusional disorder, etc.)
What is psychosis?
delusions/hallucinations
generally also includes sxs such as disorganized speech, disorganized behavior and gross distortions of reality
What are perceptual distortions?
being distressed by hallucinatory voices; hearing voices that accuse, blame or threaten punishment, seeing visions
What are some positive sxs of of psychosis and schizophrenia?
delusions, hallucinations, distortions or exaggeration in language/communication, catatonic behavior, agitation
What are some negative sxs of psychosis and schizophrenia?
blunted affect, emotional withdrawal, apathetic social withdrawal, alogia, avolition, anhedonia
What is Alogia?
restricted fluency and production of thought and speech
What is Avolition?
restriction in initiation of goal directed behavior
What is Anhedonia?
lack of pleasure
delusions
fixed beliefs that are not amenable to change in light of conflicting evidence
Persecutory delusions
belief that one is going to be harmed/harassed by someone or something
(cheated on, spied on, followed, poisoned)
referential delusions
belief that certain gestures, comments, environmental cues etc. are directed at them
Grandiose delusions
when an individual believes that they have exceptional abilities, wealth or fame
Erotomatic delusions
when an individual believes falsely that another person is in love with them
Nihilistic delusions
involve the conviction that a major catastrophe will occur
somatic delusions
preoccupatations regarding health and organ func.
What are considered bizarre delusions
if they are clearly implausible and not understandable by others
(belief that organs were switched with someone else w/o leaving any scars)
What is a non-bizarre delusion?
ex. belief that one is under surveillance by police without any proof
What are hallucinations?
perception-like experiences that occur without an external stimulus
What are hypnagogic hallucinations? hypnopompic?
occur while falling asleep
occur when waking up
considered to be WNL
What is catatonic behavior?
a marked decrease in reactivity to the environment
ranges from resistance to lack of verbal and motor responses
What are 2 prominent negative sxs in schizophrenia?
diminished emotional expression and avolition
What is avolition?
decrease in motivated self-initiated purposeful activities
Asociality
lack of interest in social interactions
Describe delusional disorder
the presence of one or more delusions with a duration of one month or longer
What are the delusional disorder subtypes?
erotomanic
Grandiose
Jealous
Persecutory
Somatic
Mixed
Unspecified
Delusions disorder epidemiology
female > male
Men: more often paranoid delusions
women = more often erotomania
Clinical features of delusional disorders
mental status: usually normal besides delusional beliefs
usually have little insight and impaired judgement regarding their delusions
What is the most common type of delusional disorder?
persecutory
Capgras syndrome
a belief that a familiar person has been replaced with an identical “imposter”
Fregoli syndrome
a belief that a familiar person is “disguised” as someone else
Cotard syndrome
pts believe that they have lost all of their possessions, status and strength as well as their entire being including their organs
Delusional disorder tx
challenging to tx
establish alliance and negotiate sxs tx goals
meds for sxs of depressed mood or irritability
outpt (unless harm to self or others)
+/- antipsychotics
psychotherapy
Describe brief psychotic disorder
presence of one or more of the following sxs (at least one must be in first 3)
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
Sxs of brief psychotic disorder
Abrupt onset of 1 or more: delusions, hallucinations, bizarre behavior/posture, disorganized speech
+/- associated sxs: affective sxs, disorientation, impaired attention, catatonic behavior
emotional volatility, outlandish dress/behavior, screaming or muteness, and impaired memory for recent events are commonly seen in which disorder?
brief psychotic disorder
What must you always take into account when making a judgement about whether a pts beliefs are delusional?
religious beliefs
What is schizophrenia?
disorder of the brain affecting how people think, feel and perceive
hallmark sxs: hallucinations and delusions
DSM 5 criteria for dx schizophrenia
2 or more:
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- negative sxs (diminished emotional expression or avolition)
What is thought broadcasting delusion?
the belief that one’s thoughts are being broadcast or transmitted to others
What is thought withdrawal delusion?
the belief that one’s thoughts are being removed from their mind
Delusions of reference
belief that all happenings revolve around oneself
Positive sxs of schizophrenia
psychotic sxs (i.e. hallucinations-auditory, delusions and disorganized speech and behavior)
Negative sxs of schizophrenia
decrease in emotional range, poverty of speech, loss of interests and drive…they have tremendous inertia
cognitive sxs of schizophrenia
deficits in working memory, attention and in executive functions such as the ability to organize and abstract
mood sxs of schizophrenia
pts often seem cheerful or sad in a way that is dif. to understand, often depressed
What are some common auditory hallucinations in schizophrenia?
hearing own thoughts spoken by another voice, hearing voices arguing, hearing voices commenting on one’s own behavior
Tx of schizophrenia
antipsychotics (aka neuroleptics): non adherence, adverse effects
psychosocial management
Goals of tx for schizophrenia pts according to recovery model
- to have few or stable sxs
- to avoid hospitalization
- to manage his or her own funds/meds
- to be working or in school at least half time
Describe schizoaffective disorder
an uninterrupted period of illness during which there is a major mood episode (depressive or manic) concurrent with schizophrenia
tx for schizoaffective disorder
pharmacotherapy and psychotherapy
(if depressive type- SSRI +antipsychotic)
neuro consult
