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NMSP Exam 1 > Schizophrenia Spectrum > Flashcards

Schizophrenia Spectrum Flashcards

1
Q

Onset of Schizophrenia is noted to be when?

A

Late adolescence

Early adulthood

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2
Q

Use of what substance is associated with a 6x increased risk of schizophrenia?

A

Cannabis

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3
Q

Are positive symptoms associated with a better or worse prognosis?

A

Better

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4
Q

Are negative symptoms associated with a better or worse prognosis

A

Worse

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5
Q

Observed concordance rate of schizophrenia is monozygotic twins

A

40-50%

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6
Q

Observed concordance rate of schizophrenia in dizygotic twins

A

10-15%

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7
Q

Schizophrenia has been associated with a number of early life complications, including what?

A

Potentially adverse events that occur during pregnancy and labor, at delivery and early in neonatal life

  • ELCs increase risk of schizophrenia by 1.5-2 fold
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8
Q

What drives the interaction between polygenic risk score and early life complications on schizophrenia risk?

A

Genes highly and differentially expressed in placenta

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9
Q

Pre-natal exposure to what during the 1st trimester appears to increase the risk of developing schizophrenia by 7-fold?

A

Influenza

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10
Q

What maternal infection encountered at any point in pregnancy is associated with a threefold increased risk of schizophrenia?

A

URI

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11
Q

What does the “revised dopamine hypothesis” for schizophrenia propose?

A
  • Hyperactive dopamine transmission in mesolimbic areas
  • Hypoactive dopamine transmission in prefrontal cortex
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12
Q

In addition to the mesolimbic areas, dopamine dysregulation is also observed in what brain regions important for emotional processing?

A
  • Amygdala
  • PFC
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13
Q

Where in the brain is the dopamine system particularly overactive in schizophrenic pt’s?

A

Hippocampus

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14
Q

What changes in cortisol have been seen in patients with schizophrenia?

A

Both heightened and decreased secretion

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15
Q

What 4 “positive” sx’s define psychotic disorders?

A
  • delusions
  • hallucinations
  • disorganized thinking (speech)
  • grossly disorganized or abnormal motor behavior
    • including catatonia
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16
Q

Delusions

  • Definition
  • Types
A

Fixed beliefs that are not amenable to change in light of conflicting evidence

  • Persecutory
  • Grandiose
  • Referential
  • Erotomanic
  • Nihilistic
  • Somatic
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17
Q

Which types of hallucinations are the most common in Schizophrenia?

A

Auditory

  • experienced as voices (familiar or unfamiliar)
  • perceived as distinct from the individual’s own thoughts
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18
Q

Hallucinations that occur while falling asleep

A

Hypnagogic

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19
Q

Hallucinations that occur while waking up

A

Hypnopomic

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20
Q

Are hypnagogic and hynopomic hallucinations indicative of psychosis?

A

No

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21
Q

What is catatonic behavior?

A

Marked decrease in reactivity to the environment

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22
Q

What is catatonic excitement?

A

Purposeless and excessive motor activity without obvious cause

23
Q

What is negativism?

A

Resistance to instructions

24
Q

What are examples of repeated stereotyped movements?

A
  • Staring
  • Grimacing
  • Mutism
  • Echoing of speech
25
Q

What 5 “negative” sx’s define psychotic disorders?

A
  • Diminshed emotional expression
  • Avolition: decrease in motivation to initiate and perform activities
  • Alogia: lack of speech
  • Anhedonia: inability to feel pleasure/loss of interest
  • -Asociality: lack of motivation to engage in social interaction and/or preference for solitarty activities
26
Q

What sxs account for most of the morbidity associated with schizophrenia?

A

Negative symptoms

27
Q

Of the negative sxs, which two are most prominent in schizophrenia?

A
  1. Diminished emotional expression
  2. Avolition
28
Q

What is the diagnostic criteria for Schizophrenia?

A
  • ≥2 of the following for most of 1 month; at least 1 of the first 3 sx’s
    • Delusions
    • Hallucinations
    • Disorganized speech
    • Grossly disorganized or catatonic behavior
    • Negative sx’s
29
Q

After the diagnosis of schizophrenia in an adult, what is commonly experienced?

A

The level of functioning is far below what it was prior to onset

30
Q

How long must there be contnuous signs of disturbance for dx of Schizophrenia?

A

≥6 months; must include at least 1 month of sx’s from criterion A:

  • Delusions
  • Hallucinations
  • Disorganized speech
  • Grossly disorganized or catatonic behavior
  • Negative sxs
31
Q

If there is a history of autism spectrum disorder or a communication disorder of early childhood onset, the additional diagnosis of schizophrenia is made only if what is present?

A

Prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, present for at least 1 month

32
Q

The catatonic type of Schizophrenia has a clinical picture dominated by at least 2 of which 5 sx’s?

A
  • Motoric immobility as evidenced by catalepsy or stupor
  • Excessive motor activity (apparently purposeless and not influenced by external stimuli)
  • Extreme negativism or mutism
  • Peculiarities of voluntary movement such as posturing, stereotyped movements, prominent mannerisms or prominent grimacing
  • Echolalia (repeated speech) or echopraxia (repeated movements)
33
Q

What is the single leading cause of death in pt’s with Schizophrenia?

A

SUICIDE!

  • Usually near illness onset
34
Q

Dementia typically mimics what symptoms of schizophrenia?

A

Negative symptoms

35
Q

How is a patient with schizophrenia + acute psychosis managed?

A
  1. Hospitilization is needed for patient safety and to get pt stabilized
  2. IM injections: Haloperidol, Fluphenazine, Lorazepam
36
Q

Stabilization phase of schizophrenia treatment includes?

A

Switching to a newer, atypical (2nd gen) antipsychotic

  • Risperidone, Ziprasidone, Quetiapine, Olanzipine, etc.
37
Q

Maintenance phase of schizophrenia treatment includes?

A

Keeping patients free from symptoms while avoiding incapacitating side effects

38
Q

Which second-gen antipsychotic used for tx of Schizophrenia is more commonly associated with QTc prolongation?

A

Ziprasidone

39
Q

Which drug class can be used for catatonic disorder of Schizophrenia?

A

Benzodiazepines

40
Q

Which second-gen antipsychotic is associated with less risk of tardive dyskinesia?

A

Quetiapine

41
Q

Nonpharmacologic therpaies for Schizophrenia

A
  • Community treatment
  • Self-help programs
  • ECT
42
Q

What is the criteria for Delusional Disorder?

A
  • Presence of 1+ delusions with duration of 1 month or longer
  • Functioning is NOT impaired and behavior is not obviously bizarre or odd
    • Criterion A for schizophrenia has never been met
43
Q

Differential diagnosis for delusional disorder

A
  1. Alzheimer’s disease
  2. Huntington’s disease
  3. Brain tumor
  4. Complex partial seizures
  5. Stroke
44
Q

What is the diagnostic criteria for Brief Psychotic Disorder?

A
  • Presence of 1+ of the following sx’s. At least one being the first 3:
    • Delusions, Hallucinations, Disorganized speech, Grossly disorganized or catatonic behavior
  • Duration of an episode is at least 1 day but <1 month, with eventual full return to premorbid level of functioning
45
Q

What is the diagnostic criteria for Schizophrenifrom Disorder?

A
  • Two (or more) of the following, each present for a significant portion of time during a 1-month period. At least one must be the first 3 sx’s:
    • Delusions, Hallucinations, Disorganized Speech, Grossly disorganized or catatonic behavior, Negative sx’s (diminished emotional expression, avolition)
  • Episode must last at least 1 month but < 6 months
46
Q

What is the diagnostic criteria for Schizoaffective Disorder?

A
  • An uninterrupted period of illness during which there is a major mood disorder (major depressive or manic) concurrent with criterion A of schizophrenia
  • Delusions or hallucinations for ≥ 2 weeks in absence of major mood episode (depressive or manic)
    • Sxs that meet criteria for major mood episode are present for the majority of the total duration of illness
47
Q

There must be the presence of one or both of which 2 sx’s for diagnosis of substance/medication-induced psychotic disorder?

A
  1. Delusions
  2. Hallucinations
48
Q

In addition to the symptoms required to make a diagnosis of Substance/medication-induced psychotic disorder, what other factors are required?

A
  • Symptoms must have developed during or soon after substance intoxication or withdrawal or after exposure to a medication
  • Involved substance/medication must be capable or producing the symptoms (delusions, hallucinations)
49
Q

What is the diagnostic criteria for psychotic disorder due to another medical condition?

A

Prominent hallucinations or delusions that are a direct pathophysiological consequence of another medical condition

50
Q

The clinical picture of Catatonia associated with another mental disorder or another medical condition is dominated by three (or more) of the following 12 symptoms:

A
  • Stupor
  • Catalepsy
  • Waxy flexibility
  • Mutism
  • Negativism
  • Posturing
  • Mannerism
  • Stereotypy
  • Agitation
  • Grimacing
  • Echolalia or echopraxia
51
Q

What characterizes attenuated psychosis syndrome?

A

Psychotic-like symptoms that are below threshold for full psychosis (i.e. sxs are less severe and more transient, and insight is relatively maintained)

52
Q

What is the timeline for Schizophrenia vs. Schizophreniform vs. Brief Psychotic Disorder?

A
  • Schizophrenia: > 6 months
  • Schizophreniform: 1-6 months
  • Brief psychotic disorder: < 1 month
53
Q

Characteristics of the “schizo spectrum”: schizoid vs. schizotypal vs. schizophrenia vs. schizoaffective

A
  • Schizoid: very introverted and voluntarily withdrawals from socal interactions
  • Schizotypal: schizoid sxs + magical thinking & odd behavior
  • Schizophrenia: schizotypal + psychosis
  • Schizoaffective: schizohrenia + mood disorder

NMSP Exam 1 (6 decks)

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