Schizophrenia spectrum and other psychotic disorders Flashcards
Introduction
Deprived from the greek “skhizo” (split) & “phren” (mind)
Affects approximately 1% of the population
Probably causes more fear, longer hospitalizations, greater disruptions in family life, & higher costs than any other mental illness
Nature of schizophrenia
Schizophrenia causes disturbances in thought processes, perception, & affect
Usually diagnosed in late adolescence or early adulthood (early 20’s)
May occur earlier in men than in women
A full return to pre-morbid function is uncommon
Prognosis
Factors associated with a positive prognosis:
- later age at onset
- No family hx of schizophrenia
- Abrupt onset precipitated by stressful event
- Associated mood disturbance
- Brief duration of active-phase sx
- Minimal residual sx
- Absence of structural brain abnormalities
- Normal neurological functioning
Predisposing factors
-Biological influences:
Genetics: family hx increases likelihood
Biochemical influences: “The dopamine hypothesis”- this theory suggest that schizophrenia may be caused by an excess of dopamine-dependent neuronal activity in the brain. Other biochemicals that may be linked include, norepinerphrine, serotonin, acetylcholine, and gamma-aminobutyric acid and in neuroregulators such as prostaglandins and endorphins
Physiological influences:
viral infections such as prenatal exposure to influenza. Also, illnesses such as huntington’s disease and epilepsy also increases risk for schizophrenia
Predisposing factors
-Environmental influences:
Sociocultural factors: people from lower social classes tend to have schizophrenia including poverty, poor nutrition, congested housing,
Stressful life events: stress does not cause schizophrenia but the stress may contribute to the severity of the illness
-Theoretical integration
Transactional model: the most current theory states that schizophrenia is a biologically based disease, the onset of which is influenced by factors within the environment (either internal or external).
Comorbidities
- Substance abuse: more than 1/2 are nicotine dependent. Some have issues with drugs and alcohol
- Depression: Can lead to relapse
- Suicidal tendencies: 1/2 make suicide ideation; 10% are successful
- Anxiety disorders: more than 1/2 have anxiety, particularly social anxiety
- Obsessive-compulsive disorder: 25% have OCD; very preoccupied with delusions
- Alzheimer disease: the older they get the more likely they are to develop dementia
DSM 5 Criteria for diagnosis of schizophrenia
Characteristic sx: Delusions, hallucinations, disorganized speech & behavior, & other symptoms that cause social and occupational dysfunction. At least two of these are needed for a diagnosis
Social/occupational dysfunction: significant impairment in major areas of social or occupational functioning.
Duration: symptoms present for 6 months with at least one month of active symptoms.
Exclusions: other mental illness, medical condition, substance induced, developmental disorder.
4 fundamental signs
Affect: outward expression of mood
Associative looseness: conversations jumping from topic to topic
Autism
Ambivalence
Development of schizophrenia
Phase 1: Premorbid phase- Fairly normal functioning, very shy, poor school performance, cold aloof, poor relationships
Phase 2: Prodromal phase- 1 month to 1 year before psychotic episode. Deterioration in role functioning, poor concentration, fatigue, intrusive thoughts, suspicious of other people. Behavior looks bizarre, neglecting personal hygiene, lacks initiative, and blunt affect.
Development of schizophrenia con’t
Phase 3: schizophrenia (acute)- psychotic symptoms are prominent, impairment in work, social relations and self care; positive and negative symptoms. Marked impairment in functioning
Phase 4: residual phase- similar to prodromal phase. Flat affect, impaired role functioning, periods of remission & impairment.
Positive symptoms
Positive symptoms (added symptoms): content of thought form of thought perception sense of self Hallucinations
Responds better to treatment
Negative symptoms
Negative symptoms (Missing something)
Flat affect
volition (inability to initiate goal-directed activity)
impaired interpersonal functioning & relationship to the external world
psychomotor behavior
Associated features
Content of thought (+)
Delusions: false belief that is not consistent of personal beliefs & culture. Very fixed. 75% oh schizophrenics experience delusions.
- Persecution: person feels threatened and believes that someone intends to harm them.
- Grandeur: an exaggerated feeling of importance, power, knowledge, or identity.
Reference: everything is related to them.
somatic: false idea about the functioning of his or her body. Ex: a 70 year old lady believes that she is pregnant with 20 fetuses although that is impossible.
Nihilistic: the individual has a false idea that the self, a part of the self, others, or the world no longer exists. (“I have no heart”).
control/influence: belief that certain individuals or objects have control over his or her behavior.
Thought insertion
Content thought (+) con’t
Religiosity: an excessive demonstration of or obsession with religious idea and behavior.
Paranoia: extreme suspiciousness of others and of their actions or perceived intentions.
Magical thinking: belief that his or her thoughts or behaviors have control over specific situations or people.
Form of thought (+)
Associative looseness: shifting of ideas that are unrelated.
Neologism: Newly made up words that only mean something to the person.
Concrete thinking: impaired abstract thinking
Clang associations: choice of words is governed by sounds. (I.E. It is very cold, I am cold and bold.)
Word salad: a group of words that are put together randomly, without any logical connection. (most forward action grows life double play)
Circumstantiality: the individual delays reaching the point of communication because of unnecessary and tedious details. The person eventually gets to the point.
Tangentiality: The person never gets to the point of the communication.
Mutism: inability or refusal to speak.
Perseveration: persistently repeating the same word or idea in response to different questions.
Echolia: repeating what you say
