Schizophrenia Spectrum Disorders (Week 4) Flashcards
What is the “clinical picture” of schizophrenia?
*It’s sensationalized.
*It effects 1% of adults
*Characterized by psychosis (Altered cognition, perception, and reality testing)
*75% develop gradually, presenting at 15 to 25 years of age.
*Child-onset and late-onset are more rare.
Theres no difference related to race, social status , or culture. More frequently diagnosed among males, in urban areas, high stress, and substance abuse.
What are the DSM-V criteria for schizophrenia?
Two or more of the following for a significant portion of time in 1 month:
1) Delusions
2) Hallucinations
3) Disorganized speech
4) Gross disorganization or catatonia
5) Negative symptoms (diminished emotional expression or avolition)
6) Functional impairment of some kind
Continuous disturbance for at least 6 months.
What are some common comorbidities in schizophrenia?
1) Substance abuse disorders such as nicotine, meth, and/or marijuana.
2) Anxiety, depression, and suicide.
3) Physical health or illness.
4) Polydipsia
What are the etiologies (causes) of schizophrenia?
1) Biological factors
-Genetics, diathesis-stress (nature vs nurture theory)
-Epidemiological factors such as toxins/drugs, trauma, stress.
2) Neurobiological Theories:
-Dopamine theory (1st gen. Antipsychotics): Theory suggests that it is caused by too much dopamine in the brain. HOWEVER, the problem with this theory is that some of the antipsychotics help produce dopemine…and the results work really well.
-Other neurochemical hypothesis (2nd gen. Antipsychotics): where basically the seotonins a bit low, GABA’s probably too high, dopamines probably a bit too high. Righting those levels are the treatment path.
3) Brain structural abnormalities:
-I.E abnormalities in the white matter, networking/connectivity, prefrontal cortex, etc.
4) Psychological and environmental stressors:
- Prenatal stressors
- Psychological stressors
- Environmental stressors
- Prognostic considerations
What is the prodromal phase?
The phase before you really get sick…
What are the phases of schizophrenia?
1) Prodromal Phase:
-Onset; Starts with some mild changes (Pos/Neg, SX’s, alterations in speech/thought process)
-Early assessment and interventions are key
-Establish rapport
-Reduce risk factors such as high stress level, substance abuse. Chances of interventions at this stage can be extremely halpful in treatment. Trust is imparative.
2) Acute Phase:
-Exacerbation of symptoms, affect is blunted even more. Were in the hospital now.
3) Stabilization Phase:
-Symptoms are diminishing and they’re moving towards previous level of functioning. Prescription drugs are most effective treatment.
4) Maintanence or residual Phase:
-This is where a new baseline is established.
What are the classifications of schizophrenic behaviors/symptoms?
1) Positive symptoms
2) Negative symptoms
3) Cognitive symptoms
4) Affective symptoms
What are ‘Positive symptoms’ of schizophrenia?
Think of plus, they are added symptoms ???
They’re alterations in reality testing.
1) Delusions-false, fixed beliefs.
2) Alterations in speech
3) Concrete thinking-inability to think abstractly
4) Hallucinations
5) Disorganized thinking
6) Abnormal motor behavior
Define the following positive symptom ‘alteration of speech’ components:
1) Associative looseness
2) Clang association
3) Neologisms
4) Echiolalia
5) Pressured speech
6) Flight of ideas
7) Circumstantiality
8) Tangentiality
9) Cognitive retardation
10) Symbolic speech
1) Associative looseness- A jumble of words, or word salad, meaningless to the listener. “Castle had mark port”
2) Clang association- Words chosen based on sound. “I was mad, because im bad, I like cad, that was rad”
3) Neologisms- Made up words only the patient knows. “Hes a forp you know, a complete fogger”
4) Echiolalia- Pathological repeitition of anothers words. (You say “I need to take your vitals”, and the patient incessantly repeats that sentence or part of the sentence, “Vitals, I need to take your vitals, vitals…”)
5) Pressured speech- Sense of urgency in speech
6) Flight of ideas- A ton of different things they want to talk about so it just jumps from one topic to another, to another and fast. Common in mania.
7) Circumstantiality- Including unnecessary and often tedious details in conversation, but eventually reaching the point.
8) Tangentiality- Wandering off topic or going off on tangents and never reaching the point.
9) Cognitive retardation- Generalized slowing of thinking, which is represented by delays in responding to questions or difficulty finishing thoughts.
10) Symbolic speech- Using symbols instead of direct communication. For example, a patient reports “demons are sticking needles in me” when what he means is that he is experiencing a sharp pain (symbolized by “needles”).
Define the following types of the positive symptoms, called disorders or distortion of thought.
1) Thought blocking
2) Thought insertion
3) Thought deletion
4) Magical thinking
5) Paranoia
1) Thought blocking: A reduction or stoppage of thought. Interruption of thought by hallucinations can cause this.
2) Thought insertion: The uncomfortable belief that someone else has inserted thoughts into their brains.
3) Thought deletion: A belief that thoughts have been taken or are missing.
4) Magical thinking: Believing that thoughts or actions affect others’ consequences.
5) Paranoia: An irrational fear, ranging from mild (wary, guarded) to profound (believing irrationally that another person intends to kill you).
What are some alterations in behavior in schizophrenia?
1) Catatonia
2) Motor retardation
3) Motor agitation
4) Stereotyped behaviors
5) Waxy flexibility- Can move pt arm and it stays where you put it, like a wax statue. Illness and medication side effect.
6) Echopraxia
7) Negativism
8) Impaired impulse control
9) Gesturing or posturing- Aggressive stance, looks like they’ll attack.
10) Boundary impairment
What are some types of alterations in perception?
1) Depersonalization
2) Derealizaton
3) Hallucinations:
-Auditory
-Visual
-Olfactory
-Gustatory
-Tactile
-Command
4) Illusions
What are ‘negative symptoms’ in schizophrenia? What are some different types of negative symptoms?
Things that are missing, gone, but should be there
Negative symptoms are the absence of human qualities.
1) Anhedonia- Lack of pleasure in life
2) Avolition- No motivation
3) Apathy
4) Alogia
5) Blunted, flat affect-
Whta are some examples of ‘cognitive symptoms’ of schizophrenia?
1) Concrete thinking
2) Impaired memory
3) Impaired information processing
4) Impaired executive functioning
5) Anosognosia:
-Inability to realize they are ill
-Caused by the illness itself
-May result inresistance to or cessation of treatment
-When combined with paranoia, can be extremely difficult to treat.
What is the L.E.A.P model?
Look it up and get the answer later*
