Schizophrenia Spectrum & Other Psychotics Flashcards
1
Q
What are the positive symptoms of schizophrenia?
A
- Observable symptoms
- Hallucination
- Delusions
- Formal thought disorder
- Behavioural disturbances
- Disorganised, catatonia, odd movements/behaviours
- Lack of insight (97%)
2
Q
What are the negative symptoms of schizophrenia?
A
Affect
- Social withdrawal (e.g. poor eye contact)
- Anhedonia
- Emotional blunting (e.g. talking in monotone)
- Confusion
Avolition
- Amotivational
- Apathy
- Self-neglect
Alogia
- Poverty of speech
- Poverty of content
>> Presence of negative symptoms suggest poorer response to treatment
3
Q
Hallucinations in schizophrenia
A
- Perception-like experiences that occur in absence of any external stimulus (vivid, clear, & not under voluntary control)
- Occurs in clear sensorium (hypnogogic & hypnopompic not included)
- Auditory
- Visual (not illusion/misperception)
- Olfactory
- Gustatory
- Tactile (e.g. insect crawling)
4
Q
Auditory hallucinations
A
- Common: 60-70% of patients
- Hearing voices:
- inside head or from external sources
- own thoughts spoken out loud
- can be comforting
- derogatory or insulting
- third person commentary
- commands to perform unacceptable behaviours
5
Q
Aggression in schizophrenia
A
- Myth: schizophrenics are highly dangerous
- Reality: not more aggressive than the general population
- Risk factors:
- Younger makes
- Non-adherence with medication
- Substance use
- Impulsivity
6
Q
Delusions in Schizophrenia
A
- False beliefs despite what others believe and despite evidence to contrary
- Not culturally accepted
- Categorised according to content and bizarreness
7
Q
Paranoid or Persecutory delusions
A
- Most common type
- Fixed, false belief one is being harmed or persecuted by particular person/group
8
Q
Delusions of Reference
A
- Neutral event interpreted to have personal meaning for individual
- E.g. TV newsreader sending messages meant specifically for the patient
9
Q
Grandiose Delusions
A
- False belief that one has special pwers, abilties, influence, achievements or another identity that typically relates to to power, wealth or fame
10
Q
Nihilistic Delusions
A
- Belief that one, bodily part, or would does not exist or has been destroyed
11
Q
Delusion of Guilt
A
- personal responsibility for events
12
Q
Jealousy Delusions
A
- Monosymptomatic delusions
- False belief that romantic partner/spouse is having an affair
13
Q
Erotomanic Delusions
A
- False belief that the patient’s romantic feelings are reciprocated
- Often by a famous other
14
Q
Misidentification Delusions
A
- Identity of someone they know has been stolen
- E.g. imposter has replaced a loved one
15
Q
Thought disorder in Schizophrenia
A
- Disturbances in flow and/or form of speech
- As opposed to content in delusions
16
Q
Negative manifestations of Thought Disorder
A
- Reduced stream of thoughts and poverty of speech
17
Q
Positive Manifestations of Thought Disorder
A
- Circumlocution
- Derailment (comments slipping from one to next)
- Tangential (irrelevant responses)
- Echolalia (acute phase)
- Word salad (Incomprehensible stream of words)
- Neologisms (idiosyncratic use of words, meanings)
18
Q
Disorganised Behaviour in Schizophrenia
A
Grossly disorganised and abnormal motor behaviour: from child-like silliness to unpredictable agitation
- Catatonic behaviour
- Extreme negativism (resistance instructions)
- Immobility (“waxy flexibility”)
- Catatonic excitement: Excessive purposeless physical activity
- Peculiar voluntary movements (posture, repetition, grimacing)
- Mutism; Echolalia; Echopraxia; Imitating speech, movement
19
Q
Prevalence rates of Schizophrenia
A
- Lifetime: 1-2%
- Male to Female ratio: 3:2
20
Q
Age of Schizophrenia Onset
A
- Late adolescence and early adulthood
- Tends to be later for women
- Onset typically preceded by a gradual deterioration in functioning
- Followed by more acute symptoms
- Onset can be sudden
- Coincides with an often stressful time of life, further complicated by impact of schizophrenia
- Early onset associated with poorer outcomes
21
Q
Course of Schizophrenia
A
- Highly variable
- >1 episodes with periods of normal (or near normal) functioning between episodes
- 66% difficulty with at least one daily living activity
- Most remain chronically unwell with a deteriorating course
- 50% classified as unable to work
- <25% engaged in employment
- Social isolation, homelessness, low income & poor health
- Chronic condition without full recovery
22
Q
Affect in Schizophrenia
A
Anxiety & perplexity
- Often frightened, perplexed & confused over emerging symptoms
- Irritability
- 30% of patients attempt suicide
- 5-10% complete suicide
23
Q
Course of Schizophrenia (phases)
A
Prodromal phase
- Median length for symptoms to develop is 2 years but highly variable
Acute phase
- Typically 1 year between onset of active symptoms & treatment
- Response to treatment related to duration of untreated psychosis
Early recovery phase
Late recovery phase
- reintegration
- 80-90% relapse within 2-5 years of treatment
24
Q
Good Prognostic Factors
A
- Good premorbid functioning
- Acute onset
- Later age of onset (females)
- Precipitating event (e.g. drug-induced psychosis)
- Low substance use
- Brief duration of active phase
- Absence of structural brain abnormalities
- No family history of schizophrenia
25
**Bad** Prognostic Factors
* Poor premorbid
* Slow insidious onset
* Prominent negative symptoms
* Duration of untreated psychosis
* Slower or less complete recovery
* Lower socioeconomic class
* Migrant status
* Social support network
26
Medication
* Primary intervention
* 60% of clients with positive symptoms respond
* 10-20% do not show symptom improvement in response to medication
* Relapse rates high wit 40% relapsing within one year
27
**Side effects** of neuroleptics
* Sedation
* Extrapyramidal side effects
* Symptoms resembling Parkinson's Disease
* Tardive dyskinesia (abnormal movements, facial grimacing, lip smacking)
* Finger tremors, shuffling gait, drooling, chewing, twisted posture
* Side effects often treated with anti-Parkinson drug
* Weight gain, diabetes, heart disease
* Clozapine additional side effects
* Blood abnormalities
* Reduced white blood count
28
**Psychological interventions** for Schizophrenia
Designed to target specific deficits or objectives
* Social skills training for interpersonal deficits
* Medication compliance
* Managing delusions/hallucinations
* Reduction of stresses
29
**CBT** for Schizophrenia
Help patients to:
* Notice early signs of relapse
* Understand relationship between thoughts, feelings & behaviours
* Challenge beliefs about not being able to manage one's thoughts & behaviours
* Learn strategies to cope with symptoms & stressors
* Evaluate evidence supporting delusional beliefs vs. alternative beliefs
30
How **effective** is CBT in treating Schizophrenia?
Better outcome overall
* Reduce relapse, hospitalisation, positive & negative outcomes
* Improve social functioning
* Gains maintained at 2-year follow-up
* Also shown to reduce numbers who go on to develop psychosis in UHR groups
31
Family Therapy
* Developed in response to higher relapse rates for patients from families high in Expressed Emotion (EE)
* Provide:
* Education about schizophrenia and its treatments
* Realistic goal setting skills
* Communications training (empathic not critical)
* Problem solving skills
* Promote social support
* Shown to reduce relapse & enhance family support
32
Psychosis **subtypes**
› Schizotypal (Personality) Disorders
› Brief Psychotic Disorder (sudden, \<1mth, return to functioning)
› Schizophreniform (\>1mth\<6mths & individual has recovered;
bipolar & depressive disorder ruled out; provisional diagnosis)
› Schizoaffective (mood disorder criteria present)
› Substance-induced psychotic
› Psychosis due to a medical condition
› Catatonia & other unspecified (exclude neurodevelopmental or
medical condition)
› Schizophrenia
