Unit 36 Schizophrenia

Question 1

What is Psychosis?

Answer 1

Impairment in reality testing as evidenced by,

• Hallucinations
• Delusions
• Thought disorganization
• Grossly disorganized behavior

Question 2

What is the DSM-IV diagnostic criteria for schizophrenia diagnosis?

Answer 2

• At least two psychotic symptoms for one month
• Social or occupational dysfunction
• Six month duration of symptoms
• Schizoaffective and other mood disorders have been excluded
• Substance abuse and medical issues have been excluded
• Developmental disorders excluded

Question 3

What are combination of factors that probably cause schizophrenia?

Answer 3

• Genetic predisposition
• Biochemical dysfunction
• Physiological factors
• Psychosocial stress

Question 4

What is the primary cause of premature death among people with schizophrenia?

Answer 4

Suicide.

10% die by suicide
40-55% have SI
20-50% attempt suicide

Question 5

Substance abuse disorders occur in what percent of individuals with schizophrenia?

Answer 5

40-50%

Question 6

What does schizophrenia disturb?

Answer 6

Affect

Perception

Thought Processes

Question 7

What does schizophrenia lead to?

Answer 7

Severe deterioration of social and occupational functioning

Question 8

What is the usual prognosis for schizophrenia?

Answer 8

A return to full premorbid functioning is not common.

Question 9

What factors lead to positive schizophrenia prognosis’?

the negative would be the opposite

Answer 9

• Good premorbid adjustment
• Later age onset
• Female gender
• Abrupt onset of symptoms as opposed to gradual
• Precipitated by a stressful event
• Associated with mood disturbances
• Brief duration of active phase symptoms
• Good inter-episode functioning
• Absence of structural brain abnormalities
• No family hx of schizophrenia

Question 10

What are the four progress stages of schizophrenia?

Answer 10

1. Premorbid
2. Prodromal
3. Active Phase
4. Residual Phase

Question 11

Describe the first stage of schizophrenia.

Answer 11

The Premorbid stage:

• Shy, withdrawn, poor peer relationships, doing poor in school, antisocial behavior
• Neurobehavioral deficits.

Question 12

Describe the second stage of schizophrenia.

Answer 12

The Prodromal stage:
(1 month - year before psychotic break)

• Socially withdrawn
• Evidence of peculiar behavior
• Role function impaired
• Personal hygiene neglected
• Disturbances in communication, ideation, perception
• Beginning to lose identity

Question 13

Describe the third stage of schizophrenia.

Answer 13

The Active stage:
(1st psychotic break)
Psychotic symptoms are prominent in active phase
-Delusions
-Hallucinations
-Impairment of work, social relations, and self-care

Continuos signs of disturbance must persist for at least 6 months for Dx.

Question 14

Describe the fourth stage of schizophrenia.

Answer 14

Residual stage

symptoms similar to those if prodromal phase, with flat affect and impairment of role functioning

Question 15

What is downward drift hypothesis?

Answer 15

Disease that has genetic connection will run down the family line

Question 16

What are predisposing factors of schizophrenia?

Answer 16

• Genetic
• Biochemical (excess dopamine, abnormalities in norepinepherine, serotonin)
• Physiological (Brain abnormalities, histological changes, epilepsy, etc.)

Question 17

What are the 6 types of schizophrenia?

Answer 17

Disorganized schizophrenia: chronic with flat or inappropriate affect, silly bizarre giggling behavior

Catatonic schizophrenia: [Catatonic Stupor] extreme psychomotor retardation, mute, waxy flexibility
[Catatonic Excitement] extreme psychomotor agitation

Undifferentiated schizophrenia: Active signs of disorder, but symptoms do not clearly fall into one category

Paranoid schizophrenia: Most common in men, constantly on guard, ready for real or imagined threat, a pattern of behavior beginning in early adulthood with distrust and suspiciousness of others. Insensitive to others feelings, but HIGHLY sensitive to their own. Commonly seen schizophrenia.

Residual schizophrenia: hx of at least one episode of schizophrenia with psychotic symptoms, BUT NOW absence of delusions, hallucinations, disorganized speech, or other behavior, however continued evidence of disturbed thinking or beliefs

Schizoaffective schizophrenia: symptoms associated with mood disorder, either manic or depressive affect
(popular) high risk for developing schizophrenia

Question 18

What are the types of disorders?

Answer 18

Brief Psychotic Disorder: Lasts 1 month after extreme stressor, than back to normal functioning, sudden onset of psychotic symptoms following a severe stressor

Delusion Disorder: Grandiose, Jealous, Persecutory, Somatic, Erotomanic

Psychotic Disorder: caused by general medical condition; includes hallucinations and delusions attributed to medical condition (NOT dementia or delirium) usually neurological, endocrine, metabolic, etc

Induced Psychotic Disorder: Hallucinations and delusions attributable to the physiological effects of a substance (such as a Rx)

Question 19

What are the positive (the crazies) and the negatives (what they lack) symptoms of schizophrenia?

Answer 19

Positives: Hallucinations, Delusions, Poor ego boundaries, loose associations

Negatives:

• apathy/anergia,
• lack of motivation,
• anhedonia (inability to feel pleasure),
• social isolation,
• blunted affect.

Question 20

What is mutism?

Answer 20

person who is normally capable of speech cannot speak in specific situations or to specific people.

Question 21

What is persecutory delusion?

Answer 21

delusional condition in which the affected persons believes they are being persecuted

Question 22

What is a word salad?

Answer 22

a confused or unintelligible mixture of seemingly random words and phrases, specifically (in psychiatry) as a form of speech indicative of advanced schizophrenia.

Question 23

What are neologisms?

Answer 23

a newly coined word or expression.

Question 24

What is clang association?

Answer 24

Clang associations are groupings of words, usually rhyming words, that are based on similar-sounding sounds, even though the words themselves don’t have any logical reason to be grouped together

Question 25

What is waxy flexibility?

Answer 25

decreased response to stimuli and a tendency to remain in an immobile posture.

Question 26

What are some communication guidelines for schizophrenia?

Answer 26

• Emphasize the hear and now
• When understanding is not possible, just listening and accepting of the PT can be meaningful
• Do not pretend to know that you understand the PT’s communications when you are confused by the words or meanings
• Place the difficulty of understanding on yourself, NOT the PT

Question 27

What are therapy treatment options?

Answer 27

• Individual psychotherapy (reality-oriented with focus of decreasing anxiety and increasing trust)
• Group therapy (outpatient with focus on social interactions)
• Social Skills Training (role-play, feedback focus on ADL’s)
• Assertive Community Treatment (ACT)

Question 28

What is prognosis generally closely related too?

Answer 28

-How well a person follows a drug treatment plan

Without meds 70-80% relapse over 12 months
(Drugs taken continuously can reduce relapse to 30%)

Question 29

What is the paradigm of thirds regarding prognosis and schizophrenia?

Answer 29

1/3 achieve significant and lasting improvement

1/3 achieve some improvement with intermittent relapses and residual disability

1/3 experience severe and permanent incapacity

Question 30

What are the TYPICAL Antipsychotic Rx’s, describe them, what do they treat, and what side effects do they/could they produce?

Answer 30

haloperidol (Haldol)
fluphenazine (Prolixin) PO first then of side effects tolerated»>decanoate injection-long lasting
chlopromazine (Thorazine)
prochlorperazine (Compazine)

TYPICAL Antipsychotics are…traditional standard, neuroleptics, and major tranquilizers, also known as DRA’s (dopamine receptor agonists) because they target dopamine type 2 (D2) receptors and reduce dopamine.

-treats ONLY POSITIVE symptoms of schizophrenia

-Produces motor side effects/extrapyramidal side effects which includes:
dystonia (involuntary muscle contractions/twitching
akathisia (restlessness)
tardive dyskinesia (slow movements of face/body)-(can be permanent)
parkinsonian-like syndrome (flat face, shuffle gait)

Other life threatening side effect :
Neuroleptic Malignant Syndrome ***

Question 31

What is Neuroleptic Malignant Syndrome, the risk factors, and where could this side effect come from?

Answer 31

Rare, acute, life-threatening reaction to typical antipsychotic meds characterized by hyperpyrexia (very high fever), muscular rigidity, altered mental status, and autonomic dysfunction (hypertension, tachycardia, diaphoresis, incontinence)

Risk factors: Older age, Female gender, rapid dose titration, presence of mood disorder

Question 32

What medications are used to treat extrapyramidal side effects (EPS) of typical antipsychotic Rx’s?

Answer 32

Antiparkinsonian/Anticholinergic agents:

• diphenhydramine hydrochloride (Benadryl)
• trihexyphenidyl (Artane)
• benzotropine mesylate (Cogentin)

Question 33

What are the ATYPICAL Antipsychotic Rx’s, describe them, what do they treat, and what side effects do they/could they produce?

Answer 33

• clozapine (Clozaril) *high risk of agranulocytosis
• quetiapine (Seroquel)
• risperidone (Dispersal)
• aripiprazole (Abilify)
• They are serotonin-dopamine agonists (SRA’s). Expensive Rx’s.
• They treat POSITIVE ANS NEGATIVE symptoms of schizophrenia.
• They produce little to no motor side effects. Weight gain however

Question 34

What is agranulocytosis?

Answer 34

low WBC