Unit 36 Schizophrenia Flashcards
What is Psychosis?
Impairment in reality testing as evidenced by,
- Hallucinations
- Delusions
- Thought disorganization
- Grossly disorganized behavior
What is the DSM-IV diagnostic criteria for schizophrenia diagnosis?
- 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
What are combination of factors that probably cause schizophrenia?
- Genetic predisposition
- Biochemical dysfunction
- Physiological factors
- Psychosocial stress
What is the primary cause of premature death among people with schizophrenia?
Suicide.
10% die by suicide
40-55% have SI
20-50% attempt suicide
Substance abuse disorders occur in what percent of individuals with schizophrenia?
40-50%
What does schizophrenia disturb?
Affect
Perception
Thought Processes
What does schizophrenia lead to?
Severe deterioration of social and occupational functioning
What is the usual prognosis for schizophrenia?
A return to full premorbid functioning is not common.
What factors lead to positive schizophrenia prognosis’?
the negative would be the opposite
- 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
What are the four progress stages of schizophrenia?
- Premorbid
- Prodromal
- Active Phase
- Residual Phase
Describe the first stage of schizophrenia.
The Premorbid stage:
- Shy, withdrawn, poor peer relationships, doing poor in school, antisocial behavior
- Neurobehavioral deficits.
Describe the second stage of schizophrenia.
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- Socially withdrawn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
Describe the third stage of schizophrenia.
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.
Describe the fourth stage of schizophrenia.
Residual stage
symptoms similar to those if prodromal phase, with flat affect and impairment of role functioning
What is downward drift hypothesis?
Disease that has genetic connection will run down the family line
What are predisposing factors of schizophrenia?
- Genetic
- Biochemical (excess dopamine, abnormalities in norepinepherine, serotonin)
- Physiological (Brain abnormalities, histological changes, epilepsy, etc.)
What are the 6 types of schizophrenia?
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
What are the types of disorders?
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)
What are the positive (the crazies) and the negatives (what they lack) symptoms of schizophrenia?
Positives: Hallucinations, Delusions, Poor ego boundaries, loose associations
Negatives:
- apathy/anergia,
- lack of motivation,
- anhedonia (inability to feel pleasure),
- social isolation,
- blunted affect.
What is mutism?
person who is normally capable of speech cannot speak in specific situations or to specific people.
What is persecutory delusion?
delusional condition in which the affected persons believes they are being persecuted
What is a word salad?
a confused or unintelligible mixture of seemingly random words and phrases, specifically (in psychiatry) as a form of speech indicative of advanced schizophrenia.
What are neologisms?
a newly coined word or expression.
What is clang association?
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
What is waxy flexibility?
decreased response to stimuli and a tendency to remain in an immobile posture.
What are some communication guidelines for schizophrenia?
- 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
What are therapy treatment options?
- 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)
What is prognosis generally closely related too?
-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%)
What is the paradigm of thirds regarding prognosis and schizophrenia?
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
What are the TYPICAL Antipsychotic Rx’s, describe them, what do they treat, and what side effects do they/could they produce?
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 ***
What is Neuroleptic Malignant Syndrome, the risk factors, and where could this side effect come from?
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
What medications are used to treat extrapyramidal side effects (EPS) of typical antipsychotic Rx’s?
Antiparkinsonian/Anticholinergic agents:
- diphenhydramine hydrochloride (Benadryl)
- trihexyphenidyl (Artane)
- benzotropine mesylate (Cogentin)
What are the ATYPICAL Antipsychotic Rx’s, describe them, what do they treat, and what side effects do they/could they produce?
- 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
What is agranulocytosis?
low WBC
