UNIT 4- Schizophrenia Flashcards
What is schizophrenia?
- Brain disease diagnosed in late adolescence or early adulthood. Part of a spectrum or continuum of a broad range of disorders.
- SSDs some of the more disabling types of mental illness usually, chronic and it can effect how a person thinks, feels, and behaves
What is the DSM-5 criteria for schizophrenia?
Two (or more) of the following, present for 1 month duration:
1. Delusions
2. Hallucinations (any sensory)
3. Disorganized speech
4. Disorganized or catatonic behavior
5. Negative symptoms
Primary Schizophrenia psychotic disorder is characterized by?
- Psychosis
- Hallucination
- Delusions
- Disorganized thoughts
- Abnormal motor behavior
- Negative symptoms
What are the concept of psychosis (mainly review for me)
- Neurocognitive symptoms impairing cognitive capacity
- Deficits in perception, functioning and social relatedness
- Primary psychosis is derived from schizophrenia spectrum disorders
- Secondary psychosis derived from substance intoxication and dementia or withdrawal from drugs
- Primary and secondary can coexist and may potentiate each other
What is the course and description of schizophrenform disorder?
Course: Symptoms must last at least 1 month but NO more than 6 months
Description: Essential features are identical those of schizophrenia but of shorter duration
What is the course and description of brief psychotic disorder.
Course: Usually no longer than a month; person returns to premorbid functioning; usually precipitated by extreme stress
Description: Sudden onset of psychiatric symptoms
What is the course and description of schizoaffective disorder?
Course: Better prognosis than schizophrenia but significantly worse than a mood disorder
Description: Symptom of mood disorder; major depressive, manic, or mixed episode, concurrent with symptoms that meet the criteria for schizophrenia. Common psychotic disorder
What is the course and description of schizotypal personality disorder?
Course: May progress to developing schizophrenia
Description: Personality disorder considered part the schizophrenia spectrum disorders (DSM-5); shares common genetics and neuropsychiatric characteristics. Intense discomfort with close relationships
What is the course and description of delusional disorder?
Course: Ranges from remission without relapse to chronic waxing and waning; symptoms must last at least 1 month
Description: Involves nonbizarre delusions such as being followed, infected, loved at a distance, or deceived by a spouse; having some great or unrecognized insight; ability to function is not markedly impaired and behavior is not obviously odd or bizarre. Delusions of persecution are the most common
What is the course and description of substance/medication-induced psychotic disorder?
Course: Psychosis usually resolves
Description: Caused by ingestion of or withdrawal from a substance.
Which onset of schizophrenia is better? Slow onset or abrupt?
Abrupt onset with good premorbid functioning has better prognosis, greater chance of remission/complete recovery.
Slow onset usually has poorer prognosis (2-3 years)
Child onset of schizophrenia is…
RARE
Early age of onset for schizophrenia is associated with?
- Structural brain abnormalities
- More negative and disabling symptoms
- Poorer prognosis
What are some comorbidity to schizophrenia?
- 50% have substance use disorder
- 50% tobacco use disorder
- Strong correlation of cannabis use and psychotic disorder
- Methamphetamine and LSD
- Schizophrenia increases the abuse of cannabis
- Premature death due to non-psychiatric illness- malnutrition, criminal activity
- Concurring
- Depressive disorder
- 20% attempt suicide
- 6-10% commit suicide
- Anxiety/panic disorder
- OCD
- Schizotypal and paranoid personality disorder may develop into schizophrenia
What should we know about the course and prognosis of schizophrenia?
- Recurrent acute exacerbations of psychosis
- Periods of full or partial remission
What is primary and secondary interention of schizophrenia?
Primary: Target people at high risk
Secondary: Intervening early and reducing duration of untreated diagnosis
What are the phases of schizophrenia?
- Prodromal occur in 80-90% of people. Early reognition and treatment are vital
- Acute phase- severe and well-developed symptoms
- postive symptoms
- negative symptoms
- cognitive/neurocogntive symptoms
- Mood symptoms
- Stabilization phase- not having dulusions or psychosis because meds are working
- Maintenance phase- this is where we want our patient to stay as much as possible. Patient education is important esp. once patient is out of the psychosis
What are the risk factors associated with schizophrenia?
- Genetic factor
- Alteration in brain structure
- Brain’s neurotrasmitter system disruptions
- Alterations to neural circuts
What are some neurochemical contributing factors to schizophrenia?
More so for review
- Hyperactive dopamine transmission in the mesolimbic area
- Hypoactive dopamine transmission in the prefrontal cortex
- Dyregulation in multiple other other areas of the brain
- abnomral levels of serotonin may cause some of the negative symptoms and mood symptoms
- NMDA (N-methyl-d-asparatate) an amino acid is iplicated in the psychotic, negative and cognitive symptoms
- Glutamate activity insuffcieency or excess with other neurotransmitters
If both parents have schizo what is the likely hood a child will have it?
46%
What are some non genetic risk factors of schizophrenia?
- viral infection affecting neurogensis
- poor maternal nutrition
- exposure to toxins
- perinatal complications and births
- closed head injuries after birth
- advacnced parental age
- overactive immune system
- first and second-generation immigrants stress
What are some cultural considerations for schizophrenia?
- Hallucinations shaped by cultural expectations
- Source of mental illness
- attributed to spiritual versus religious or supernatrual or biomedical
- can affect adherence to medication and other tx
- Hearing voices network believes it may be possible to improve relationships with voices by respecting, understanding and adapting to the voices
What are secondary causes of psychosis in schizophrenia?
- brain tumors
- cysts
- dementia
- neurological diseases
- environemental toxins
- misuse of and addictions to prescription meds
What are postive signs of schizophrenia?
KNOW
- Hallucinations
- Delusions
- Bizarre behavior
- Catatonia
- Formal thought disorder
What are negative symptoms of schizophrenia?
KNOW
- Apathy
- lack of motivation
- Anhedonia
- blunted or flat affect
- poverty and speech- doesnt respond with many words
- Social withdrawal
What are cognitive symptoms of schizophrenia?
KNOW
- Impairment in memory
- disruption in social learning
- Inability to reason, slve problems, focus attention
What are mood symptoms of schizophrenia?
- Depression
- Anxiety
- demoralization
- suicidality
- excitability
- agitation
What are some types of delusions?
- Mind reading
- Somatic:
- Idea of reference
- Persecution
- grandiose (religious)
- jealosuy
- Control
- Thought broadcasting
- Thought insertion
- Thouhght withdrawal
- Concrete thinking
What is somatic delusions?
A belief about the meaning of a phsycial sensation
Example: snakes are eating out my stomach
What are ideas of reference delusions?
The person believes a neutral event has a special and personal meaning
Example: a person drives by a billboard and starts to believe the message on the bill board was private and personal message
What is a delsuion of persecution?
A belief that “others” are out to harm that person. Paranoid delsions put the patient at risk for harm to self and others
Example: I know my enemies were actively trying to interfere with with activites, were trying to harm me, and even kill me
What are delsuions of grandiosity?
An unrealistic sense of superitiory
Example: I felt that I had the power to determin ethe weather, which responded to my inner beliefs
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What are delusions of jealousy?
A feeling of envy over someone else’s achievemetns or advantages or advantages or unfolded suspicion that someone is unfaithful
example: my spouce is always cheating on me
What is the delsuion of control?
- Belief that one’s body or mind is controled by outside force or agency
exmaple: There is a man from darkness who controls my thoughs with electrical waves
What is the delusion of thought broadcasting?
- Belif that one’s thoughts can be heard by others. This type of delsuion can make the assessment of a patients thinking more challenging for the nurse
Example: a women refuses to explain her problems, saying I know you know what I am thinking. Everybody hears what I am thinking
What is the delusion of thought insertion?
Belief that thoughts of others are being inserted into one’s mind
Example: They make me think bad thoughts
What is the delusion of thought withdrawal?
- Belief that thoughts have been removed from one’s mind by an outside agency. People experiencing thought withdrawal may experience other irregulatrities in speech and thinking such as thought blocking
exmaple: the devil takes my thoughts away and leaves my empty