W4 - Schizophrenia Spectrum Disorders Flashcards
What’s psychosis? (2)
- severe mental disturbance where individual loses touch with reality
- Characterised by: delusions
hallucinations, disorganised thoughts & behaviour
whats the difference between delusions, hallucinations & disorganised thoughts & behaviour
Delusions
Fixated, False & Unshakeable personal belief
Hallucinations
False perceptions in the
absence of a real external
stimulus
I heard “voices
Disorganized Thinking
I abandoned sentences half way and
started new ones.
I sounded incoherent
Whats schizophrenia?
Intellectual and emotional
components of mental
activity are fragmented
́ Not “split personality”
Negative symptoms (5 As):
- Lack of facial expression (Flatten Affect)
- Lack of pleasure (Anhedonia)
- Lack of drive and energy (Apathy)
- Lack of interest (Avolitional)
- Lack of speech (Alogia)
Disorganized symptoms:
- Thought disorder
- Disorganized behavior
Cognitive symptoms:
- Memory impairment
- Executive function impairment
Diagnostic criteria for schizophrenia?
́ A. CHARACTERISTIC SYMPTOMS:
TWO (OR MORE) OF THE FOLLOWING,
EACH PRESENT FOR A SIGNIFICANT PORTION OF TIME DURING A 1-MONTH PERIOD (OR
LESS IF SUCCESSFULLY TREATED):
́ delusions
́ hallucinations
́ disorganized speech (e.g., frequent derailment or
incoherence)
́ grossly disorganized or catatonic behavior
́ negative symptoms, i.e., affective flattening, alogia, or avolition
Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behaviour or thoughts, or two or more voices conversing with each other.
́B. Social/occupational dysfunction:
For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).
́ C. Duration:
Continuous signs of the disturbance persist for at least 6months.
must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e.,
active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative
symptoms or two or more symptoms listed in Criterion A present in an
attenuated form (e.g., odd beliefs, unusual perceptual experiences)
Diagnostic criteria
́ D. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) no Major Depressive, Manic, or Mixed Episodes have occurred concurrently with the active-phase symptoms; or (2) if
mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.
́ E. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
́F. Relationship to a Pervasive Developmental Disorder: If there is a
history of Autistic Disorder or another Pervasive Developmental
Disorder, the additional diagnosis of Schizophrenia is made only if
prominent delusions or hallucinations are also present for at least a
month (or less if successfully treated).
Mental State Examinations for schizophrenia?
Appearance:
- Unkempt, Dirty, Unshaved, long fingernails
Behaviour:
- Preoccupied, Talking or laughing to self
Speech:
- Loosening of association (not joining the dots)
- Tangential (off topic)
- Overinclusive (too much details)
Mood:
- Overtly expressive or totally none
Affect: Blunted affect
Perceptual Disturbance:
- Auditory hallucination
- Running commentary, voices talking among each other, command hallucination
Delusion:
- Persecutory delusion
- Being harmed, monitored, followed
- Delusion of passivity
- Delusion of reference
Insight:
- Lack of insight of symptoms
Suicidal ideation:
- May be present
What are the causes of schizophrenia?
Interaction of genetic & environmental factors
Genetic:
- higher risk when family members have schizo
Environmental:
1. Maternal viral infection/malnutrition
trigger an inflammatory immune response in the mother -> cytokines can cross the placenta & disrupt fetal brain development -> brain abnormalities
- low levels of folate, iron, or vitamin D, can impair normal fetal brain growth and development
- Obstetric issues (Using recreational drugs)
- reduced oxygen supply to the brain -> disrupting brain development - Substance use especially cannabis
- Strong evidence links early cannabis use to increased risk of schizophrenia
Characteristics of schizophreniform disorder?
- presence of criterion A symptoms of
schizophrenia: delusions, hallucinations,
disorganized speech, disorganized or catatonic
behavior, and negative symptoms. - its prodromal, active, and
residual phases: >1 month but
< 6 months.
An uninterrupted period of illness occurs during which a major depressive
episode, a manic episode, or a mixed episode occurs with symptoms that
meet criterion A for schizophrenia. The major depressive episode must
include criterion A1 (i.e. depressed mood).
́ During the same period of illness, delusions or hallucinations occur for at
least 2 weeks without prominent mood symptoms.
́ Symptoms that meet the criteria for mood episodes are present for a substantial portion of the total active and residual periods of illness.
́- not due to direct physiologic effects of a substance like illicit drugs, medications) or a general medical condition.
́ The bipolar type is diagnosed if the disturbance includes a manic or a mixed episode (or a manic or a mixed episode and major depressive
episodes).
The depressive type is diagnosed if the disturbance includes only major
depressive episodes.
Overall Goals of Treatment for
Schizophrenia?
- Safety in all settings (home; hospital or community)
- Stabilised on antipsychotic
medication - Educate Client and family about schizophrenia and its treatment
- Physical care of client
- Psychosocial support for client and family
Intervention for schizophrenia?
- Antipsychotic medications
- Adjunctive pharmacotherapies
- Electroconvulsive therapy ECT
- Usually for treatment-resistant
- Effective for acute schizophrenia, mania,
depression
- Safe
-Administered under light general anesthesia - Psychological interventions
- Family interventions
- Vocational rehabilitation
- helps individuals with schizophrenia regain or develop the skills needed to secure and sustain employment. - Community treatment & multidisciplinary care team case for management of patient
What medical treatment is used for schizophrenia?
1st gen anti-psychotics:
- Thorazine, Fluanxol,
& Haloperidol.
- effective in treating positive symptoms of schizophrenia like effectively control the
hallucinations, delusions, and confusion of schizophrenia
́2nd generation anti-psychotics include Risperdal, Clozaril, and
Aripiprazole
- first-line treatment: good at reducing negative symptoms
Whats delusional disorder?
- non-bizarre delusions: false fixed beliefs that are not usually accepted by the person’s culture,
- possible but not true
- delusions persist despite evidence that its not true
- no other mood or psychotic symptoms
