Week 8 - Schizophrenia & Psychotic Disorders Flashcards
What is psychosis?
Loses touch with reality (impaired reality orientation)
Hallucinations
Delusions
What are the psychotic disorders?
schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, brief psychotic disorder
What are positive symptoms of schizophrenia?
Delusions Hallucinations Disorganized thinking, speech, and behavior Inappropriate affect Catatonia
What are negative symptoms of schizophrenia?
Flat affect Alogia Avolition Anhedonia Lack of insight
What are delusions?
Disturbance in the content of thought
Irrational or false belief
Fixed and firmly held even with clear contradictory evidence or others’ attempts to persuade
What are hallucination?
Sensory experience that seems real to the person having it but it is not real
What are types of hallucinations?
auditory, visual, tactile, olfactory
What is rapid shifts from one topic to another?
loose associations
What are made up words?
neologisms
What is repeated words and statements?
perseveration
What is rhyming?
clang
What is inappropriate affect?
Showing emotions that are inconsistent with the situation
What is unusual motor symptoms?
catatonia
What are examples of catatonia?
Absence of all movement and speech
Move a person’s body part and it stays there for a long time
Uncontrolled motor activity
May hold an unusual or rigid posture for a long time
What is flat affect?
wing very little emotion
Monotone
Few changes in facial expression
what is alogia?
Speaking very little
Appears withdrawn
If speaks, speech is basic and brief
What is avolition?
Apathy, drained of energy, inability to initiate or persist in goal directed activities
E.g., self care, working, or communicating with others
What is lack of pleasure or interest in life activities?
anhedonia
What is poor insight into medical condition?
lack of insight
What are the phases of schizophrenia?
prodromal –> psychotic prephase –> active phase –> residual phase
What happens in prodromal phase?
peculiar behaviors and negative symptoms
What happens in psychotic prephase?
first full blown positive symptom
What happens in active phase?
many positive and negative sx
What happens in residual phase?
low grade sx
What is the DSM-5 for schizophrenia?
A. 2 or more of the following, present for a significant portion of time during a 1 month period
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms
B. Level of functioning in 1 or more major areas is markedly below the level achieved prior to the onset
C. Continuous signs of disturbance for at least 6 months
D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have ben ruled out
E. Not due to substances or medical condition
F. With a history of autism spectrum disorder, or communication disorder in childhood, only diagnose schizophrenia if prominent delusions or hallucinations
What is the time line required for schizophrenia?
1 mo of symptoms bu 6 mo disturbance
What is DSM-5 for schizophreniform disorder?
A. 2 or more of the following, present for a significant portion of time during a 1 month period
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms
B. Episode of the disorder lasts at least 1 month but less than 6 months
C. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have ben ruled out
D. Not due to substances or medical condition
What is the timeline for schizophreniform?
1 mo symptoms but less than 6 mo disturbance
What is schizoaffective DSM-5 criteria?
A. An uninterrupted period of illness during which there is a major mood episode concurrent with criterion A of schizophrenia
B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode during the lifetime duration of the illness
C. Symptoms that meet criteria for major mood episode are present for the majority of the total duration of the active residual portions of the illness
D. The disturbance is not due to substances or medical condition
What are the specifiers for schizoaffective?
bipolar or depressive
What is the DSM-5 for delusional disorder?
A. Presence of 1 (or more) delusions with a duration of 1 month or longer
B. Criterion A for schizophrenia has NEVER been met
C. Functioning is NOT markedly impaired and behavior is NOT obviously bizarre or odd
D. If mood episodes have occurred, they are brief relative to delusions
E. The disturbance is not due to substances or medical condition
What is the criteria for brief psychotic disorder?
A. Presence of one (or more) of the following
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
B. Duration of the episode is at least 1 day but less than 1 month, with eventual full return to premorbid functioning
C. Not better explained by major depression or bipolar disorder with psychotic features or another psychotic disorder and not due to substances or medical condition
What is the timeline for brief psychotic disorder?
at least 1 day but less than 1 mo
What are medical conditions that cause psychosis?
Substance abuse Thyroid disorder Delirium caused by infection Dementia Systemic lupus erythematosus HIV/AIDS Vitamin B12 Deficiency Cushing syndrome Temporal lobe epilepsy Brain tumor Wilson disease Porphyria
What are some screening questions?
Do you ever hear or see things that other people do not?
Do your eyes or ears ever play tricks on you?
Do you feel that someone or something is out to get you?
Do you ever get special messages meant just for you from the newspapers, internet, television, radio, etc?
What is the most common psychotic disorder?
schizophrenia
What is the median age of onset for schizophrenia?
22 yo
What are comorbid disorders with psychotic disorders?
anxiety disorders, depressive and bipolar disorders, and substance use disorders
Who gets schizophrenia more?
men
Who gets schizoaffective more?
women
Who gets delusional disorder more?
women
Who gets brief psychotic disorders more?
women
What is important about psychotic disorder?
HIGH GENETIC BASIS
due to chromosome abnormalities or genetic mutations
What is the dopamine hypothesis?
Excess dopamine hypothesis can explain positive symptoms but not negative symptoms
What other NT may be involved?
noradrenaline, serotonin, GABA, glutamate
What are the brain differences in psychotic pts?
enlarged ventricles undeveloped temporal lobe reduction in brain size smaller size in other areas lack of asymmetry in areas related to language and decision making
What are some prenatal issues that could result in psychotic conditions?
virus or infection during pregnancy hypoxic ischemia --> enlarged ventricles low birth wt, head circum maternal stress exposure to rubella, encephalitis or malnutrition
What are pt with psychotic disorders more likely to use?
marijuana
