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63 Cards in this Set
- Front
- Back
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What is the prototypical psychotic illness?
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Schizophrenia
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What does schizophrenia consist of?
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Several related symptom clusters
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Why is it important to know about Schizophrenia?
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Because it accounts for ~2.5% of all healthcare costs in the US
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What is the average lifetime prevalence of Schizophrenia worldwide?
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1%
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How does schizophrenia compare in males and females?
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-Equal lifetime prevalence
-Earlier age onset in men |
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Who was the first professor to distinguish Bipolar disorder from dementia praecox??
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Emil Kraepelin
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What is Dementia praecox?
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A premature deteriorating disorder
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Who was the first person to describe the common feature of schizophrenias as a SPLIT among affect, thought, emotion, and behavior?
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Eugen Bleuler
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What are Bleuler's four A's?
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-Associations
-Affect -Autism -Ambivalence |
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What did Kurt Schneider come up with in re: to schizophrenia?
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First Rank Symptoms
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What are the first rank symptoms?
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-Thought broadcasting
-Thought withdrawal -Voices -Somatic passivity |
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What is somatic passivity?
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Letting one's body be controlled by something outside - Catatonic schizophrenia
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What are the DSM4 A criteria for Schizophrenia?
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2/more during 1mo period:
1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized, or catatonic behavior 5. Negative symptoms |
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What are negative symptoms?
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-Flat affect
-Alogia -Avolition |
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When is only one A Criterion needed to diagnose schizophrenia?
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-Delusions are bizarre
-Hallucinations are a voice keeping up a running commentary on person's behaviors/thoughts -2/more voices conversing |
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What is the main reason that patients with Schizophrenia have a difficult time getting along in life?
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Negative symptoms
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What is alogia?
What is avolition? |
Alogia: Complete lack of speech
Avolition: General lack of desire, motivation, and persistence. |
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What are the B symptoms?
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Social and occupational dysfunctions
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What is the criteria for B symptoms?
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Marked disturbance in 1/more major areas of functioning - socially or in job/selfcare
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What is the C symptom?
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Duration
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What is the duration of symptoms required to diagnose Schizophrenia?
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AT LEAST 6 MONTHS OF DISTURBANCE
-Criterian A sx for 1 month or less if treated successfully -Prodrome and persistence of attenuated symptoms |
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What 2 disorders have to be ruled out in diagnosing schizophrenia?
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-Schizoaffective
-Mood disorder |
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What else rules out Schizophrenia?
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-Substance abuse is causing the disturbance
-General medical condition ie hypothyroidism is causing it |
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When can you diagnose Schizophrenia on top of a pervasive developmental disorder like Autism?
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Only if prominent delusions or hallucinations are also present for at least a month.
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What are Positive symptoms, in general?
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The most clearly visible symptoms of schizophrenia.
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What are 3 examples of positive symptoms?
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-Delusions
-Hallucinations -Behavioral disturbances |
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What are the more disabling symptoms?
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Negative symptoms
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What are some negative symptoms?
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-Social isolation
-Withdrawal -Poor grooming -Anergy -Loss of interest, blunted affect |
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What is a good way to differentiate Schizoaffective disorder from schizophrenia then?
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Affect - should be flattened in schizophrenia, will be much more variable in schizoaffective disorder.
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What are 3 Cognitive symptoms that develop in Schizophrenia?
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-Impaired abstract thinking
-Impaired problem solving -Disturbed memory |
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What are the 5 subtypes that Schizophrenia is classified into?
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1. Catatonic
2. Disorganized 3. Paranoid 4. Residual 5. Undifferentiated |
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What is Catatonic schizophrenia?
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Severe problems with motor posturing; they stand motionless in the hospital ward for days.
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What is Disorganized schizophrenia?
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A disturbance of Affect
-empty laughter -inappropriate silliness |
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What is Paranoid schizophrenia?
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An increase in positive symptoms - hallucinations/delusions, etc
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What is Residual schizophrenia?
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When residual positive symptoms and some blunting of affect remain, but no longer acute episodes that were previously experienced.
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What is undifferentiated schizophrenia?
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The case where there are no predominant symptoms, just a few.
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What is the cause of Schizophrenia?
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It's poorly understood.
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What has been CLEARLY shown in schizophrenia?
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A genetic component
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What anatomic changes are present in schizophrenia?
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-Enlarged lateral ventricles
-Increased width of 3rd ventricle -Sulci enlarged (gyri smaller) |
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What physiologic brain changes are responsible for neg sx?
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Poorly activated dorsolateral prefrontal cortex.
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What physiological brain changes are responsible for pos sx?
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Increased limbic functioning
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What biochemical factor is blocked by ALL antipsychotics?
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Dopamine D2 receptors
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What is the primary treatment method for schizophrenia?
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Medication
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What is the preferred medication?
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Atypicals
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What are Atypicals?
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Dopamine-Serotonin antagonists
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What were the typical antagonists?
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Dopamine alone antagonists
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What are 3 atypicals?
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-Olanzapine
-Risperidone -Quetiapine |
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What are 3 typicals?
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Haloperidal
Chlorpromazine Fluphenazine |
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What are side effects of typicals?
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-Acute dystonia
-Akathisia -Tardive dyskinesia That's why we use atypicals |
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What treatment is essential in addition to medications?
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Psychosocial intervention - with housing, community, job, etc.
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What is "The rule" in schizophrenia prognosis?
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Residual impairment
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Which symptoms get more severe or less severe over time in schizophrenia?
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Pos symptoms get less severe
Neg symptoms get worse |
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What has a major effect on prognosis in schizophrenia?
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The FAMILY environment
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What is the longterm prognosis for schizophrenia patients?
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20-30% lead normal lives
20-30% experience mod symptoms 40-60% are significantly impaired |
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What is Schizophreniform disorder?
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Schizophrenia but for only 1-6 months
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What is the hallmark of Schizoaffective disorder?
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mood symptoms
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What is a Brief Psychotic disorder?
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Psychosis for 1 day to 1 month
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What is Delusional disorder?
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Disorder where NONBIZARRE disorders don't impair functioning much, and aren't auditory or visual. "My wife is having an affair"
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When is Shared psychotic disorder seen?
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In weird married couples where one becomes delusional and the other buys into it.
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Why do older patients seem to smack and lick their lips? What is this called?
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Tarditive Dyskinesia - they become loose as a goose and hyperreactive due to years of D2 receptor blockade.
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What is Akathisia?
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A sensory experience where you feel like you HAVE to move your arms/legs, but when you do there is no relief
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What med may help akathisia?
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Benadryl
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Look at schizoaffective disorder diagnosis again
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ok
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