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232 Cards in this Set
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General description of psychotic d/o
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brain-based psych d/o that are grouped together b/x of similarity in frequent Psychotic sx, but each has somewhat different etiologies
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Psychotic disorders are one of the most _____ classes of psychiatric d/o as determined by the degree of _____ ______ & _____ ____ of this chronic illness
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Psychotic d/o are one of the most DEBILITATING classes of psychiatric d/o as determined by the degree of FUNCTIONAL IMPAIRMENT & FINANCIAL BURDEN of this chronic illness
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Psychotic implies inability to
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test reality
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Psychotic manifests in sx such as
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Hallucinations
Delusions Disorganized thinking & speech Frequent illusional perceptions |
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Psychotic d/o are generally known to have a strong ____ component
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Psychotic d/o are generally known to have a strong GENETIC component
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Schizophrenia sig disturbance in many areas of functioning including:
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Cognition
Perception Emotionality Behavior Movement Socialization |
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Etiology of schizophrenia
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many theories exist, ranging from psychological to neurobiological
A probable multifactorial etiological profile exists |
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Biological theory of etiology of schizophrenia implicates 3 areas of biological functioning
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Genetics
neurodevelopment neurobiological defects |
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Genetic as biological etiology of schizophrenia
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Studies of twins have identified schizophrenia as having a strong genetic etiological component
No one specific gene has yet been identified A polygenic single nucleotide polymorphism (SNP) defect is believed to exist |
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Twin studies have identified schizophrenia
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as having a Strong genetic etiological component
Incidence increases from 1% risk of illness in gen pop to ~50% risk in monozygotic twin of a person with schizophrenia ~15% risk in dizygotic twin of a person with schizophrenia ~40% risk in children if both parents have schizophrenia |
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Chromosomes have been implicated in schizophrenia
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5
6 8 11 18 19 22 |
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Hallucinations
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false sensory experience w/o a stimuli being present
Hypnopmpic & hypnogogic are considered normative & do not fall under the true definition of hallucinations |
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Type of hallucinations
Most common to least common |
Auditory (most common)
visual tactile olfactory gustatory |
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Delusion
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a false belief firmly maintained despite evidence to the contrary
Types of delusions *persecutory *religious *grandiosity *somatic *referential *jealousy *Erotomanic |
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Types of delusions
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Types of delusions
*persecutory *religious *grandiosity *somatic *referential *jealousy *Erotomanic |
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disorganized thinking
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aka formal thought disturbance or thought disorder
Problems with information organization & interpretation that are best assessed in the speech patterns of patients |
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Disorganized thinking types
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Loose association
Derailment Tangentiality Word salad |
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Problems with information organization & interpretation that are best assessed in the speech patterns of patients
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disorganized thinking
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Loose association
Derailment Tangentiality Word salad |
disorganized thinking
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Loose association
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disorganized thinking
(aka derailment) shift in thinking in which ideas move from one apparently unrelated topic to another |
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Tangentiality
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Disordered thinking
Shifts in topics that often start as related shifts bur progressively move farther away from the original topic |
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Word Salad
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disordered thinking
form of very disorganized speech in which syntaz is lost and word use is random & idiosyncratic |
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Clanging
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disordered thinking
form of loose association in which topics change on a basis of sounds of words rather than meaning of the words |
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form of loose association in which topics change on a basis of sounds of words rather than meaning of the words
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Clanging
common finding of thought disorder (disordered thinking) |
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form of very disorganized speech in which syntaz is lost and word use is random & idiosyncratic
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word salad
common finding of thought disorder (disordered thinking) |
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Shifts in topics that often start as related shifts bur progressively move farther away from the original topic
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tangentiality
common findings of thought disorder (disordered thinking) |
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Perserveration
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Persistent repetition of words or phrases
common findings of thought disorder (disordered thinking) |
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Confabulation
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fabrication of facts and details to fill gaps in memory
common findings of thought disorder (disordered thinking) |
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Persistent repetition of words or phrases
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Perseveration
common findings of thought disorder (disordered thinking) |
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fabrication of facts and details to fill gaps in memory
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Confabulation
common findings of thought disorder (disordered thinking) |
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Echolalia
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Echoing of words or phrases just spoken by another
common findings of thought disorder (disordered thinking) |
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Echopraxia
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Echoing of behavior of another
common findings of thought disorder (disordered thinking) |
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Echoing of words or phrases just spoken by another
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Echolalia
common findings of thought disorder (disordered thinking) |
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Echoing of behavior of another
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Echopraxia
common findings of thought disorder (disordered thinking) |
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Blocking
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sudden stoppage of speech attributed to losing thought or forgetting
common findings of thought disorder (disordered thinking) |
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Sudden stoppage of speech attributed to losing thought or forgetting what was being talked about
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Blocking
common findings of thought disorder (disordered thinking) |
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Circumstantiality
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Inclusion of unnecessary detail & parenthetical information into the conversation
common findings of thought disorder (disordered thinking) |
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Inclusion of unnecessary detail & parenthetical information into the conversation
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Circumstantiality
common findings of thought disorder (disordered thinking) |
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Neologisms
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Word inventions or unusual application of current words that, while having personal significance to the person, have no apparent meaning for the listener
common findings of thought disorder (disordered thinking) |
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Word inventions or unusual application of current words that, while having personal significance to the person, have no apparent meaning for the listener
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Neologisms
common findings of thought disorder (disordered thinking) |
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Poverty of content
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Vague, repetitive, & abstractive form of speech that contains many words but little information
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Vague, repetitive, & abstractive form of speech that contains many words but little information
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Poverty of content
common findings of thought disorder (disordered thinking) |
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Flight of ideas
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speech pattern characterized by accelerated speech and rapid shifts in topics.
Often disorganized & difficult to follow, but syntax & vocabulary remain intact |
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speech pattern characterized by accelerated speech and rapid shifts in topics.
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Flight of ideas
common findings of thought disorder (disordered thinking) |
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Disorganized behavior
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Unusual behavior ranging from childlike silliness to anger.
Is a sx of schizophrenia Sx of psychosis Type of disorganized behavior *silliness *unpredictable anger *difficulties w/ ADLs *disheveled *odd or unusual dress *inappropriate sexual activity *Stereotypic motor activities |
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*silliness
*unpredictable anger *difficulties w/ ADLs *disheveled *odd or unusual dress *inappropriate sexual activity *Stereotypic motor activities |
Disorganized behavior
Is a sx of schizophrenia |
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Referential thinking & delusion of control
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Sx of psychosis
Belief that events, actions or situations in the environment hold special significance or meaning Types of referential thinking *thought insertion *thought withdrawal *thought control *thought broadcasting |
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Sx of psychosis
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hallucinations
Delusions illusional perceptions Disorg behavior Disorg thinking Referential thinking & delusions of control |
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Type of referential thinking & delusions of control
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*thought insertion
*thought withdrawal *thought control *thought broadcasting |
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Illusional perceptions
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Sx of psychosis
Misperception of actual environmental stimuli Types os illusions Auditory visual tactile olfactory gustatory |
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Types of illusional perceptions
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Auditory
Visual Tactile Olfactory Gustatory |
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Hypnompic hallucinations
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a false perception that occurs when one is waking up
Hallucination when you POP up from sleep Not considered pathological |
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Hypnogogic hallucinations
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a false perception that occurs when one is falling asleep
Hallucination when one is GOing to sleep Not considered pathological |
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Neurodevelopment etiology of schizophremia
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Genetic defects are believed to cause abnormal neuronal cell development, connection, organization and migration.
These include inadequate synapse formation, excessive pruning of synapses, and excitotoxic death or neurons intrauterine insults may contribute to etiological picture |
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Etiology of schizophrenia
Genetic defects are believed to cause |
abnormal neuronal cell development connection, organization and migration
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Etiology of schizophrenia
These Intrauterine insults may contribute to etiological picture: |
~prenatal exposure to toxins, including viral agents (thought why more schizophrenics are born in winter/e.spring)
~Oxygenation deprivation ~maternal malnutrition, substance use, or other issues |
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maternal malnutrition, substance use, or other issues
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These Intrauterine insults may contribute to etiological picture of schizophrenia
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Oxygenation deprivation of fetus
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This Intrauterine insults may contribute to etiological picture of schizophrenia
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Prenatal exposure to toxins, including viral agents
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This Intrauterine insults may contribute to etiological picture of schizophrenia
(thought why more schizophrenics are born in winter/e.spring) |
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Several abnormal brain structures have been identified in individuals with schizophrenia:
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Neurobiological defect etiology of schizophrenia
*enlarged ventricles *smaller frontal and temporal lobes *cortical atrophy *decreased cerebral blood flow *hippocampal reduction |
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enlarged ventricles
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Abnormal brain structure in schizophrenia
Neurobiological defect etiology of schizophrenia |
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smaller frontal and temporal lobes
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Abnormal brain structure in schizophrenia
Neurobiological defect etiology of schizophrenia |
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cortical atrophy
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Abnormal brain structure in schizophrenia
Neurobiological defect etiology of schizophrenia |
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*enlarged ventricles
*smaller frontal and temporal lobes *cortical atrophy *decreased cerebral blood flow *hippocampal reduction |
Abnormal brain structured in schizophrenia
Neurobiological defect etiology of schizophrenia |
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decreased cerebral blood flow
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Abnormality of brain structures found in schizophrenia
Neurobiologic defect etiology of schizophrenia |
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hippocampal reduction
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Abnormality of brain structures found in schizophrenia
Neurobiologic defect etiology of schizophrenia |
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Abnormalities of the brain lead to suspected impaired neuronal communication in
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schizophrenia
Neurobiologic defect etiology of schizophrenia |
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Suspected alteration in chemical neuronal signal transmission d/t brain abnormalities in schizophrenia are
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~excess dopamine in mesolimbic pathway
~decreased dopamine in the mesocortical pathway ~excess glutamate ~decreased gamma-aminobutyric acid ~decreased serotonin |
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NT in schizophrenia that are out of whack
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Dopamine (high in mesolimbic, low in mesocortical)
Glutamate (High) GABA (low) 5HT (low) |
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Excess ______ in _______ pathway in schizophrenia
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Excess DOPAMINE in MESOLIMBIC pathway in schizophrenia
Suspected alteration in chemical neuronal signal transmission d/t brain abnormalities of schizophrenia which lead to suspected impaired neuronal communication |
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Dopamine in schizophrenia
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excess in mesolimbic pathway
decreased in the mesocortical pathway Suspected alteration in chemical neuronal signal transmission d/t brain abnormalities of schizophrenia which lead to suspected impaired neuronal communication |
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Glutamate in schizophrenia
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excess of glutamate
Suspected alteration in chemical neuronal signal transmission d/t brain abnormalities of schizophrenia which lead to suspected impaired neuronal communication |
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Decreased ______ in the ________ pathway in schizophrenia
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Decreased DOPAMINE in the MESOCORTICAL pathway in schizophrenia
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GABA and schizophrenia
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GABA is decreased in
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5ht in schizophrenia
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decreased in
Suspected alteration in chemical neuronal signal transmission d/t brain abnormalities of schizophrenia which lead to suspected impaired neuronal communication |
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Acetyl Choline in schizophrenia
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no changes
not a major player |
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glycine in schizophrenia
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no changes
not a major player in |
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NT that are decreased in schizophrenia
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dopamine in the mesocortical pathway
5HT GABA |
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NT that are increased in schizophrenia
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Glutamate
excess dopamine in mesolimbic pathway |
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Mesolimbic pathway
Mesocortical pathway |
DA excess in schizophrenia
Decreased DA in schizophrenia |
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Schizophrenia prevalence
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1%-1.5% of US population
Geographic and historical variations in incidence give insight into etiological factors ~higer rates in urban born individuals ~higher rates in 1st born individuals ~higher rates in individuals with lower socioeconomic status |
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Higher rates of schizophrenia are found where
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1st born
urban-born lower socioeconomic status |
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Schizophrenia prevalence & gender
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equally prevalent in men and women
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Men w/ schizophrenia onset
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18-25
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Men w/ schizophrenia have more ______ sx
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Male schizophrenics have more NEGATIVE sx
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Women w/ schizophrenia age of onset
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25-35 years
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women w/ schizophrenia have more ______ sx
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Female schizophrenics have more POSITIVE sx
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Who has more positive sx
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Female schizophrnics
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Who has more negative sx
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male schizophrenics
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Usually experience more dsyphoria in schizophrenia
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females
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Tend to have poorer prognosis in schizophrenia
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males
More negative sx |
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Tend to have more hospitalizations associated w/ schizophrenia
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Males
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Tend to have less responsiveness to medication in schizophrenia
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Males
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Tend to have more paranoid delusions in schizophrenia
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Females
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Tend to have more hallucinations in schizophrenia
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females
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Women & schizophrenia
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onset 25-35
***Usually less premorbid dysfunction than men ***Tend to have paranid delusions & more hallucinations than me ***Usually experience more dysphoria than men |
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Men and schizophrenia
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Onset 18-25
***Tend to have more negative sx than men ***Tend to have poorer prognosis, more hospitalizations, and less responsiveness to medications than women |
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Age of onset has pathophysiological and prognostic significance in
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schizophrenia
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Characteristics of earlier age of onset Schizophrenia
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~tend to be men
~have poorer premorbid fxning ~Have more evidence of structural brain abnormalities ~have more prominent negative sx ~have morre cognitive impairment ~have poorer prognosis |
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Characteristics of later age of onset Schizophrenia
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~tend to be women
~have less evidence of structural abnormalities ~have less cognitive impairment ~have better prognosis |
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~tend to be women
~have less evidence of structural abnomalities ~have less cognitive impairment ~have better prognosis |
Characteristics of later age of onset Schizophrenia
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~tend to be men
~have poorer premorbid fxning ~Have more evidence of structural brain abnormalities ~have more prominent negative sx ~have morre cognitive impairment ~have poorer prognosis |
Characteristics of earlier age of onset Schizophrenia
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These people have less evidence of structural abnormalities in schizophrenia
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later age of onset Schizophrenia
~tend to be women ~have less cognitive impairment ~have better prognosis |
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These people have poorer premorbid fxning in schizophrenia
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earlier age of onset Schizophrenia
~tend to be men ~Have more evidence of structural brain abnormalities ~have more prominent negative sx ~have morre cognitive impairment ~have poorer prognosis |
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These people have morre cognitive impairment in schizophrenia
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Earlier age of onset group
~tend to be men ~have poorer premorbid fxning ~Have more evidence of structural brain abnormalities ~have more prominent negative sx ~have poorer prognosis |
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Have more evidence of structural brain abnormalities
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early onset in schizophrenia
*men *more cognitive impairment (hand and had with more structural brain abnormalities) ~worse prognosis than later onset |
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Possible risk factors for schizophrenia
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~genetic loading
****1st degree relative with schizophrenia ~prenatal exposure to flu or virus ~prenatal malnutrition ~obstetrical complications ~CNS infection in a little kid |
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prenatal malnutrition
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Possible risk factors for schizophrenia
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CNS infection in a little kid
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Possible risk factors for schizophrenia
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obstetrical complications
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Possible risk factors for schizophrenia
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prenatal exposure to flu or virus
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Possible risk factors for schizophrenia
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1st degree relative with schizophrenia
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genetic loading
Possible risk factors for schizophrenia |
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Possible risk factors for schizophrenia
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~genetic loading
****1st degree relative with schizophrenia ~prenatal exposure to flu or virus ~prenatal malnutrition ~obstetrical complications ~CNS infection in a little kid |
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usually mild manifestations of schizophrenia sx seen in
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Significant & protracted prodromal sx period usually noted before full onset of illness
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Usually mild manifestations of schizophrenia sx seen in prodromal period
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~Odd or unusual beliefs but not to delusional proportion
~Feel unliked or picked on but not to delusional proportions ~Odd speech patterns but not illogical ***digressions ***tangentiality ~overly concrete or abstractive thinking ~Odd behavior but not disorg **collects odd or worthless items **mumbles to self **isolates self and avoids interaction w/ others |
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Odd speech patterns but not illogical
****digressions ****Tangentiality seen in |
Usually mild manifestations of schizophrenia sx seen in prodromal period
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Odd behavior but not disorg
**collects odd or worthless items **mumbles to self **isolates self and avoids interaction w/ others |
Usually mild manifestations of schizophrenia sx seen in prodromal period
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overly concrete or abstractive thinking
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Usually mild manifestations of schizophrenia sx seen in prodromal period
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Feel unliked or picked on but not to delusional proportions
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Usually mild manifestations of schizophrenia sx seen in prodromal period
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Odd or unusual beliefs but not to delusional proportion
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Usually mild manifestations of schizophrenia sx seen in prodromal period
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†here is no single pathognomonic sx of schizophrenia but rather
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a constellation of clustered symptoms
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Schizophrenia is a disease of _______ processing
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Schizophrenia is a disease of information processing
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The clusters of sx are ______ and __________ in schizophrenia
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The clusters of sx are BEHAVIORAL & COGNITIVE in schizophrenia
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Schizophrenia is associated with marked _____ or ______ dysfxning
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Schizophrenia is associated w/ marked SOCIAL & OCCUPATIONAL functioning
Prominent dysfunction exists in many spheres of daily living |
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Interpersonal relationships & schizophrenia
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60-70% of clients do not marry
If good support &/or married this is a predictive of a better prognosis |
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Downdrift functionality
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Social or occupational fxning in schizophrenia; downdrift is noted over time.
*Schizophrenics do not go as far as their unaffected siblings *Have difficulty holding jobs *are underemployed relative to intellectual capacity |
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Self-care deficits in schizophrenia
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~poor hygiene
~poor money mgmt ~limited ability for independent living |
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Characteristic sx clusters for schizophrenia
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Positive sx
Negative sx Associated sx |
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Positive sx
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Sx the respond positively to and that can be controlled by typical antipsychotic meds
~reflect excess or distortions of normal brain fxning ~Caused by increased dopamine in the mesolimbic pathway |
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What causes positive sx
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increased dopamine in the mesolimbic pathway
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This type of sx reflects excess or distortions of normal brain fxning
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Positive sx
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_______ respond to and can be controlled by typical antipsychotic medications
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Positive sx
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Clinical manifestations positive sx
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Hallucinations
Delusions Referential thinking disorganized behavior Hostility Grandiosity Mania Suspiciusness |
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Suspiciusness
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Clinical manifestations positive sx
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Mania
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Clinical manifestations positive sx
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Grandiosity
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Clinical manifestations positive sx
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Hostility
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Clinical manifestations positive sx
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Referential thinking
is what kind of sx |
+
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Delusions is what kind of sx?
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Clinical manifestations positive sx
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Hallucinations is what kind of sx?
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Clinical manifestations positive sx
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Negative sx
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Sx less responsive to typical antipsychotic meds but may respond to and be controlled by atypical antipsychotic meds
Represent a decrease or loss of normal fxning Caused by decreased dopamine in the mesocortical pathway |
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Caused by decreased dopamine in the mesocortical pathway
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Negative
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____ sx represent a decrease or loss of normal fxning
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Negative sx
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This type of sx less responsive to typical antipsychotic med
mar respond to and be controlled by atypical antipsychotic meds |
Negative sx
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Clinical manifestations of negative sx
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~affective flattening
~alogia or poverty of speech ~avolition ~apathy ~abstract thinking problems ~anhedonia ~attention deficits |
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attention deficits
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Clinical manifestations of negative sx
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anhedonia
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Clinical manifestations of negative sx
inability to derive pleasure from ordinarily pleasurable activities |
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abstract thinking problems
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Clinical manifestations of negative sx
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apathy
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Clinical manifestations of negative sx
A state of indifference, or the suppression of emotions such as concern, excitement, motivation and passion. An apathetic individual has an absence of interest in or concern about emotional, social, spiritual, philosophical or physical life. They may lack a sense of purpose or meaning in their life. He or she may also exhibit insensibility or sluggishness. |
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alogia or poverty of speech
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Clinical manifestations of negative sx
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Clinical manifestations of associated sx
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~Inappropriate affect
~dysphoric mood ~depersonalization ~derealization ~high anxiety |
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affective flattening
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Clinical manifestations of negative sx
is a general category which includes diminishment of, or absence of, emotional expressiveness. It is sometimes inappropriately equated with blunted or restricted affect. "Blunted" is affect that is present but only with minimal degrees of emotions evident. |
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Associated sx
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Sx not required to be present to dx condition but often are present and a focus of tx
Clinical manifestions: Inappropriate affect Inappropriate affect Dysphoric mood depersonalization Derealization High anxiety |
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depersonalization
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Clinical manifestation of associated sx
feeling self far away, disconnected |
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Derealization
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Clinical manifestation of associated sx
Sense that one's environment has changed and is different from the way it had been before |
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High anxiety and dsyphoric mood
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Clinical manifestation of associated sx
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Inappropriate affect
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Clinical manifestation of associated sx
affect that is incongruent with the situation or with the content of a patient's ideas or speech. i.e. display of emotion that does not reflect a Pt's reality |
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affect
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the external expression of emotion attached to ideas or mental representations of objects.
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display of emotion that does not reflect a Pt's reality
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Clinical manifestation of associated sx
Inappropriate affect |
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DSM-IV criteria for schizophrenia
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2 or more of the following frequently are present during a 1 mo period
(only one need if delusions are bizarre or hallucinations consist of a voice that is running commentary of 2 or more voices conversing with each other) Delusions Hallucinations Disorganized speech Grossly disorganized behavior Presence of negative sx Sig impairment usually is evident by social or occupational dysfxn Duration of sx lasts for at least 6 months |
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Schizophrenia time frame
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2 of the psychotic sx are present during a 1 mo period
(only 1 psychotic sx if bizarre delusion or 2+ voices conversing w/ each other) Duration of sx lasts for at least 6 months |
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2+ auditory hallucinations conversing with each other
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then only need ONE of the following during a one month period
Delusions Hallucinations Disorganized speech Grossly disorganized behavior Presence of negative sx |
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Bizarre delusions then
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then only need ONE of the following during a one month period for dx of schizophrenia
Delusions Hallucinations Disorganized speech Grossly disorganized behavior Presence of negative sx |
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Bizarre and unorganized type delusions
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Bizarre delusion associated w/ severe psychotic d/o bizarre vs. non-bizarre changes based on society
e.g include delusions that manifest as loss of control over mind or body: ***thought withdrawal ***thought insertion If pt has bizarre deluion then only need ONE of the following during a one month period for dx of schizophrenia Delusions Hallucinations Disorganized speech Grossly disorganized behavior Presence of negative sx |
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Delusions are
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false beliefs that cannot be dislodged by logic or contradictory evidence not congruent w/ normative culture or religious beliefs
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Remember what Always trumps pathology
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Religion & culture
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Delusions (types)
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Of reference
Persecution Religious Nihilistic Grandiose |
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Persecution delusion
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other people have malevolent intentions toward self or are conspiring against the person
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Delusions of reference
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other people's thoughts, words or actions refer to self
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Religious delusions
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Unrealistic special relationship w/ god
Remember religion & culture always trumps pathology |
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Nihilistic delusions
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Destruction of self, world, or body part
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Grandiose delusions
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Special or gifted, powerful, or important w/o factual support
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Echolalia is pt response to
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external stimulus
repetition of other peoples' words or phrases |
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perseveration is repetition
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of the same words or ideas regardless of internal stimulus
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Bizarre & unorganized type hallucinations ex
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hallucinations that are improbable or readily apparent as not likely to have occurred
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Subtypes of schizphprenia
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Disorganized type
Paranoid type Catatonic type Undifferentiated type Residual type Subtype identification is of limited clinical value because illness course, response to tx and prognosis appear unrelated to subtype |
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Subtype identification of schizophrenia is of limited clinical value because
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illness course, response to tx and prognosis appear unrelated to subtype
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Most severe type of schizophrenia
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disorganized type
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Least severe type of schizophrenia
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paranoid type
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complete remission of
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schizophrenia
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The course of schizophrenia illness is
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variable and unrelated to subtype
Many pt have a fairly stable illness course |
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What type of sx tend to appear 1st in schizophrenia as the illness develops
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Negative sx
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____ sx appear to decrease over time, but _____sx persist
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Positive symptoms to decrease over time, but negative sx persist
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_____ sx persist
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NEGATIVE
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_____ sx appear to decrease over time
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Positive
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Factors predictive of good prognosis in Schizophrenia
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~good premorbid fxning
~acute onset ~later age of onset ~clear precipitating event ~married pt ~good support system ~positive sx ~short interval between tx and onset of 1st sx ***the sooner the pt is tx the better the prognosis ~absence of structural brain abnormalities ~family hx of mood d/o ~no family hx of schizophrenia |
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no family hx of schizophrenia
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Factors predictive of good prognosis in Schizophrenia
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family hx of mood d/o
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Factors predictive of good prognosis in Schizophrenia
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absence of structural brain abnormalities
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Factors predictive of good prognosis in Schizophrenia
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married pt &/or good support system
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Factors predictive of good prognosis in Schizophrenia
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acute onset at later age
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Factors predictive of good prognosis in Schizophrenia
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good premorbid fxning
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Factors predictive of good prognosis in Schizophrenia
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short interval between tx and onset of 1st sx
***the sooner the pt is tx the better the prognosis |
Factors predictive of good prognosis in schizophrenia
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The longer the premorbid period is untx in schizophrenia
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the worse the prognosis
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positive sx indicates a ____ prognosis
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good, positive sx appear to decrease over time
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negative sx indicates a _____ prognosis
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poor, negative sx persist
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Paranoid subtype of schizophrenia
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Least severe type
Prominent delusions or auditory hallucination Lack of prominence of disorganized speech or behavior |
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Disorganized subtype of schizophrenia
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Most severe type
Prominence of disorganized speech, disorganized behavior and flat or inappropriate affect |
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Catatonic subtype of schizophrenia
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Prominence of motor sx, including immobility as evidenced by catalepsy or stupor, excessive motor movement that is purposeless and not influenced by environmental stimuli,
extreme negativity, mutism, oddities of posturing, echolalia and echopraxia |
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echolalia
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characteristic of catatonic type schizophrenia
Repetition of the last-heard words of other individuals Echolalia- repeats words or phrases |
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echopraxia
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characteristic of catatonic type schizophrenia
imitation of observed behavior or movements EchoPRAxia-mimics behavior (PRActices behavior) |
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Undifferentiated subtype of schizophrenia
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Presence of sx consistent w/ schizophrenia but not a prominence of sx consistent w/ any of the other subtypes
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Presence of sx consistent w/ schizophrenia but not a prominence of sx consistent w/ any of the other subtypes
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Undifferentiated type of schizophrenia
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Residual subtype of schizophrenia
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Absence of prominent delusions,
hallucinations, disorganized speech disorganized or catatonic behavior and the continued presence of disturbance as indicated by presence of negative sx |
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Absence of prominent delusions, hallucinations, disorganized speech disorganized or catatonic behavior and the continued presence of disturbance as indicated by presence of negative s
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Residual subtype of schizophrenia
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Physical exam findings in schizophrenia
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~abnormal smooth peursuit eye movement
~abnormal saccadic eye movement ~ Poor eye-hand coordination **pt identified as "clumsy or awkward" ~Presence of neurological nonlocalizing soft signs: **asterognosis *Dysdidochokinesia *Impaired fine-motor movement *Left-right confusion *mirroring Presence of neurological localizing "hard signs" *weakness *decreased reflexes ~other abnormalities that may be noted: *highly arched palate *narrow or wide set eyes *subtle malformation of the ears |
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Appearance of a schizophrenic
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Odd
unusual peculiar |
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Speech of a schizophrenic
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bizarre content
disorganized Tangential loose association |
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Affect of a schizophrenic
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blunted
flat inappropriate |
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Mood of a schizophrenic
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blandness
impoverished |
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Thought process of a schizophrenic
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Psychotic
*hallucination *delusion *referential *thought control, insertion, or withdrawal |
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Thought content of a schizophrenic
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Thematically matched to psychotic content
may be impoverished |
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Cognition of a schizophrenic
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Illogical
disorganized |
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memory of a schizophrenic
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impaired short term
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Concentration of a schizophrenic
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Impaired during acute episodes
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Abstraction of a schizophrenic
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concrete on formal testing
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Judgement of a schizophrenic
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impaired for self-welfare
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Neurological localizing Hard signs
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weakness
Decreased reflexes |
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Neurological nonlocalizing soft signs in schizophrenia on physical exam
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Astereognosis: loss of ability to judge the form of an object by touch
Twitches, tics or rapid eye movement Impaired fine-motor skills Left-right confusion Mirroring Dydiadochokinesia: impairment of the ability to perform rapidly alternating movements |
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weakness
Decreased reflexes |
Neurological localizing Hard signs
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Astereognosis
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inability to discriminate between objects based on touch alone:
result of a lesion in the parietal lobe |
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inability to discriminate between objects based on touch alone:
result of a lesion in the parietal lobe |
Astereognosis
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inability to discriminate between objects based on touch alone:
result of a lesion in the parietal lobe |
Astereognosis
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Astereognosis
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loss of ability to judge the form of an object by touch
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Graphesthesia
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test the ability to identify figures, letters, or words by tracing the figure on the skin of the palm of the hand
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test the ability to identify figures, letters, or words by tracing the figure on the skin of the palm of the hand
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sensory fxn in the neurological exam
Graphesthesia |
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Stereognosis
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sensory fxn in the neurological exam
test the ability to distinguish forms by placing objects in the pt's hands while his/her eyes are closed |
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sensory fxn in the neurological exam
test the ability to distinguish forms by placing objects in the pt's hands while his/her eyes are closed |
Stereognosis
sensory fxn in the neurological exam |
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Stereognosis
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sensory fxn in the neurological exam
test the ability to distinguish forms by placing objects in the pt's hands while his/her eyes are closed |
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Astereognosis
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inability to discriminate between objects based on touch alone:
result of a lesion in the parietal lobe neurological soft sign |
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Graphesthesia
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test the ability to identify figures, letters, or words by tracing the figure on the skin of the palm of the hand
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Dysdiadochokinesia
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Inability to perform rapid alternating movements;
result of a lesion to the posterior lobe of the cerebellum neurological soft sign |