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232 Cards in this Set

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General description of psychotic d/o
brain-based psych d/o that are grouped together b/x of similarity in frequent Psychotic sx, but each has somewhat different etiologies
Psychotic disorders are one of the most _____ classes of psychiatric d/o as determined by the degree of _____ ______ & _____ ____ of this chronic illness
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
Psychotic implies inability to
test reality
Psychotic manifests in sx such as
Hallucinations

Delusions

Disorganized thinking & speech

Frequent illusional perceptions
Psychotic d/o are generally known to have a strong ____ component
Psychotic d/o are generally known to have a strong GENETIC component
Schizophrenia sig disturbance in many areas of functioning including:
Cognition
Perception
Emotionality
Behavior
Movement
Socialization
Etiology of schizophrenia
many theories exist, ranging from psychological to neurobiological

A probable multifactorial etiological profile exists
Biological theory of etiology of schizophrenia implicates 3 areas of biological functioning
Genetics
neurodevelopment
neurobiological defects
Genetic as biological etiology of schizophrenia
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
Twin studies have identified schizophrenia
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
Chromosomes have been implicated in schizophrenia
5
6
8
11
18
19
22
Hallucinations
false sensory experience w/o a stimuli being present

Hypnopmpic & hypnogogic are considered normative & do not fall under the true definition of hallucinations
Type of hallucinations

Most common to least common
Auditory (most common)
visual
tactile
olfactory
gustatory
Delusion
a false belief firmly maintained despite evidence to the contrary

Types of delusions
*persecutory
*religious
*grandiosity
*somatic
*referential
*jealousy
*Erotomanic
Types of delusions
Types of delusions
*persecutory
*religious
*grandiosity
*somatic
*referential
*jealousy
*Erotomanic
disorganized thinking
aka formal thought disturbance or thought disorder

Problems with information organization & interpretation that are best assessed in the speech patterns of patients
Disorganized thinking types
Loose association
Derailment
Tangentiality
Word salad
Problems with information organization & interpretation that are best assessed in the speech patterns of patients
disorganized thinking
Loose association
Derailment
Tangentiality
Word salad
disorganized thinking
Loose association
disorganized thinking

(aka derailment) shift in thinking in which ideas move from one apparently unrelated topic to another
Tangentiality
Disordered thinking

Shifts in topics that often start as related shifts bur progressively move farther away from the original topic
Word Salad
disordered thinking

form of very disorganized speech in which syntaz is lost and word use is random & idiosyncratic
Clanging
disordered thinking

form of loose association in which topics change on a basis of sounds of words rather than meaning of the words
form of loose association in which topics change on a basis of sounds of words rather than meaning of the words
Clanging

common finding of thought disorder (disordered thinking)
form of very disorganized speech in which syntaz is lost and word use is random & idiosyncratic
word salad

common finding of thought disorder (disordered thinking)
Shifts in topics that often start as related shifts bur progressively move farther away from the original topic
tangentiality

common findings of thought disorder (disordered thinking)
Perserveration
Persistent repetition of words or phrases

common findings of thought disorder (disordered thinking)
Confabulation
fabrication of facts and details to fill gaps in memory

common findings of thought disorder (disordered thinking)
Persistent repetition of words or phrases
Perseveration

common findings of thought disorder (disordered thinking)
fabrication of facts and details to fill gaps in memory
Confabulation

common findings of thought disorder (disordered thinking)
Echolalia
Echoing of words or phrases just spoken by another

common findings of thought disorder (disordered thinking)
Echopraxia
Echoing of behavior of another

common findings of thought disorder (disordered thinking)
Echoing of words or phrases just spoken by another
Echolalia

common findings of thought disorder (disordered thinking)
Echoing of behavior of another
Echopraxia

common findings of thought disorder (disordered thinking)
Blocking
sudden stoppage of speech attributed to losing thought or forgetting

common findings of thought disorder (disordered thinking)
Sudden stoppage of speech attributed to losing thought or forgetting what was being talked about
Blocking

common findings of thought disorder (disordered thinking)
Circumstantiality
Inclusion of unnecessary detail & parenthetical information into the conversation

common findings of thought disorder (disordered thinking)
Inclusion of unnecessary detail & parenthetical information into the conversation
Circumstantiality

common findings of thought disorder (disordered thinking)
Neologisms
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)
Word inventions or unusual application of current words that, while having personal significance to the person, have no apparent meaning for the listener
Neologisms

common findings of thought disorder (disordered thinking)
Poverty of content
Vague, repetitive, & abstractive form of speech that contains many words but little information
Vague, repetitive, & abstractive form of speech that contains many words but little information
Poverty of content

common findings of thought disorder (disordered thinking)
Flight of ideas
speech pattern characterized by accelerated speech and rapid shifts in topics.

Often disorganized & difficult to follow, but syntax & vocabulary remain intact
speech pattern characterized by accelerated speech and rapid shifts in topics.
Flight of ideas

common findings of thought disorder (disordered thinking)
Disorganized behavior
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
*silliness
*unpredictable anger
*difficulties w/ ADLs
*disheveled
*odd or unusual dress
*inappropriate sexual activity
*Stereotypic motor activities
Disorganized behavior

Is a sx of schizophrenia
Referential thinking & delusion of control
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
Sx of psychosis
hallucinations
Delusions
illusional perceptions
Disorg behavior
Disorg thinking
Referential thinking & delusions of control
Type of referential thinking & delusions of control
*thought insertion
*thought withdrawal
*thought control
*thought broadcasting
Illusional perceptions
Sx of psychosis

Misperception of actual environmental stimuli

Types os illusions
Auditory
visual
tactile
olfactory
gustatory
Types of illusional perceptions
Auditory
Visual
Tactile
Olfactory
Gustatory
Hypnompic hallucinations
a false perception that occurs when one is waking up

Hallucination when you POP up from sleep

Not considered pathological
Hypnogogic hallucinations
a false perception that occurs when one is falling asleep

Hallucination when one is GOing to sleep

Not considered pathological
Neurodevelopment etiology of schizophremia
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
Etiology of schizophrenia

Genetic defects are believed to cause
abnormal neuronal cell development connection, organization and migration
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
maternal malnutrition, substance use, or other issues
These Intrauterine insults may contribute to etiological picture of schizophrenia
Oxygenation deprivation of fetus
This Intrauterine insults may contribute to etiological picture of schizophrenia
Prenatal exposure to toxins, including viral agents
This Intrauterine insults may contribute to etiological picture of schizophrenia

(thought why more schizophrenics are born in winter/e.spring)
Several abnormal brain structures have been identified in individuals with schizophrenia:
Neurobiological defect etiology of schizophrenia

*enlarged ventricles
*smaller frontal and temporal lobes
*cortical atrophy
*decreased cerebral blood flow
*hippocampal reduction
enlarged ventricles
Abnormal brain structure in schizophrenia

Neurobiological defect etiology of schizophrenia
smaller frontal and temporal lobes
Abnormal brain structure in schizophrenia

Neurobiological defect etiology of schizophrenia
cortical atrophy
Abnormal brain structure in schizophrenia

Neurobiological defect etiology of schizophrenia
*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
decreased cerebral blood flow
Abnormality of brain structures found in schizophrenia

Neurobiologic defect etiology of schizophrenia
hippocampal reduction
Abnormality of brain structures found in schizophrenia

Neurobiologic defect etiology of schizophrenia
Abnormalities of the brain lead to suspected impaired neuronal communication in
schizophrenia

Neurobiologic defect etiology of schizophrenia
Suspected alteration in chemical neuronal signal transmission d/t brain abnormalities in schizophrenia are
~excess dopamine in mesolimbic pathway
~decreased dopamine in the mesocortical pathway
~excess glutamate
~decreased gamma-aminobutyric acid
~decreased serotonin
NT in schizophrenia that are out of whack
Dopamine (high in mesolimbic, low in mesocortical)

Glutamate (High)

GABA (low)

5HT (low)
Excess ______ in _______ pathway in schizophrenia
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
Dopamine in schizophrenia
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
Glutamate in schizophrenia
excess of glutamate

Suspected alteration in chemical neuronal signal transmission d/t brain abnormalities of schizophrenia which lead to suspected impaired neuronal communication
Decreased ______ in the ________ pathway in schizophrenia
Decreased DOPAMINE in the MESOCORTICAL pathway in schizophrenia
GABA and schizophrenia
GABA is decreased in
5ht in schizophrenia
decreased in

Suspected alteration in chemical neuronal signal transmission d/t brain abnormalities of schizophrenia which lead to suspected impaired neuronal communication
Acetyl Choline in schizophrenia
no changes
not a major player
glycine in schizophrenia
no changes
not a major player in
NT that are decreased in schizophrenia
dopamine in the mesocortical pathway

5HT

GABA
NT that are increased in schizophrenia
Glutamate

excess dopamine in mesolimbic pathway
Mesolimbic pathway

Mesocortical pathway
DA excess in schizophrenia

Decreased DA in schizophrenia
Schizophrenia prevalence
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
Higher rates of schizophrenia are found where
1st born
urban-born
lower socioeconomic status
Schizophrenia prevalence & gender
equally prevalent in men and women
Men w/ schizophrenia onset
18-25
Men w/ schizophrenia have more ______ sx
Male schizophrenics have more NEGATIVE sx
Women w/ schizophrenia age of onset
25-35 years
women w/ schizophrenia have more ______ sx
Female schizophrenics have more POSITIVE sx
Who has more positive sx
Female schizophrnics
Who has more negative sx
male schizophrenics
Usually experience more dsyphoria in schizophrenia
females
Tend to have poorer prognosis in schizophrenia
males

More negative sx
Tend to have more hospitalizations associated w/ schizophrenia
Males
Tend to have less responsiveness to medication in schizophrenia
Males
Tend to have more paranoid delusions in schizophrenia
Females
Tend to have more hallucinations in schizophrenia
females
Women & schizophrenia
onset 25-35
***Usually less premorbid dysfunction than men

***Tend to have paranid delusions & more hallucinations than me

***Usually experience more dysphoria than men
Men and schizophrenia
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
Age of onset has pathophysiological and prognostic significance in
schizophrenia
Characteristics of earlier age of onset Schizophrenia
~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 later age of onset Schizophrenia
~tend to be women
~have less evidence of structural abnormalities
~have less cognitive impairment
~have better prognosis
~tend to be women
~have less evidence of structural abnomalities
~have less cognitive impairment
~have better prognosis
Characteristics of later age of onset Schizophrenia
~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
These people have less evidence of structural abnormalities in schizophrenia
later age of onset Schizophrenia
~tend to be women
~have less cognitive impairment
~have better prognosis
These people have poorer premorbid fxning in schizophrenia
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
These people have morre cognitive impairment in schizophrenia
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
Have more evidence of structural brain abnormalities
early onset in schizophrenia

*men
*more cognitive impairment (hand and had with more structural brain abnormalities)
~worse prognosis than later onset
Possible risk factors for schizophrenia
~genetic loading
****1st degree relative with schizophrenia
~prenatal exposure to flu or virus
~prenatal malnutrition
~obstetrical complications
~CNS infection in a little kid
prenatal malnutrition
Possible risk factors for schizophrenia
CNS infection in a little kid
Possible risk factors for schizophrenia
obstetrical complications
Possible risk factors for schizophrenia
prenatal exposure to flu or virus
Possible risk factors for schizophrenia
1st degree relative with schizophrenia
genetic loading

Possible risk factors for schizophrenia
Possible risk factors for schizophrenia
~genetic loading
****1st degree relative with schizophrenia
~prenatal exposure to flu or virus
~prenatal malnutrition
~obstetrical complications
~CNS infection in a little kid
usually mild manifestations of schizophrenia sx seen in
Significant & protracted prodromal sx period usually noted before full onset of illness
Usually mild manifestations of schizophrenia sx seen in prodromal period
~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
Odd speech patterns but not illogical
****digressions
****Tangentiality
seen in
Usually mild manifestations of schizophrenia sx seen in prodromal period
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
overly concrete or abstractive thinking
Usually mild manifestations of schizophrenia sx seen in prodromal period
Feel unliked or picked on but not to delusional proportions
Usually mild manifestations of schizophrenia sx seen in prodromal period
Odd or unusual beliefs but not to delusional proportion
Usually mild manifestations of schizophrenia sx seen in prodromal period
†here is no single pathognomonic sx of schizophrenia but rather
a constellation of clustered symptoms
Schizophrenia is a disease of _______ processing
Schizophrenia is a disease of information processing
The clusters of sx are ______ and __________ in schizophrenia
The clusters of sx are BEHAVIORAL & COGNITIVE in schizophrenia
Schizophrenia is associated with marked _____ or ______ dysfxning
Schizophrenia is associated w/ marked SOCIAL & OCCUPATIONAL functioning

Prominent dysfunction exists in many spheres of daily living
Interpersonal relationships & schizophrenia
60-70% of clients do not marry

If good support &/or married this is a predictive of a better prognosis
Downdrift functionality
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
Self-care deficits in schizophrenia
~poor hygiene
~poor money mgmt
~limited ability for independent living
Characteristic sx clusters for schizophrenia
Positive sx
Negative sx
Associated sx
Positive sx
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
What causes positive sx
increased dopamine in the mesolimbic pathway
This type of sx reflects excess or distortions of normal brain fxning
Positive sx
_______ respond to and can be controlled by typical antipsychotic medications
Positive sx
Clinical manifestations positive sx
Hallucinations
Delusions
Referential thinking
disorganized behavior
Hostility
Grandiosity
Mania
Suspiciusness
Suspiciusness
Clinical manifestations positive sx
Mania
Clinical manifestations positive sx
Grandiosity
Clinical manifestations positive sx
Hostility
Clinical manifestations positive sx
Referential thinking
is what kind of sx
+
Delusions is what kind of sx?
Clinical manifestations positive sx
Hallucinations is what kind of sx?
Clinical manifestations positive sx
Negative sx
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
Caused by decreased dopamine in the mesocortical pathway
Negative
____ sx represent a decrease or loss of normal fxning
Negative sx
This type of sx less responsive to typical antipsychotic med
mar respond to and be controlled by atypical antipsychotic meds
Negative sx
Clinical manifestations of negative sx
~affective flattening
~alogia or poverty of speech
~avolition
~apathy
~abstract thinking problems
~anhedonia
~attention deficits
attention deficits
Clinical manifestations of negative sx
anhedonia
Clinical manifestations of negative sx

inability to derive pleasure from ordinarily pleasurable activities
abstract thinking problems
Clinical manifestations of negative sx
apathy
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.
alogia or poverty of speech
Clinical manifestations of negative sx
Clinical manifestations of associated sx
~Inappropriate affect
~dysphoric mood
~depersonalization
~derealization
~high anxiety
affective flattening
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.
Associated sx
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
depersonalization
Clinical manifestation of associated sx

feeling self far away, disconnected
Derealization
Clinical manifestation of associated sx

Sense that one's environment has changed and is different from the way it had been before
High anxiety and dsyphoric mood
Clinical manifestation of associated sx
Inappropriate affect
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
affect
the external expression of emotion attached to ideas or mental representations of objects.
display of emotion that does not reflect a Pt's reality
Clinical manifestation of associated sx

Inappropriate affect
DSM-IV criteria for schizophrenia
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
Schizophrenia time frame
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
2+ auditory hallucinations conversing with each other
then only need ONE of the following during a one month period

Delusions
Hallucinations
Disorganized speech
Grossly disorganized behavior
Presence of negative sx
Bizarre delusions then
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
Bizarre and unorganized type delusions
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
Delusions are
false beliefs that cannot be dislodged by logic or contradictory evidence not congruent w/ normative culture or religious beliefs
Remember what Always trumps pathology
Religion & culture
Delusions (types)
Of reference
Persecution
Religious
Nihilistic
Grandiose
Persecution delusion
other people have malevolent intentions toward self or are conspiring against the person
Delusions of reference
other people's thoughts, words or actions refer to self
Religious delusions
Unrealistic special relationship w/ god

Remember religion & culture always trumps pathology
Nihilistic delusions
Destruction of self, world, or body part
Grandiose delusions
Special or gifted, powerful, or important w/o factual support
Echolalia is pt response to
external stimulus

repetition of other peoples' words or phrases
perseveration is repetition
of the same words or ideas regardless of internal stimulus
Bizarre & unorganized type hallucinations ex
hallucinations that are improbable or readily apparent as not likely to have occurred
Subtypes of schizphprenia
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
Subtype identification of schizophrenia is of limited clinical value because
illness course, response to tx and prognosis appear unrelated to subtype
Most severe type of schizophrenia
disorganized type
Least severe type of schizophrenia
paranoid type
complete remission of
schizophrenia
The course of schizophrenia illness is
variable and unrelated to subtype

Many pt have a fairly stable illness course
What type of sx tend to appear 1st in schizophrenia as the illness develops
Negative sx
____ sx appear to decrease over time, but _____sx persist
Positive symptoms to decrease over time, but negative sx persist
_____ sx persist
NEGATIVE
_____ sx appear to decrease over time
Positive
Factors predictive of good prognosis in Schizophrenia
~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
no family hx of schizophrenia
Factors predictive of good prognosis in Schizophrenia
family hx of mood d/o
Factors predictive of good prognosis in Schizophrenia
absence of structural brain abnormalities
Factors predictive of good prognosis in Schizophrenia
married pt &/or good support system
Factors predictive of good prognosis in Schizophrenia
acute onset at later age
Factors predictive of good prognosis in Schizophrenia
good premorbid fxning
Factors predictive of good prognosis in Schizophrenia
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
The longer the premorbid period is untx in schizophrenia
the worse the prognosis
positive sx indicates a ____ prognosis
good, positive sx appear to decrease over time
negative sx indicates a _____ prognosis
poor, negative sx persist
Paranoid subtype of schizophrenia
Least severe type

Prominent delusions or auditory hallucination

Lack of prominence of disorganized speech or behavior
Disorganized subtype of schizophrenia
Most severe type

Prominence of disorganized speech, disorganized behavior
and flat or inappropriate affect
Catatonic subtype of schizophrenia
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
echolalia
characteristic of catatonic type schizophrenia

Repetition of the last-heard words of other individuals

Echolalia- repeats words or phrases
echopraxia
characteristic of catatonic type schizophrenia

imitation of observed behavior or movements

EchoPRAxia-mimics behavior (PRActices behavior)
Undifferentiated subtype of schizophrenia
Presence of sx consistent w/ schizophrenia but not a prominence of sx consistent w/ any of the other subtypes
Presence of sx consistent w/ schizophrenia but not a prominence of sx consistent w/ any of the other subtypes
Undifferentiated type of schizophrenia
Residual subtype of schizophrenia
Absence of prominent delusions,

hallucinations,

disorganized speech

disorganized or catatonic behavior

and the continued presence of disturbance as indicated by presence of negative sx
Absence of prominent delusions, hallucinations, disorganized speech disorganized or catatonic behavior and the continued presence of disturbance as indicated by presence of negative s
Residual subtype of schizophrenia
Physical exam findings in schizophrenia
~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
Appearance of a schizophrenic
Odd
unusual
peculiar
Speech of a schizophrenic
bizarre content
disorganized
Tangential
loose association
Affect of a schizophrenic
blunted
flat
inappropriate
Mood of a schizophrenic
blandness
impoverished
Thought process of a schizophrenic
Psychotic
*hallucination
*delusion
*referential
*thought control, insertion, or withdrawal
Thought content of a schizophrenic
Thematically matched to psychotic content

may be impoverished
Cognition of a schizophrenic
Illogical

disorganized
memory of a schizophrenic
impaired short term
Concentration of a schizophrenic
Impaired during acute episodes
Abstraction of a schizophrenic
concrete on formal testing
Judgement of a schizophrenic
impaired for self-welfare
Neurological localizing Hard signs
weakness
Decreased reflexes
Neurological nonlocalizing soft signs in schizophrenia on physical exam
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
weakness
Decreased reflexes
Neurological localizing Hard signs
Astereognosis
inability to discriminate between objects based on touch alone:

result of a lesion in the parietal lobe
inability to discriminate between objects based on touch alone:

result of a lesion in the parietal lobe
Astereognosis
inability to discriminate between objects based on touch alone:

result of a lesion in the parietal lobe
Astereognosis
Astereognosis
loss of ability to judge the form of an object by touch
Graphesthesia
test the ability to identify figures, letters, or words by tracing the figure on the skin of the palm of the hand
test the ability to identify figures, letters, or words by tracing the figure on the skin of the palm of the hand
sensory fxn in the neurological exam

Graphesthesia
Stereognosis
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
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
Stereognosis
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
Astereognosis
inability to discriminate between objects based on touch alone:

result of a lesion in the parietal lobe

neurological soft sign
Graphesthesia
test the ability to identify figures, letters, or words by tracing the figure on the skin of the palm of the hand
Dysdiadochokinesia
Inability to perform rapid alternating movements;

result of a lesion to the posterior lobe of the cerebellum

neurological soft sign