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30 Cards in this Set

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Schizophrenia

*Range of cognitive, behavioral, and emotional dysfunctions.


*Recognition of a constellation of signs and symptoms associated with impaired occupational or social functioning


*Heterogeneous (several causes) clinical syndrome


*Positive symptoms (presence of): delusions, hallucinations, disorganized thinking/motorized behavior


*Negative symptoms (lack of): volition, decrease in attendance to ADLS (activity of daily living skills)

What are the marked disturbances found in thought disorders?

Affect (flat, inappropriate)
Behavior (unpredictable, bizarre)
Social interactions (isolation)

When is the onset of schizophrenia?

Late adolescents (20s) - first psychotic episode

What are the Diagnostic Criteria of Schizoprenia? 1 of 2

1. Two or more active-phase symptoms such as:
* bizarre delusions
* hallucinations- (auditory, commanding(
* disorganized speech
* grossly disorganized or catatonic behavior
* negative symptoms


2. Since onset, functioning in one or more areas are below level before onset (work, relationships, self-care)


3. Symptoms must last at least 6 months with at least 1 month of following symptoms, may include periods of residual symptoms

What are the Diagnostic Criteria of schizophrenia? 2 of 2

4. Schizoaffective, depressive/bipolar disorders with psychotic features are ruled out because - a) no major depressive or manic episodes occurred with active-phase, b) if mood episodes have occurred during active-phase, they have been present for a minority of total duration


5. Not due to physiological or substance effects, or another medical condition


6. If hx of autism or communication disorder of childhood onset, this diagnosis is given only if delusions or hallucinations, and other symptoms, are present for at least one month.

Delusional disorder

Pt has delusions that do not impair functioning

Brief psychotic disorder

*Pt returns to pre-morbidity level
ex: postpartum psychosis (loss of reality, delusions, hallucinations)


*Lasts more than one day, but remits by one month

Psychotic disorder not otherwise specified

Pt with psychosis (loss of reality, delusions, hallucinations, inability to assess internal/external environment accurately; a way to cope with intense confusion/anxiety) that does not meet criteria of other diagnoses.

What are the 3 dimensions of psychopathyology in schizophrenia?

Disorganized (speech, behavior, incongruent affect)
Psychotic (delusions and hallucinations)
Negative (alogia, affective blunting, avolition,
anhedonia and attentional impairment)

Nihilistic

Delusion involving death

What are the types of delusions seen in schizophrenia?

Persecutory
Guilt
Grandiose
Somatic
Ideas of reference
Thought broadcasting, insertion, and withdrawal
Nihilistic (major catastrophe)

What are the positive symptoms of schizophrenia?

Hallucinations
Delusions
Bizarre behavior
Illogical thinking
Clanging

Clanging (def.)

Speaking words that rhyme and don't make sense

Perserervation (def)

"Stuck in mud" continuous repetition of words or movements

Anhedonia (def)

no longer enjoys pleasure; often seen in depression

What are the 5 primary symptoms/domains of schizophrenia?

1. Delusions


2. Hallucinations
3. Disorganized Speech
4. Grossly disorganized or Catatonic behavior
5. Negative symptoms

5 Domains of SCHIZOPHRENIA

Delusions

*Fixed beliefs that are no likely to change, even w/ evidence.


* Content include themes of persecution, belief that things are directed at oneself, grandiose ideas, that another person is in love with them, nihilistic thoughts (catastrophe will occur), and somatic (health function)


*Bizarre in nature, not realistic


5 Domains OF SCHIZOPHRENIA

Hallucinations

*Vivid w/out external stimulus


*Occur in any sensory modality, but auditory are most common; voices, not own

5 Domains OF SCHIZOPHRENIA

Disorganized Thinking (Speech)

*May switch from one topic to another


*Unrelated responses, incomprehensible


*Must impair effective communication


5 Domains OF SCHIZOPHRENIA

Grossly Disorganized or Abnormal Motor Behavior (Catatonia)

*Childlike silliness or unpredictable agitation


*Catatonic is a decrease in reactivity to environment; purposeless motor activity (echoing of speech, staring)

5 Domains OF SCHIZOPHRENIA

Negative Symptoms

* Diminished emotional expression; face, eye contact, speech, movements


*Avolition-decrease in motivated self-initiated purposeful activities


*Alogia-less talking, anhedonia-less pleasure, asociality-less social

What are the goals of antipsychotic medications?

Manage acute positive psychiatric symptoms
Induce remission
Maintain stability
Prevent relapse

ANTIPSYCHOTIC DRUGS USED TO TX SCHIZOPHRENIA

Traditional drugs use and side effects?

"Old Meds"
Primary used to tx hallucinations and delusions
Side effects include extrpyramidal and tardive dyskinesia

ANTIPSYCHOTIC DRUGS USED TO TX SCHIZOPHRENIA

Atypical drugs use?

"New Meds"
Relieve both positive and negative symptoms of schizophrenia
Less likely to to cause distressing EPSs

What are the tips and overall goals of tx for schizophrenia?

-Don't argue with client's delusions; can challenge later after relationship is built.


-Try to understand emotion/event


-Empathize - they might not know what they are saying either.


-Focus on what would help now? No power struggles.


-Be careful in taking away delusions. They could serve a self-esteem function. Must build up support first.


-Safety in all settings
Stabilization on antipsychotic meds
Pt and family education about schizophrenia and its tx
Physical care of pt (they're prone to medical problems)
Psychosocial support of pt and family

Key features that define Psychotic Disorders:

1. Delusions


2. Hallucinations


3. Disorganized Thinking (speech)


4. Grossly Disorganized or Abnormal Motor Behavior (including Catatonia)


5. Negative Symptoms

Schizophrenia Spectrum and Other Psychotic Disorders Considerations:

1. Conditions that do not reach full criteria for a psychotic disorder or limited to one domain of psychopathology


2. Time-limited conditions


3. Requires the exclusion of another condition that may give rise to psychosis

Schizotypal Personality Disorder

*Full description is under personality disorders. *Captures a pervasive pattern of social and interpersonal deficits, including reduced capacity for close relationships; cognitive or perceptual distortions; and eccentricities of behavior, usually beginning by early adulthood, but some times in childhood and adolescence.

Delusional and Catatonia Disorders:

Limited to one domain of psychosis



Catatonia can occur in several disorders

Psychotic Disorders - introduction

*May be induced by another condition


*If substance/medication induced, symptoms will cease after the substances are gone