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34 Cards in this Set

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dx of schizophrenia requires at least ____ of the _____ types of positive and negative symptoms
2 of the 5 types
4 positive sx of schizophrenia
what are these sx considered?
4 negative sx of schizophrenia
what are these sx considered?
Positive:
1. delusions
2. hallucinations
3. disorganized speech
4. grossly disorganized or catatonic behavior
these sx are considered to be psychotic
Negative:
1. withdrawal
2. anhedonia (and loss of spontaneity)
3. anergia (and lack of initiative)
4. affective flattening
these are considered NOT psychotic
in which 3 other disorders are the positive and negative sx of schizophrenia found
1. bipolar disorder
2. drug-induced states
3. psychoses due to general medical conditions
what needs to be absent in order for schizophrenia to be diagnosed?
the criteria for major depression or mania must be absent during the same period that psychotic sx are present; it is a dx of exclusion
delusions in schizophrenia are usually of this nature
hallucinations in schizophrenia are usually of this nature
paranoid, suspicious, and bizarre
auditory
the 3 syndromes or types of pathophysiology in schizophrenia
which is most common?
positive sx
negative sx
disorganization (loose associations, poverty of thought content)
it is most common to manifest mixtures of all 3 forms at some time, but only 1 or 2 forms may be present at a given time
what sx is diagnostic of schizophrenia
there is no one sign or sx
what 3 things may be seen on brain CT/MRI in schizophrenics?
1. ventricular enlargement, associated w/ decreased cerebral brain tissue
2. smaller cerebral and cranial sizes
3. smaller hippocampus
________ correlate w/ increased flow in the left temporal lobe in schizophrenia
________ correlate w/ bilateral frontal hypoperfusion in schizophrenia
positive sx
negative sx
how should neuroleptics be started for schizophrenics?
what are 2 side effects of not dosing properly?
low dosages
if dosing is raised rapidly, increases the risk of extrapyramidal sx and secondary negative sx
how long does it usually take for schizophrenics to respond to typical antipsychotics?
2-6 weeks
optimal is 4-6 weeks
what can be added to a neuroleptic in the tx of a schizophrenic if anxiety and agitation aren't adequately controlled?
benzos
what 2 effects do both low-potency and high-potency antipsychotics have in schizophrenics?
decrease agitation
decrease combative behavior
this may be used as adjunctive therapy for antipsychotic drugs in schizophrenics , especially when very rapid control of agitated behavior is needed
short-course of ECT (6-12 weeks)
mainstay of tx of schizophrenia
antipsychotic drugs
major factor limiting the life of patients w/ schizophrenia
suicide
2 factors that predict outcome of schizophrenia
1. age at onset
2. nature of prodrome and 1st episode
what age of onset is worse outcome of schizophrenia?
what nature of prodrome and onset is worse outcome?
early onset (14-18 yo)
insidious onset or negative sx
(florid psychosis, abrupt onset, positive sx have good prognosis b/c antipsychotics are more effective)
most pts with this disorder will proceed on to meet diagnostic criteria for schizophrenia; however a small number show complete recovery
schizophreniform disorder
when do you dx a schizophreniform pt with schizophrenia?
once the sx have lasted more than 6 months
4 characteristics that are more common in schizophreniform pts who have resolution of sx than those who go on to have schizophrenia
1. acute onset (often after stressor)
2. good premorbid function
3. mood symptoms predominate
4. FH of mood disorders
is overt cognitive impairment common or uncommon in schizophreniform disorder?
uncommon
sx of schizophrenia w/ superimposed episodes of full depressive or manic sx
how long must sx of schizophrenia be present for the dx of this disorder
schizoaffective disorder
2 weeks
which type of schizoaffective disorder has consistent sx of schizophrenia w/ cycling mania and depression
bipolar type
the negative sx of schizophrenia (apathy, withdrawal, avolition, blunted affect) can be confused with...
sx of depression
how do you tx schizoaffective disorder?
antipsychotics for the schizophrenia sx
focus is on tx of the mania (mood stabilizers like lithium, carbamazepine, or valproate) or depression (antidepressants)
schizophrenia
schizoaffective
major depression w/ psychotic features
bipolar I disorder
in which are the affective components more pronounced? in which is insight improved?
going from top to bottom, the affective component is more prominent, but insight improves
social withdrawal
introverted, shy, and asocial w/ few or no friends
highly unusual hobbies (such as the occult)
bizarre thinking
disheveled appearance
poor self-care and grooming
schizophrenia
affect incongruent w/ state of mind (happy affect while talking about a sad event)
echolalia (repeating what others say)
thought blocking (stop talking in the middle of a sentence)
unable to understand abstract concepts
belief that thoughts are being broadcast or controlled
schizophrenia
cognitive dysfunction is a cardinal feature of...
how severe is this dysfunction?
schizophrenia
the dysfunction is usually not marked; a small % of pts have worsening cognition over the course of their illness
children w/ lower IQs and abnormalities in attention and concentration are at risk for...
schizophrenia
hallucinations, delusions, negative symptoms, disorganization of thought, speech, and behavior lasting 1-6 months
schizophreniform disorder
this disorder is characterized by prominent mood sx (mania or depression) occurring during the course of a chronic psychotic disorder
schizoaffective disorder
dx of delusional disorder depends on...
the presence of nonbizarre delusions in the ABSENCE of schizophrenic sx (no hallucinations, thought disorder, or prominent negative sx)