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32 Cards in this Set
- Front
- Back
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What is the life expectancy in schizophrenia relative to the general population? (What is the increased mortality attributed to? |
*
mortality
attributed
to
increased
rate
of
suicide
(18
–
55%),
accidents/poor
physical
health.
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What medical conditions are persons with schizophrenia at a higher risk for? |
higher risk of Obesity, diabetes, dyslipidemia, coronary artery and cerbrovascular disease. |
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What are the demographics for persons with schizophrenia in terms of: gender, age, social status, social support, ethnicity, and other factors? |
Gender - more common in males than females (Male : Female risk ratio is 1.4)
Age - The age of onset for men appears to be earlier (18-25 years) than for women (25-35 years) |
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What is the definition and common symptoms of the prodromal phase of schizophrenia? |
prodromal phase - time between early signs of the illness, and when diagnostic criteria is met negative symptoms or “near-psychotic” experiences. The prodrome can persist for several years. most frequently noted signs: impairment in role functioning, social withdrawal, mood changes, odd thinking and perceptual experiences, disrupted sleep, and poor appetite |
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What are the clinical features of schizophrenia? Social Status -
Social Support -
Ethnicity -
Other factors-
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The prevalence rate of schizophrenia is higher in densely populated urban areas, as well as in industrialized nations. Individuals with schizophrenia are more likely to be single, divorced or separated Schizophrenia affects individuals from all racial and ethnic groups. Schizophrenic patients have an increased likelihood of having being born in the late winter and spring months – February and March. The seasonal effect has been linked to epidemics of influenza or viral infections. |
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clinical features create a heterogeneous mixture known as psychosis. features include: |
* abnormal behavior
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What are the different levels of severity and how do they present clinically?
severity is rated by a quantitative assessment of the primary symptoms of psychosis, including___,______,______, abnormal psychomotor behavior and negative symptoms.
Each of these symptoms may be rated for its current severity (most severe in the last __ days) on a ___point scale ranging from 0 (not present) to 4 (present and severe) |
delusions, hallucinations, disorganized speech
7
5 |
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What are DSM-5 diagnostic criteria for schizophrenia?
Characteristic symptoms: two or more of the following: each present for a significant portion of time during a ___month period (or less if successfully treated). At least one of these should be 1, 2, or 3: o 1. Delusions o 2. o 3. Disorganized speech o 4. Grossly _____ or catatonic behavior o 5. Negative symptoms, ie diminished emotional expression or _____
Social/occupational dysfunction: significant portion of time in one or more major areas of function such as work, _________, or self care
· Duration: continuous signs of the disturbance persist for at least____months. This 6 month period must include at least 1 month of symptoms that meet the ____criteria · Schizoaffective and mood disorder exclusion · Substance/general medical condition exclusion · Relation to a pervasive developmental disorder
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-1 -Hallucinations -disorganized -avolition
-interpersonal relations - 6 -first
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What are the definitions and examples of the positive symptoms of schizophrenia?
o Hallucinations: Auditory hallucinations: sounds are heard in the ____of any real auditory stimulus · Patients may hear sounds of _____, whistles, whispers, rustling and other noises but most often, the sounds are ____. Most common are voices talking to each other in a _____ or disparaging way.
-Visual hallucinations: things are seen in the absence of any real _____ · Most often accompanied by ____ ideas, otherwise indicate delirium
*Auditory more _____ than visual *Also possible to have tactile, ____ and gustatory hallucinations
o Delusions: fixed ideas based on _____ perceptions of reality that do not stem from a shared system of _____ -Commonly _____ or persecutory and may also be bizarre, somatic, grandiose and referential -Schneider’s ____rank symptoms include thought _____, thought insertion, thought withdrawal
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-absence -bells -voices talking -critical
-visual stimulus -delusional
-common -olfactory
-incorrect -cultural beliefs -paranoid -first -broadcasting
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Negative symptoms include: o Affective flattening -Most common emotional change is general _____ or ______ of affective expression -Patients seem to be emotionally attached or distant, ______ are limited - Gradual loss of volition, accompanied by _______ and emotional blunting
o Asociality - Lack of _____ to engage in social events
o Attentional _____ o Anhedonia o Aloiga - Poverty of _____ o Poverty of _____of speech |
-“blunting” or “flattening” -facial expressions -apathy
-motivation
-disturbance
-speech
-content
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What are examples of psychotic, negative, and disorganized symptoms?
Psychotic symptoms o Hallucinations, delusions, abnormal _____, cognitive problems, abnormal _____
Disorganized symptoms o Most people with schizophrenia have significant cognitive and behavioral disorganization symptoms which are the __________ o Most characteristic type of formal thought disorder is “_________”, in which thoughts seem completely unrelated to other thoughts. o Other forms include clanging and ______ |
-emotions -behavior
-most disabling -loosening of associations -word salad
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What is the most common emotional change in schizophrenia?
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· Affective flattening (as listed above under negative symptoms) |
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What is apathy and how does it relate to functional outcome? · Apathy is defined as a “_____” that is clinically manifested by a diminished goal directed behavior and goal directed _____ and affective responsivity to events. · More strongly associated with ______ than every other symptom in both chronic schizophrenia and first episode _____ |
-lack of motivation
-cognition
-functional outcome
-psychosis |
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Schizophreniform Disorder o Signs and symptoms are essentially the same as those of _____ with two key differences: § The duration of the illness must be at least 1 month but ___ than 6 months § Impaired social and occupational functioning may be present but _______
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-schizophrenia - less -is not required for the diagnosis
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· Schizoaffective Disorder o Key features is a major _____, manic or mixed episode occurring ______ with the criterion A symptoms of schizophrenia o During the episode, _____ or _____ must be present without any prominent mood symptoms for at least ___weeks |
-depressive -simultaneously -delusions or hallucinations -2 |
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· Delusional Disorder o Essential feature is a _____delusion of at least _____ month duration, that is not accompanied by hallucinations, disorganized speech, ______ behavior, or negative _____, markedly impaired function or _____ behavior |
-nonbizarre -1 -catatonic -symptoms -bizarre |
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Brief Psychotic Disorder o The delusions, hallucinations, or disorganized speech or behavior are present for at least ____ day but ____ than 1 month § Patient returns to ____ premorbid functioning after this brief period o Brief psychotic disorder is often, but not always, seen in the context of ______ |
-1 -less -full -severe emotional stressor |
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Psychotic Disorder Due to a General Medical Condition o Diagnosis is made when hallucinations or delusions are caused by the ________ |
direct effect of a medical illness |
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· Substance-Induced Psychotic Disorder o Hallucinations and delusions are the result of substance _____ or _______ o Substances associated with psychotic symptoms include: alcohol, amphetamines, cannabis, cocaine, hallucinogens, inhalants, opioids, phencyclidine, sedatives |
-intoxication or withdrawal
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What structural abnormalities have been discovered in the brains of people with schizophrenia?
***No laboratory or neuroimaging findings are considered pathognomonic for schizophrenia. * Histologic studies have reported that the volumes of several ____regions are decreased in _____ temporal lobe.-At the cellular level of cortical organization, abnormalities of cell______, protein expression, and gene ______ have been reported. |
-third ventricles -cortical -medial -number -expression
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White Matter - abnormalities of _____ cells and myelinated ____pathways in schizophrenia. -The cellular abnormalities include a decreased number of oligodendroglia and a decreased expression of ______genes. |
-glial -fiber -myelin-related |
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cerebellum involved in motor coordination, control of muscle tone and ______ involved in cognitive functions such as attention, working ______, verbal _____ and sensory _______ -There is evidence from research that _______ signaling is decreased in the cerebellum of schizophrenia patients. |
-equilibrium -memory -learning -discrimination
-GABAergic |
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dopamine hypothesis (predominant biological hypothesis for schizophrenia) The human brain has four principal dopamine tracts: 1. The _____tract - regulation of extrapyramidal ______ 2.Mesolimbic tract 3.Mesocortical tract -disturbances in dopamine functioning of the mesolimbic and mesocortical tracts are hypothesized to play a central role in mediating the disorders of _____, affect and ______ processes in schizophrenia.4. Tuberoinfundibular tract - has its cell bodies in the _____, and exerts an inhibitory effect on _____secretion from the posterior _______ |
-Nigrostriatal -motor activity -thought -symbolic
-hypothalamus -prolactin -pituitary |
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Dopamine pathways -Hypodopaminergic cortical activity underlies the _____symptoms of schizophrenia.-Hyperdopaminergic mesolimbic activity accounts for positive symptoms, including ______ and _______ |
negative
hallucinations and delusions. |
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Viruses - prenatal exposure to the ___ or rubella is associated with an increased risk for schizophrenia |
flu |
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What pt. and treatment factors are associated with an increased risk of relapse in schizophrenia? * Age less than years * member and carers |
-substance -insight -symptoms -made -40
- medication regimen -planning - care -interaction |
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What guidelines are important to follow during interviews?
Listen attentively and respectfully to the patient in order to ______ Provide structure, keep interactions _____, and steer the interview towards _____ when interviewing a disorganized and severely delusional patient. Avoid _____ with a patient about delusional beliefs but, at the same time, do not _____ with or encourage them. Take an educational approach and label psychotic symptoms as reactions to _____ **Do not remain in a situation that feels dangerous
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-establish an alliance -brief -neutral subjects -arguing -agree -stress. |
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Psychosocial Treatment Types:
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* Vocational Support Programs
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* Schizophrenia is treated using multiple _____
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-Pharmacology - recovery-oriented -modalities |
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Settings
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Hospital treatment Community residences Day Programs Rehabilitative Programs Psychosocial Clubs – Fountain House Assertive Community Treatment (ACT) – provides comprehensive psychiatric treatment in the community. |
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What is the impact of schizophrenia on cognitive areas including: attention, memory, and executive functioning?
Poor occupational performance of people with schizophrenia due to _____ These include: attention, speed of _____, verbal______ , reasoning, problem _____, and social cognition. These deficits negatively impact: new learning, work tolerance, recall of work instructions, _____solving capacity, workplace ______ (with peers and superiors). |
cognitive deficits.
processing
memory
solving
problem
relationships
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What are the implications of cognitive problems as related to vocational rehab? * keeping a schedule, medication management, ______, education, increasing _______participation, community access (grocery store, library, bank, etc.), ______ management skills, engaging in productive activities to fill the day, coping skills, routine building, building ______ skills, and childcare |
-employment -medication -community -money -social |
