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31 Cards in this Set

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How long must symptoms be noted before a diagnosis of schizophrenia is made?
At least 6 months.
What is the age of onset for men? women?
Men: 15-25 years
Women: 25-35 years
T/F: Schizophrenia is more prevalent in men than women.
False: equal prevalence in both sexes
T/F: Schizophrenia occurs equally in all cultural and ethnic groups.
True
Positive symptoms of schizophrenia (4)
Delusions, hallucinations, agitation, and talkativeness
Negative symptoms (6)
Lack of motivation, social withdrawal, flat affect, cognitive disturbances, poor grooming, poor speech content
T/F: The traditional antipsychotics treat positive symptoms.
True: Negative symptoms respond better to atypical antipsychotics.
What are the three phases of schizophrenia?
Prodromal - avoid social activities, physical complain, interest in religion/the occult/philosophy

Psychotic phase - lose touch with reality, disorders of perception, thought content, though process, form of thought

Residual phase - in touch with reality, but abnormal behavior (social withdrawal, flat or inappropriate affect, peculiar thinking)
Illusions and hallucinations are disorders of _____________.
Perception
Disorders of though content include ___________ (2).
Delusion and idea of reference
Impaired abstraction ability and neologisms (inventing new words) are disorders of ________________.
Though processes
Disorders of form of thought include ____________ in which patients shift between subjects in unrelated ways and _______________ in which the patient moves further from the point during conversation.
1. Loose associations
2. Tangentiality
Prognosis:
Acute or chronic?
Chronic, downhill course over years that stabilizes in mid-life.
Suicide is a major risk of schizophrenia. What are some factors that are protective?
Older at onset of illness
Married
Social relationships
Female
Good employment history
Mood symptoms (schizoaffective)
Positive symptoms
Few relapses
Occurrence:
General population ____
Child with one schizophrenic parent/sibling ____
Child with two schizophrenic parents ____
Monozygotic twin ____
1%
12%
40%
50%

This shows evidence of genetic factors. Chromosome markers on 6, 8, and 13 have been implicated in some studies.
Season of birth with the greatest prevalence?
Cold weather months - possible association with viral infection of mother in second trimester of pregnancy.
What is the meaning of the "downward drift" hypothesis?
Social deficits cause patients to drift down social scale, so many are in lower socioeconomic status groups (e.g. homeless).
Evidence of neural pathology:
Frontal lobes?
Ventricles?
Decreased use of glucose in frontal lobes (using PET).

Lateral and third ventricles are enlarged; abnormal symmetry and changes in brain density may also be present. Ventricle enlargement is associated with negative symptoms (and therefore worse prognosis).
What neurotransmitter has been implicated? What is its metabolite?
Dopamine

Metabolite is elevated: homovanillic acid (HVA)
What disturbance is present in eye movements?
Poor smooth visual pursuit in 50-80% of patients and their relatives.
Differential:
Medical illnesses, medications, and other psychotic disorders.

List some other conditions that must be considered:
Manic phase of bipolar disorder
Cognitive disorders
Substance-related disorders
Brief psychotic disorder
Schizophreniform disorder
Schizoaffective disorder
Delusional disorder
Shared delusional disorder (folie a deux)
Name the subtype:
Poor grooming, disheveled appearance, inappropriate emotional responses, disinhibition, onset before 25 years of age.
Disorganized schizophrenia
Name the subtype:
Stupor or agitation, lack of coherent speech, bizarre posturing (waxy flexibility), currently rare form (treated with antipsychotic agents)
Catatonic schizophrenia
Name the subtype:
Delusions of persecution, better functioning and older age at onset than other subtypes.
Paranoid schizophrenia
Name the subtype:
Characteristics of more than one subtype.
Undifferentiated schizophrenia
Name the subtype:
One previous schizophrenic episode and subsequent continued symptoms but no psychotic symptoms.
Residual schizophrenia
Name the disorder and give its prognosis:
Psychotic symptoms >1day, but <1month; often precipitating psychosocial factors
Brief psychotic disorder; 50-80% recover completely
Name the disorder and give its prognosis:

Psychotic and residual symptoms lasting 1-6 months.
Schizophreniform disorder; 33% recover completely
Name the disorder and give its prognosis:

Symptoms of mood disorder and psychotic symptoms.
Schizoaffective disorder; lifelong social/occupational impairment, but more functioning than schizophrenics.
Name the disorder and give its prognosis:

Fixed, persistent, nonbizarre delusional system.
Delusional disorder; 50% complete recovery
Name the disorder and give its prognosis:

Development of delusions in person in close relationship with someone with delusional disorder.
Shared delusional disorder (folie a deux); 10-40% recover completely