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106 Cards in this Set
- Front
- Back
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What are 4 general phases in schizophrenia?
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1. Acute Illness period
2. Stabilization period 3. Maintenance and recovery period 4. Relapse |
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Describe the scizophrenia during the acute illness phase. What is the patient at high risk for?
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episodes of staying up all night for several nights, incoherent conversations, aggressive acts against self/others.
patients are less able to eat, sleep, bathe. substance use common. high risk for suicide |
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Describe schizophrenia during the stabilization period.
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symptoms become less acute but may be present.
intense medication regimen established aim to stop substance use and to increase socialization |
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What does the patient focus on during the maintenance and recovery period?
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to regain the previous level of functioning and quality of life
no medication can cure schizophrenia |
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When can relapses occur?
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anytime during treatment and recovery, but they are not inevitable
with each relapse, there is a longer recovery period |
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What is a major reason for relapse?
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noncompliance with medication.
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What is the DSM-IV definition of schizophrenia?
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schizophrenia is a mixture of positive and negative symptoms that present for a significant portion of a 1-month period, but with continuous signs of disturbance for at least 6 months
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When are most people diagnosed with schizophrenia?
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late adolescence-early adulthood
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What are the sex differences in age of diagnosis?
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men: 18-25
women: 25-35 |
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Which gender tends to have a poorer prognosis for schizophrenia? Why?
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men;
Men are more likely to get negative symptoms, while women typically function better socially prior to onset. |
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Which age group does early onset schizophrenia occur in?
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childhood
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What age group does late onset schizophrenia occur in? What features predominate?
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late onset: over the age 45
more often occurs in women, in which paranoia symptoms predominate |
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What is the risk that first degree biologic relatives have?
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10x greater the risk for schizophrenia than the general population
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What are the 3 types of biologic theries of etiology for schizophrenia?
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1. genetic
2. brain anatomy changes 3. biochemical |
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What percentage of schophrenia cases are attributed to genetic etiology? Which aspect of genetic etiology?
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80% Inherent predisposition
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What is the most significant hypothesis for the biochemical theory of schizo etiology?
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the dopamine hypothesis: positive symptoms are caused by dopamine hyperactivity in the mesolimbic tract (why dopamine blocking meds relieve positive symptoms)
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Are psychological theories valid for schizo etiology?
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no
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Describe the Expressed Emotion Theory (a social theory of schizo etiology).
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correlates certain family communication patterns with an increase in symptoms and a relapse in patients with schizo; family emotional tone may increase the course of schizo over time
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What are the comorbidities associated with schizo?
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Increased:
1. risk of medical problems (CVD, obesity, diabetes) 2. depression/suicide 3. substance abuse 4. cig smoking |
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What feature of schizo contributes to suidical tendency?
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command auditory hallucinations
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During a one month period, at least 2 of 5 symptoms must be present. What are the 5 symptoms?
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1. delusions
2. hallucinations 3. disorganized speech 4. grossly disorganized or catatonic behavior 5. negative symptoms |
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What are the positive symptoms of schizo (4)
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1. delusions
2. hallucinations 3. disorganized speech 4. grossly disorganized or catatonic behavior |
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What is the most common/extreme positive symptom in schizo?
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hallucinations
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What is a hallucination?
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subjective, perceptual experiences that occur without actual external sensory stimuli
ex: patient hearing voices |
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Name the types of hallucinations. Which is most common**?
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1. auditory **
2. visual 3. tactile 4. olfactory 5. gustatory |
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What is a command auditory hallucination?
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the patient may feel compelled to listen to voices (noises, animal sounds). they may be friendly or violent
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What are delusions?
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erroneos fixed, false beliefs that cannot be changed by reasonable argument.
usually involve misinterpretation of an experience |
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What are 7 types of delusions?
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1. persecutory
2. reference 3. grandoise 4. nihilistic 5. somatic 6. religous 7. substitution |
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What is a persecutory delusion?
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the belief that one is being watched, ridiculed, harmed, or plotted against
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What is a reference delusion?
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the belief that events within the environment pertain to the individual
ex: news talking about pt |
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What is a grandoise delusion?
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the belief that one has exceptional powers, wealth, skill, influence, identity, destiny
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What is a nihilistic delusion?
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the belief that one is dead or a calamity is impending (ie, self, part of self, others or world is nonexistent)
ex: i have no head; i can't die |
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What are somatic delusions?
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beliefs about abnormalities in bodily structures or functions
ex: think they have cancer, food causes knee pain |
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What are religious delusions?
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excessive demonstration of or obsession with religious ideas/ behavior
(ie hear the voice of God) |
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What are substitution delusions?
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belief that an individual is someone else
(ie wife is the devil) |
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What are 2 features of thought disorder, a positive schizo symptom?
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1. disorganized speech
2. disorganized or catatonic behavior |
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Disorganized Speech:
Define loose associations. |
when ideas shift from one unrelated topic to another (patient is unaware that topics are not connected)
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Disorganized Speech:
Define word salad. |
A group of random, unconnected words without meaning to the listener
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Disorganized Speech:
Define clang associations |
choosing words based on sounds, rhyming
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Disorganized Speech:
Define echolalia |
repeating words or phrases said by another
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Disorganized Speech:
Define perseveration |
repetition of the same word or idea in response to different questions, regardless of topic being discussed
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Disorganized or catatonic behavior:
Define catatonic excitement |
extreme motor agitation
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Disorganized or catatonic behavior:
Define waxy flexibility |
maintains rigid position, but moveable when clinician moves the patient
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Disorganized or catatonic behavior:
Define catatonic posturing |
voluntary assumption of bizarre position
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Disorganized or catatonic behavior:
Define catatonic stupor |
seemingly unaware of surroundings
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Disorganized or catatonic behavior:
Define echopraxia |
involuntary imitation of another person's movements and gestures
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List 5 negative symptoms.
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1. affective blunting
2. anhedonia 3. avolition 4. alogia 5. apathy |
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Negative symptoms:
Define affective blunting |
reduced range of emotional expression
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Negative symptoms:
Define anhedonia |
inability to experience pleasure (physiological reason)
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Negative symptoms:
Define avolition |
inability to pursue and persist in goal-directed behavior or activities
(seen as lazziness, stubbornnesss) |
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Negative symptoms:
Define alogia |
reduces fluency and production of language and thought
(usually give 1 word response: poverty of speech) |
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Negative symptoms:
Define apathy |
feelings of indifference
(toward people, activities, learning) |
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What is neurocognition?
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memory, vigilance or sustained attention, verbal fluency or the ability to generate new words, and executive functioning
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In addition to positive and negative symptoms, which type of impairment exists for schizos?
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neurocognitave impairment
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Name 3 main types of neurological impairments.
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1. memory
2. vigilance 3. executie functioning |
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What is working memory?
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includes short-term memory and the ability to store and process information
*impaired in schizophrenia |
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What is the main outcome difference between relapse prevention and medication side effects?
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1. relapse prevention: relapses may be irreversible (ie suicide, homicide)
2. med side effects (outcome reversible) |
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In recurrent acute exacerbations of psychosis, what is the effect of RESIDUAL DYSFUNCTION?
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with each relapse, the patient fails to return back to baseline
**a key difference between schizophrenia and mood disorders |
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In recurrent acute exacerbations of psychosis, what do early patterns of the illness indicate?
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indicates the course of the disease throughout the person's life
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In recurrent acute exacerbations of psychosis, describe the patient's vulnerability to stress.
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life-long
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List 5 types of schizophrenia?
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1. paranoid
2. disorganized 3. catatonic 4. undifferentiated 5. residual |
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What are the key features of paranoid schizophrenia?
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1. prominent delusions and/or hallucinations (may/may not be paranoid in content)
2. not prominent: thought disorder, flat affect |
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What are the key features of disorganized schizophrenia?
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1. disorganized speech
2. disorganized behavior 3. flat or inappropriate affect *have more fragmented delusions and hallucinations than paranoid schizo |
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What is the most severe form of schizophrenia?
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disorganized schizophrenia
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What are the key features of catatonic schizophrenia?
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extreme motor dysfunction
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What are the key features of undifferentiated schizophrenia?
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Criterion A symptoms are present without meeting the criteria for another type
*dx can change over time |
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What are the key features of residual schizophrenia?
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one documented episode, but no prominent positive symptoms (mainly see negative symptoms, withdrawal, illogical thinking)
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What criteria do schizophreniform disorder need to meet in order for it to be diagnosed?
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Criteria A,D,E for schizophrenia
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What is the duration of schizophreniform disorder?
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episode lasts at least 1 mo, but less than 6 mo
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When is schizophreniform disorder used as a provisional dx?
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if symptoms have lasted more than 1 month, but it is uncertain whether the person will recover before the end of the 6 mo period
(may be an early manifestation of schizophrenia) |
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how does schizophreniform disorder affect social or occupational functioning?
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may effect these areas, but it's not necessary
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What is the schizophreniform disorder recovery rate?
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1/3
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Describe schizoaffective disorder (SCA).
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uninterrupted period of illness during which there is a major depressive, manic, or mixed episode concurrent with 2 criterion A symptoms for schizophrenia
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What is a major difference between SCA and schizophrenia?
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In SCA, there are many more "mood" responses and they are VERY SUSCEPTIBLE to suicide (23-42% attempt)
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Describe the commonality of SCA in comparison to schizophrenia and a mood disorder (ie depression)
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SCA has a slightly better prognosis than schizophrenia, but a worse prognosis than a mood disorder
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Describe the gender differences in SCA
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more common in women, but developed later
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In SCA, how long must the positive symptoms be present without the mood symptoms?
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at least 2 weeks, even though most of the illness is characterized by mood
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Describe delusional disorder.
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a stable, well systemized and logical, nonbizarre delusional disorder that occurs in the absence of other psychiatric disorders
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How long must delusional disorder last in order to be diagnosed?
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at least 1 mo
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What are delusions?
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false, fixed beliefs unchanged by reasonable arguments
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What is a nonbizarre delusion?
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adherence to possible situations that could occur in real life and are plausible in the context of the person's ethnic and cultural background
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Do patients with delusional disorder have schizophrenic symptoms?
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no--there are no characteristic symptoms of schizophrenia in delusional disorder
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What is the age of onset for delusional disorder?
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middle and late adulthood
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Describe 2 courses of delusional disorder
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1. fast onset- acute
2. gradual onset- can become chronic |
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How do people with delusional disorder function?
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normally, unless when the patient focuses on the delusion
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What are 6 subtypes of delusional disorders
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1. erotomanic
2. jealous 3. unspecified 4. grandiose 5. somatic 6. persecutory (mixed=multiple types at once) |
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What is erotomanic delusional disorder?
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delusions that another person of usually higher status is in love with the person
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What are grandoise type delusions?
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delusions of inflated worth, power, knowledge, identity; or a special relationship to a deity or famous person
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What are jealous type delusions?
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delusions that the individual's sexual partner is unfaithful
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What are persecutory type delusions?
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delusions that person or someone close to person is being malevolently treated in some way
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What are somatic type delusions
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delusion that person has some physical defect or general medical condition
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What are unspecified type delusions
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delusion cannot be clearly identified or described
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Define brief psychotic disorder.
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one or more criterion A symptom for schizophrenia present for at least 1 day but less than 1 month
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Describe 3 features of brief psychotic disorder.
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1. return to prior level of functioning
2. may be due to stressful event 3. rare |
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Name 4 additional psychotic disorders
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1. Shared psychotic disorder (Folie a Deux)
2. Psychotic Disorder Due to a General Medical Condition 3. Substance-induced Psychotic Disorder 4. Psychotic Disorder NOS |
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What is Shared Psychotic Disorder (Folie a Deux)?
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when a person, who is in close relationship with an individual who has a psychotic disorder with prominent delusions, believes and shares part or all of the inducer's delusional beliefs
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What is Psychotic Disorder NOS?
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occurs when diagnostic criteria doesn't meet other disorders
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Name 4 potential pharmacological interventions for psychotic disorders
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1. Serotonin-Dopamine Antagonists
2. Dopamine Receptor Antagonists 3. Anticonvulsants 4. Benzodiazepines |
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How do S-D antagonists work?
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they block D and S receptors
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What are 2 benefits from using S-D antagonists?
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they are newer antipsychotics that are:
1. more efficacious -against negative symptoms 2. safer: - Less extrapyramidal side effects |
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What are 2 other pharmacological interventions that arent simply drug therapy?
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1. ECT
2. Psychosurgery |
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How long might it take for an antipsychotic drug to work?
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1. immediately (some)
2. 1-2 weeks |
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How long is an adequate trial for antipsychotic drugs?
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6-12 weeks
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What are the various forms of antipsychotic drugs that are available?
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1. injectable
-immediate -long-lasting 2. oral -tablet, capsules -liquid -rapidly dissolving tablet |
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List 4 extrapyramidal side effects (EPS) of antipsychotic drugs:
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1. parkinsonism
2. dystonia 3. akathisia 4. tardive dyskinesia |
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Name 9 additional side effect of antipsychotic drugs:
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1. anticholinergic
2. orthostatic hypotension 3. elevated prolactin 4. weight gain 5. sedation 6. photosensitivity 7. new-onset diabetes 8. cardiac arrhythmias 9. agranulocytosis |
