031315 schizophrenia

Question 1

onset of schizophrenia usually occurs

Answer 1

in late teens. usually INSIDIOUS

men get onset earlier than women

Question 2

Bleuler’s four As

Answer 2

associations-loose

affect (incongruence-pt will talk about sad subject and laugh)

autism- not “autism”. difficulty telling what’s on outside and what’s on inside (delusions, hallucinations)

ambivalence-hard time making decisions

Question 3

Schneider’s “first rank symptoms”

Answer 3

not specific to schizophrenia

broadcasting (what they are thinking can be heard by others), thought withdrawal, voices arguing or commenting, somatic passivity (catatonia-if you raise their hand they will leave it there)

Question 4

characteristic symptoms of schizophrenia (DSM V)

Answer 4

delusions (beliefs)

hallucinations

disorganizd speech (derailment, incoherence)

grossly disorgnized or catatonic behavior

negative symptoms (affect, alogia, avolition)

Question 5

other symptoms of schizophrenia

Answer 5

social or occupational dysfxn

duration (continuous signs of disturbance persist for at least 6 months)

schizoaffective and mood disorder exclusion

substance/general medical condition exclusion

Question 6

cognitive symptoms of schizophrenia

Answer 6

impaired abstract thinking
impaired problem solving
disturbed memory

Question 7

theories of schizophrenia’s etiology

Answer 7

genetic predisposition 
anatomic changes (enlarge lateral ventricles, increased width of third ventricle, sulcal enlargement)

physiologic changes (dorsolateral prefrontal cortex poorly activated, thalamus and cerebellum may be involved)

biochemical factors (dopamine D2 receptors blocked by all antipsychotics)

Question 8

negative symptoms of schizophrenia

Answer 8

social isolation
withdrawal
poor grooming
anaergy
loss of interest
blunted affect

Question 9

tx for schizophrenia

Answer 9

medication is primary tx
atypical antipsychotics preferred over old antipsychotics

psychosocial interventions (housing, case management w emphasis on med compliance and community involvement, supportive psychotherapy, job training)

Question 10

prognosis of schizophrenia

Answer 10

exacerbations and remissions common
residual impairment when not active phase
positive symptoms less severe over time
neg symptoms more severe over time

Question 11

long term prognosis for schizophrenics

Answer 11

20-30% lead somwhat normal lives
20-30% have moderate symptoms
40-60% significantly impaired