Flashcards in 13 Schizophrenia Deck (48):
Psychosis refers to the loss of contact with reality characterised by what two factors?
1. Impaired perceptions
2. Impaired thought processes
What are 5 of the positive symptoms of schizophrenia?
3. Thought disorder
4. Behavioural disturbances
5. Lack of insight
What are 9 of the negative symptoms of schizophrenia?
1. Social withdrawal
3. Emotional blunting
8. Poverty of speech
9. Poverty of content
How does the DSM-5 define hallucinations?
Perception-like experiences that occur in clear sensorium in absence of any external stimulus.
What percentage of patients with schizophrenia report hallucinations?
Voices heard in schizophrenia can be _________ but are typically __________.
Voices heard in schizophrenia can be comforting but are typically hostile.
Are schizophrenics more aggressive than the general population?
No, it's a myth.
What are delusions according to DSM-5?
False firmly held beliefs despite what others believe and despite evidence to the contrary. These beliefs must NOT be culturally accepted.
What is the most common type of delusion in SZ?
Paranoid or persecutory delusions
What are delusions of reference in SZ?
Belief that TV is talking about you.
What kind of delusions in SZ and bipolar are deemed as grandiose delusions?
False beliefs one has special powers, abilities, influence, achievements or another identity that typically relates to power, wealth or fame.
What are nihilistic delusions in SZ?
Belief that a catastrophe will occur (says DSM)
Belief that you or part of you is dead (says everyone else)
What kind of somatic delusions are typical of SZ?
False belief that ones organs are diseased. Distinguished from hypochondriasis as the diseases are really odd - e.g. infected by insects, dismorphophobia – guy thought nose was two big, got surgery, it didn’t shift belief, confronted surgeon with rifle.
What are delusions of passivity in SZ?
Belief that under control by others.
What are misidentification delusions in SZ?
Belief that someone you know has been replaced by an imposter.
What is a knight's move in SZ speech?
An illogical segue from one subject to another. “I am going to the movies. So the bleach is placed on the hair.”
What are some negative manifestations of thought disorder in SZ?
Reduced stream of thoughts and poverty of speech.
What are some positive manifestations of thought disorder in SZ?
Derailment – comments slipping from one to next
E.g. ‘Went to the tennis court. Met the judge. Last day of judgement.’
Tangentiality – irrelevant responses
What are the main subtypes of psychotic disorders?
- Schizotypal disorder – a personality disorder characterised by psychotic symptoms
- Delusional – 1 month of delusions, no other symptoms
- Brief psychotic disorder – sudden, less than 1 month, return to functioning
- Schizophreniform – psychotic symptoms for between 1 and 6 months; lack of impaired functioning
- Schizoaffective – SZ plus mood disorder
What is the A criterion for schizophrenia?
Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
5. Negative symptoms (i.e., diminished emotional expression or avolition).
What are the B & C criteria for schizophrenia?
B. Clinically significant impact to functioning. (Functioning below that prior to onset of the disorder).
C. Continuous signs of disturbance are present for at least 6 months, with at least one month of psychotic symptoms.
What are the 5 subtypes of schizophrenia in DSM-IV (deleted in DSM-5)?
- Disorganised – disorganised speech and affect, no delusions
- Residual - history of SZ, unusual beliefs, negative symptoms
- Undifferentiated – diagnosis for SZ, but not of other subtypes
What's the lifetime prevalence of schizophrenia?
What's the female:male ratio for schizophrenia?
2:3 - more males get SZ
In which countries and settings is schizophrenia more common?
In developed nations and in urban settings.
What's the typical age of onset for schizophrenia?
Late teens to mid-30s. Early onset associated with poorer outcomes.
What are some outcome statistics for schizophrenia?
20% recover completely
50% classified as unable to work
66% difficulty with at least one daily living activity
What's the suicide risk for schizophrenics?
20% attempt, 5% succeed.
What are the four phases in the course of schizophrenia?
1. Prodromal phase: median length for symptoms to develop is two years (but highly variable)
2. Acute phase: time between onset of active symptoms and treatment is typically 1 year. (Better outcomes if treated early).
3. Early recovery phase
4. Late recovery phase: reintegration
What percentage of schizophrenics relapse within 2-5 years of treatment?
What are some positive prognostic factors for schizophrenia?
- good premorbid functioning
- acute onset
- later age of onset (for females)
- precipitating event (e.g. drug psychosis)
- low substance use
- brief duration of active phase
- absence of structural brain abnormalities
- no family history of schizophrenia
What are some negative prognostic factors for schizophrenia?
- Poor premorbid functioning
- Slow insidious onset
- Prominent negative symptoms
- Long duration of untreated psychosis
- Slower or less complete recovery
- Lower SES
- Migrant status
- No social support network
- Family history of SZ
How heritable is schizophrenia?
Highly. 46.3% risk for children with two affected parents. 44.3% concordance for MZ twins.
What is the dopamine hypothesis?
Schizophrenia caused by overproduction of dopamine or oversensitivity of dopamine receptors.
What evidence is there for the dopamine hypothesis?
1. Psychosis responds to anti-dopaminergic medication.
2. Amphetamine psychosis
3. Excess L-Dopa in Parkinson's precipitate psychotic episodes
What are some neurological differences in schizophrenics?
1. Enlarged ventricles
2. Brain tissue loss in prefrontal cortex
3. Smaller left hippocampal volume (also in those only with family history of SZ)
What environmental factors may contribute to SZ?
- Obstetric complications – increases risk fourfold, birth complications found in 40% of schizophrenics
- Urban birth
- High paternal age
Birth at what time of year is more associated with SZ?
Late winter, early spring.
What is the primary intervention for schizophrenia?
What is the response to medication for schizophrenics?
80-90% with positive symptoms respond. Less effective with negative symptoms.
What antipsychotics are successful for positive, but not negative, symptoms?
First-generation antipsychotics – e.g. Haloperidol
What antipsychotics are successful for reducing (but not eliminating) negative symptoms of SZ?
Second-generation antipsychotics (olanzapine, clozapine, risperidone)
What percentage of schizophrenics show no improvement in response to medication?
What are some of the common side effects of antipsychotic medication?
Extrapyramidal side effects:
- Parkinson's disease-type symptoms
- Tardive dyskinesia (involuntary movements of face and jaw)
- Finger tremors, shuffling gait, drooling, twisted posture
These side effects often treated with anti-Parkinson drugs
Also, weight gain, diabetes, heart disease
What family factors contribute to relapse?
Relapse rates are higher for patients from families high in expressed emotion (EE).
What psychotherapies have proven effective in reducing relapse?
CBT has proved useful in what regards in SZ patients?
- Reducing relapse and hospitalisation
- Reducing positive and negative symptoms
- Improving social functioning
Gains maintained at 2-year follow-up.