Flashcards in 3 Deck (20)
What is included in the Criteria A signs and symptoms in schizophrenia
Hallucinations (auditory MC),
What are Negative Symptoms?
5A’s=Anhedonia, Affect (flat), Alogia (don’t speak), Avolition (apathy), Attention (poor)
how many negative symptoms do patients need to meet criteria?
2 out of the 5 for at least 1 month
how long do symptoms need to last for diagnosis for schizophrenia
Total duration of illness (including prodrome, residual sx) needs to be at least 6 months
<1 mo=brief psychotic reaction or psychosis NOS
What is Criteria “B” for schizophrenia?
-Work, interpersonal relationships, self-care
-downward drift hypothesis- gradually lose their resources due to dysfunction
what developmental disorders could present w/psychosis?
Asperger’s, Rett's disorder, Autism
what medications (rx) could cause psychosis?
Do more men or more women get schizophrenia?
Males=Females but males w/more severe illness
At what age is the onset of schizophrenia?
-males age 15, then 18-25years
-women age 25-35, up to 40 years (3/4 after age 30)
When is the most common time schizophrenics may attempt suicide?
During remission of illness just following a relapse
-note that younger males who are DOING WELL with good insight into illness are at highest risk for attempt and often complete suicide.
What are the cognitive deficits of schizophrenia?
S-Speed of thinking
T-Tact (Social cognition)
What is the general lifespan for someone with schizophrenia?
Shortened to about 50 (comparison: 78 general pop)
Why? -Substance abuse (smoking, EtOH)
-Higher completion rates of suicide (8-10% complete)
-Increased CV Risks (smoking, antipsychotics, obesity)
4 dopamine tracts
Nigrostriatal=EPS (dystonia, parkinsonism, akathisia, tardive dyskinesia)
Tuberoinfundibular=endocrine changes like prolactin, gynecomastia, menstrual changes
Mesocortical= May be responsible for negative signs/symptoms
algorithm for schizophrenia treatment
Stage 1: SGA
2: Different SGA or try FGA
Stage 3: Consider Clozapine (3rd line)
Stage 4: Clozapine +SGA or FGA
Stage 5: Modify SGA or FGA in Stage 4
Stage 6 (last line): Give 2 FGA’s, 2 SGA’s or one of each
How long is an adequate antipsychotic trial?
About 4 weeks of therapeutic dose
*patients should have SOME response in first 2 weeks.
What is the 1st and 2nd most common method of suicide for both sexes?
2nd: men- hanging, women-drug OD
What country has highest suicide rate?
Lithuania. Japan is #2.
What are risk factors for suicide?
Men, Age >65 or adolescents, Whites, Prior Attempt (repeat is usually within 2 years), Divorced, Family hx, History of Abuse in childhood, Mental illness (50% of suicides d/t MDD, aso think bipolar, then schizo), Substance Abuse, other Co-Morbid medical conditions.
Of the anxiety disorders, which one carries the highest risk of suicide?