32: Schizophrenia Spectrum - Sieleni Flashcards Preview

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schizophrenia spectrum

schizotypal (personality) disorders --> psychotic disorders --> schizophrenia

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definition schizophrenia

abnormalities in 1 or more of 5 domains
- delusions
- hallucinations
- disorganized thinking and/or speech
- grossly disorganized or abnormal motor behavior including catatonia
- negative symptoms

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fixed beliefs that are not amenable to change in light of conflicting evidence

delusions

can be persecutory, referential, grandiose, erotomanic, nihilistic, or somatic)

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perception-like experiences that occur without an external stimuli

hallucinations

includes auditory voices

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inferred from the individual's speech and it must impair communication

disorganized thinking

a less severe impairment occurs in prodromal and residual phase of schizophrenia

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define these domains:
- derailment or loose associations
- tangentiality
- incoherence or word salad

- switching from topic to topic

- answers to questions obliquely related or unrelated

- severely disorganized resembling receptive aphasia

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resistance to instructions =

negativism (catatonia)

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rigid, inappropriate or bizarre posture to a complete lack of verbal or motor responses =

mutism (catatonia)

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purposeless and excessive motor activity without obvious cause =

catatonic excitement (catatonia)

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diminished emotional expression: reductions in the expression of emotions in face ,eye contact, and intonation of speech

negative symptoms

account for morbidity of schizophrenia (less prominent in other psychotic disorders)

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decrease in motivated self initiated purposeful activities

avolution

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diminished speech output

alogia

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decrease ability to experience pleasure from positive stimuli or degradation in teh recollection of pleasure previously experienced

anhedonia

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lack of interest in social interactions

asociality

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a pervasive pattern of social and interpersonal deficits marked by discomfort or inability to have close relationships as well as cognitive and perceptual distortions and eccentricities of behaviors, beginning in early adulthood and present in a variety of contexts

schizotypal disorder

must have 5 of the below
- ideas of reference
- odd beliefs or magical thinking
- unusual perceptual experiences including body illusions
- odd thinking or speech
- suspicious or paranoid ideation
- inappropriate or constricted affect
- behavior or appearance that appears odd eccentric or peculiar
- lacks close friends or confidents other than first degree relatives
- extensive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgements about oneself

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schizotypal disorder is more prevalent in ...

males

only a small percentage of schizotypals go on to schizophrenia

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presence of one or more delusions with a duration of 1 mo or longer but no significant hallucinations and no markedly impaired or bizarre behavior

delusional disorders

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delusion disorders =
erotomanic
grandiose
jealous * more com. in men
persecutory * most freq
somatic
mixed
unspecified

another person is in love with individual

conviction of having some great talent or insight or having made some important unrecognized discovery

spouse or lover is unfaithful

belief that one is being conspired against, cheated, spied on, followed, poisoned, drugged, maligned, harassed, or long term goals are obstructed

involved bodily functions or sensations

no one theme is prominent

dominant delusional belief cannot be determined

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duration at least 1 day but not more than 1 mo with eventual return to premorbid functioning

presence of one or more of following: delusion, hallucination, disorganized speech, grossly disorganized or catatonic behavior

brief psychotic disorder

disturbance is brief but level of impairment is severe

those with time frames of 1-6 mo as opposed to 1 mo are found more in developing countries

more common in females

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2 or more of the following present for a significant time during a 1 MONTH period. at least one of these must be one of the first 3 choices
- delusions
- hallucinations
- disorganized speech
- disorganized/catatonic behavior
- negative symptoms

schizophreniform disorder

lasts at least 1 mo but less than 6 mo

1/3 recover in 6 mo and the other 2/3 go on to have schizophrenia or schizoaffective disorder

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2 or more of the following present for a significant time during a 1 MONTH period. at least one of these must be one of the first 3 choices
- delusions
- hallucinations
- disorganized speech
- disorganized/catatonic behavior
- negative symptoms

AND

for a significant protion of time since onset the level of function is decreased in one or more major areas

schizophrenia

continuous signs of disturbance persist for at least 6 months with 1 month of active symptoms

lifetime prevalence 0.3-0.7%

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anosognosia =

lack of insight into one's own clinical illness

hallmark of schizophrenia

symptom, not coping strategy

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with schizophrenia, _____ symptoms are more closely related to prognosis and are more persistent

negative

psychotic symptoms tend to diminish over life course

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risk factor for schizophrenia

late winter early spring or summer are increased risk

higher risk in urban areas

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males v. females with schizophrenia

male: early to mid 20s
poorer adjustment
lower education
more brain sturcture abnormalities
more negative s/s
more cognitive impairment
limited social contact

female: late 20s
lower incidicence
less brain structure abnormalities, less cognitive impairment
better outcomes with 35% develop before age 30
more psychotic symptoms

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schizophrenia rates of comorbidity with substance disorders is __________

high

over 50% use tobacco (dampens hallucinations)

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delusions or hallucination for 2 or more weeks in absence of major mood episode during the lifetime duration of the illness

schizoaffective disorders

1/3 as common as schizophrenia with lifetime prevalence of 0.3%

higher in female and depressed

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prevalence of substance/medication induced psychotic disorder

7-25%

of individual with first episode psychosis

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psychotic disorders can be due to another medical disorder. which have an increased suicide rate associated with illness greater than with psychosis?

Ms
epilepsy

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if psychotic and older than 80...

medical condition is major neurocognitive disorder (dementia) (comorbidity)


lifetime prevalence of psychotic disorder due to another medical disorder is 0.21 -0.54 when stratified by age. in those older than 65 it is as high as 0.74%

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describe catatonia

stupor
catalepsy
waxy flexibility
mutism
negativism
posturing
mannerism
stereotypy (repetitive, abnormal, frequent non-goal directed movement)
agitation
grimacing
echolalia (minic speech)
echopraxia (mimic movement)

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35% of inpatients with schizophrenia get this specifier

catatonia

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monozygotic twin rates

40-50%

16% chance if partents schizophrenic

risk correlates with age of father

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histopathological changes

- decreased volume of hippocampus, thalamus, temporal and prefrontal cortex
- decreased total gray matter volume
- cyto-architerctural abnormalities
- decreased synaptic connectivity


- caudate volume decreased in neuroleptic naive; increased with neuroleptic exposure
- evidence of abnormal cell migration in hippocampus and frontal cortex
- absence of gliosis suggests developmental abnormality

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neuroimaging changes

- lateral and third ventricle enlarged
- bilateral (L greater than R) approximately 10% volume reduction
- if present at time of diagnosis this may progress to poor outcome pt
- larger ventricles in affected discordant monozygotic twins

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functional brain imaging

- hypofrontality at rest in chronic pts may correlate with negative symptoms
- consistent failure to activate prefrontal cortex during performance of cognitive task (deficit syndrome)
- temporal lobe activity increased at baseline - impaired activation in response to memory task

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long term psychosocial tx

evidence based practices SMAHSA

1. assertive community tx
2. integrated treatment for co-occurring disorders
3. supported employment
4. illness management and recovery
5. family psycho-education
6. permanent supportive housing
7. Med TEAM
8. consumer-operated services
9. interventions for disruptive behavior disorders
10. tx of depression in older adults
11. supported education

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homicide rate may be ____________ but still ______ of the pop

increased by 10 fold

less than 1%

as a group they are more frequently victimized than other individuals

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suicide risk is _______ ( ____ with schizophrenia) with the highest risk in the _______ of illness

10-15%
20%
first 5 yrs

5-6% of those with schizophrenia/schizoaffective disorder die by suicide