Alterations in Cognition

Question 1

Schizophrenia Overview

Answer 1

1 in 100 people, 1% in Canada
any race, culture or SE group

substance abuse disorder occurs in nearly 50% of persons diagnosed

gradually prodromal phase, often mistaken for difficult behaviour

phenomenological picture varies

Question 2

Epidemiology of Schizophrenia

Answer 2

age of onset
- late teens, early twenties (5-45yo)

gender difference
- men early 20s, women late 20s

comorbid conditions
- depression, substance abuse, anxiety, OCD

Question 3

Etiology of Schizophrenia

Answer 3

Biological/biochemical

• overactive neuronal activity r/t excessive dopamine transmission
• genetics

Psychosocial

• coping
• sensitivity and vulnerability to personal, family and environmental stress
• risk and protective factors
• social support

Question 4

Risk Factors for Schizophrenia

Answer 4

perinatal complications

• traumatic delivery
• maternal malnutrition
• exposure to toxins
• hypoxia
• in utero exposure to influenza viruses
• late winter or early spring births

Question 5

Prodromal phase of early psychosis

Answer 5

from onset of unusual behaviour to onset of psychotic symptoms

Question 6

Schizophrenia Diagnosis

Answer 6

a. impaired functioning
- social or occupational below previously achieved level

b. signs of illness persist at least 6 months, 1 month of active symptoms
c. Two out of five symptoms:

Positive - delusions, hallucinations, disorganized speech, abnormal behaviour (excessive dopamine, hyperstimulation of D2 receptors)

Negative - such as impairments, anhedonia, blunted affect

Question 7

Schizophrenia Subtypes

Answer 7

paranoid, disorganized, catatonic, undifferentiated, residual

subtypes are eliminated because they are not stable conditions, no significant clinical utility or scientific validity and reliability

Question 8

Delusions

Answer 8

false belief based on incorrect inference about external reality
firmly held despite objective and contradictory proof

Question 9

Overvalued idea

Answer 9

belief or idea sustained beyond the bounds of reason

held with less intensity or duration than delusions

Question 10

Preoccupation

Answer 10

thought content centred on a particular idea with strong affective tone
- suicidal, homicidal, paranoid trend

Question 11

Delusions of Reference

Answer 11

behaviour of others refers to self

Question 12

Delusions of Control

Answer 12

false belief that one’s will, thoughts or feelings are being controlled by external forces

• thought insertion
• thought withdrawal
• thought broadcasting

Question 13

Bizarre Delusion

Answer 13

false belief that is absurd or fantastic beyond the range of possibility

Question 14

Alogia

Answer 14

poverty of thinking and speech

Question 15

Affective flattening or blunting

Answer 15

lack of emotional expression

Question 16

Avolition

Answer 16

unable to start tasks, lack of motivation

Question 17

Anhedonia

Answer 17

unable to experience enjoyment

Question 18

Attentional Impairment

Answer 18

social inattentiveness

hypostimulation of D1 receptors

Question 19

Treatment for Schizophrenia

Answer 19

a. psychopharmacological
b. training in illness self-management
c. case management (ACT)
d. family psychoeducation
e. supported employment
f. integrated substance abuse treatment
g. ECT
h. brain exercise

Question 20

Interaction Strategies for those with altered realities or disordered thoughts

Answer 20

• accept and make effort to understand
• decrease stimuli, redirect to quieter areas
• use focused questions deliberately
• listen for themes, seek clarification
• • focus on how they feel and not the content
• avoid arguing or explain
• be aware of non-verbal communication
• reorient calmly

Question 21

Dos and Don’ts (with disordered thoughts)

Answer 21

Do

• open, empathic, describe their experience
• observe for triggers and help reduce
• ask about feelings
• focus on reality based thoughts

Don’t

• react
• negate their experience
• underestimate feelings
• don’t dwell

Question 22

Antipsychotic Medications

Answer 22

1. Conventional
   - typical, first generation
   - more side effects, i.e. EPS
   - dopamine antagonist
2. Novel
   - atypical, second generation
   - serotonin-dopamine antagonist

efficacy requires:

• assessment
• appropriate dosing and duration
• management of side effects

Question 23

First Generation or Typical Antipsychotics

Answer 23

*treats positive symptoms but can cause EPS

Loxapine (loxitane)
Haloperidol (Haldol)
Chlorpromazine (Thorazine)

Question 24

Extrapyramidal Side Effects (EPS)

Answer 24

• tardive dyskinesia
• pseudoparkinsonian symptoms
  ridigity, mask-like facial expression, stiff gait
• restlessness, akathisia
• weakness
• muscle fatigue
• slowed movements
• oculogyric crisis
  prolonged involuntary upward deviation of the eyes

Question 25

Ancillary Medications

Answer 25

a. antidepressants b. benzodiazepines (anxiety or sleep disturbance) c. antidyskinetics benztropine (Cogentin) d. anticonvulsant (mood stabilizer?) Carbamazapine (Tegratol) Divolproex (Epival)

Question 26

Second Generation or Atypical Antipsychotics

Answer 26

*Relieves both positive and negative symptoms with fewer EPS ``` Risperidone (Risperdal) Olanzapine (Zyprexa) Clozapine (Clozaril) Aripiprazole (Abilify) Quetiapine (Seroquel) ```

Question 27

Neuroleptic Malignant Syndrome (NMS)

Answer 27

an extremely serious reaction to neuroleptic drugs and dopamine blockage, at high doses of neuroleptic onset: - elevated temperature - labile blood pressured - elevated CPK - altered LOC - rigidity - diaphoresis - tachycardia treatment: - discontinue medication - keep cool - hydrate well

Question 28

Schizophreniform Disorder

Answer 28

identical to schizophrenia except symptoms lasts at least 1 month but no longer than 6 months, return to baseline functioning after exacerbation

Question 29

Schizoaffective Disorder

Answer 29

features of both schizophrenia and mood disorder - manic or depressive episode while exhibiting positive symptoms of schizophrenia - delusions or hallucination present for 2 weeks without prominent mood symptoms - symptoms of mood episode last for substantial portion of the total illness

Question 30

Delusional Disorder

Answer 30

delusions are non-bizarre for at least 1 month never had characteristic symptoms of schizophrenia disturbances does not markedly impair functioning - persecutory - grandiose - somatic (investigate medical condition) - religious (unusual religious experiences) - guilt - jealous - erotomanic - mixed

Question 31

Brief Psychotic Disorder

Answer 31

duration of 1 day but less than a month with full return to normal functioning

Question 32

Substance Induced Psychotic Disorder

Answer 32

Prominent hallucination or delusions

Question 33

Psychotic Disorder NOS (not otherwise specified)

Answer 33

when there is not enough information for more specific diagnosis