Schizo spectrum disorders

Question 1

Schizophrenia spectrum and other psychotic disorders involve what three things?

Answer 1

1) . severely impaired cognitive processes
2) . personality disintegration/deterioration
3) . social withdrawal

Question 2

what are the two components of severely impaired cognitive process?

Answer 2

1) . unusual or distorted thought processes

2) perceptual disturbances

Question 3

schizo spectrum and other psychotic DOs: onset and which gender has higher risk?

Answer 3

onset- late adolescence, early adulthood

men have slightly higher risk

Question 4

what is catatonia?

Answer 4

Catatonia - extreme loss of motor ability or constant hyperactive motor activity

Question 5

what is avolition?

Answer 5

inability to take goal oriented action

Question 6

what is poverty of speech?

Answer 6

lack of meaningful speech/limited output of speech

Question 7

what are positive symptoms? examples

Answer 7

symptoms that are “added” to normal behavior

• hallucinations: sensory perception without physical stimuli
• delusions: firm, fixed beliefs despite evidence to the contrary
• disorganized speech
• behavioral disturbances

Question 8

what are negative symptoms? examples

Answer 8

symptoms that take away from normal behavior

• Affect flattening
• Alogia: poverty of speech
• avolition: lack of will
• Asociality: social withdrawal
• Absence of normal cognition
• anhedonia

Question 9

schizo spectrum and other psychotic disorders have abnormalities in the following five domains:

Answer 9

1) . delusions
2) . hallucinations
3) . disorganized thinking (speech)
4) . grossly disorganized or abnormal motor behavior
5) . negative symptoms

Question 10

what are the 5 disorders?

Answer 10

1. schizophrenia
2. schizophreniform disorder
3. schizoaffective disorder
4. brief psychotic disorder
5. delusional disorder

Question 11

4 criteria for schizophrenia

Answer 11

1) . 2 or more of the following symptoms: positive symptoms, negative symptoms, grossly disorganized or catatonic behavior FOR AT LEAST 6 MONTHS
- AT LEAST ONE must be a delusions, hallucination, or disorganized speech for ONE MONTH
2) . social/occupational dysfunction (below level prior to onset)
3) . schizoaffective and bipolar disorders with psychotic features have been ruled out
4) . not due to substance or medical condition

Question 12

what are the three phases of schizophrenia course?

Answer 12

1) . prodromal- onset and buildup of symptoms (negative symptoms present)
2) . Active/progressive phase: psychotic symptoms, positive symptoms predominate “psychotic break”
3) . residual phase: active symptoms decline; prodromal symptoms remain

Question 13

___ in 6 schizophrenics commits an act of serious violence during first psychotic break

Answer 13

1 in 6

Question 14

which type of meds reduce occurrence of violence in schizophrenics?

Answer 14

antipsychotics

Question 15

criteria of brief psychotic disorder (4)

Answer 15

1) . No longer than ONE MONTH
2) . returns to premorbid level of functioning (REMISSION)
3) . commonly encountered after catastrophic event
4) . one or more: delusions, hallucinations, disorganized speech, disorganized/catatonic behavior

Question 16

what is schizophreniform disorder?

Answer 16

same symptoms as schizophrenia (2 or more symptoms, not better explained by schizoaffective or bipolar with psychotic features, and not due to mental condition or substance) but is diagnosed if symptoms last between 1-6 months long (before 1 month = brief psychotic episode; after 6 months = schizophrenia)

Question 17

what is schizoaffective disorder?

Answer 17

person meets criterion A for schizophrenia (2 or more symptoms, including one positive symptom, for at least a month) AND MDE, manic episode, or mixed episode
**Schizophrenia + mood disorder

Question 18

criteria for delusional disorder (4)

Answer 18

1) . presence of 1 or more delusions
2) . LASTS ONE MONTH OR MORE
3) . Criterion A for schizophrenia has NEVER been met (NO PSYCHOTIC SYMPTOMS- no bizarre behavior)
4) . NO impairment in functioning

Question 19

what are two main differential diagnoses for schizophrenia? (bc similar but doesn’t meet criteria for schizophrenia)

Answer 19

1) . MDD with psychotic features

2) . bipolar disorder with delusions

Question 20

what is alogia?

Answer 20

Alogia is the inability to speak because of mental defect, mental confusion, or aphasia

Question 21

first degree relative of a person with schizophrenia has a ____x greater risk of getting it

Answer 21

10x

Question 22

the identical twin of a person with schizophrenia has a ___-___ % chance of developing it

Answer 22

40-65%

Question 23

what is the primary treatment for schizo spectrum DOs?

Answer 23

MEDS

2nd gen antipsychotic meds are first line (risperidone, clozapine, quetiapine- fewer ADRs, less risk of EPS)

Question 24

what are extra-pyramidal side effects (EPS)?

Answer 24

rigidity, bradykinesia, and tremor resembling Parkinson’s disease; severe restlessness known as akathisia; and abnormal involuntary movements known as tardive dyskinesia

Question 25

what types of therapy are for people with schizo spectrum DOs?

Answer 25

CBT- for coping methods, rational cognitive perspectives
Family psychoeducation
Personal therapy
Compliance therapy- during acute illness phase

Question 26

schizophrenia is a disorder encompassing what three things?

Answer 26

abnormal thinking, behavior, and emotion

Question 27

pathophys of schizophrenia in relation to positive vs negative symptoms

Answer 27

exact cause unknown
POSITIVE symptoms thought to be from excess dopamine in the mesolimbic pathway and NEGATIVE symptoms from dopamine decrease in the mesocortical pathway

Question 28

what is seen on a CT scan for a patient with schizophrenia

Answer 28

ventricular enlargement as well as decreased cortical volume

Question 29

meds for treating schizophrenia

Answer 29

FIRST LINE: 2nd gen antipsychotics (TX POSITIVE AND NEGATIVE SYMPTOMS)
-risperodone, olanzapine, quetiapine, ziprasidone, abilify, lurasidone
2nd line: 1st gen (BEST FOR POSITIVE SYMPTOMS)
-haldol, droperidol, fluphenazine, chlorpromazine (increased risk of EPS)

Question 30

Acute treatment of schizophrenia

Answer 30

if extremely agitated psychotic pt: IM zyprexa, geodon or abilify may be used. Haldol too but more ADRs

• hospitalize patient
• urine toxicology to rule out drug use

Question 31

how do you treat acute EPS symptoms from 1st gen antipsychotics?

Answer 31

add a antimuscarinic drug such as benztropine or diphenydramine to block the M1 receptor so less ACh is able to bind

Question 32

tx for delusional disorder

Answer 32

2nd gen antipsychotics first line

psychotherapy might be additive in some pts (not group)

Question 33

tx for brief psychotic disorder

Answer 33

2nd gen antipsychotics