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Behavioral Medicine > Schizophrenia 1 > Flashcards

Schizophrenia 1 Flashcards

1
Q

Psychiatric conditions associated with psychosis include bipolar, MDD, Schcizophrenia/schizoaffective disorder as well as _____ (4).

A
  1. Schizophreniform Disorder
  2. Delusional Disorder
  3. Brief Psychotic Disorder
  4. Shared Psychotic Disorder
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2
Q

Differential diagnosis for psychosis include Panic Disorder, Depersonalization Disorder, Obsessive-compulsive Disorder as well as _____ (3).

A
  1. Personality Disorders (eccentric cluster)
  2. Autistic Disorder
  3. Substance abuse or withdrawal
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3
Q

Medical conditions associated with psychosis include brain trauma, CVA, tumor, epilepsy as well as _____(4).

A
  1. Metabolic disorder
  2. Vitamin deficiency
  3. Infection
  4. Toxic illness
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4
Q

Drugs that are associated with psychosis (3):

A
  1. Recreational drugs (stimulants, hallucinogen)
  2. Meds (anticholinergic, L-dopa/DA agonists, Ioniazid: anti-fungal)
  3. Withdrawal (EtOH, barbituates)
  4. Toxicity (Digitalis)
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5
Q

Prevalence of schizophrenia

A

0.5 - 1%

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6
Q

Schizophrenia age of onset

A
  • 18-25 years old in men
  • 21-30 years old in women
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7
Q

What are some risk factors for schizophrenia and development?

A
  1. Maternal age, stress, drug use, medical conditions
  2. High childhood insulin levels
  3. Low socioeconomic status

(schiz accounts for about 3% of all healthcare cost)

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8
Q

Schizophrenia genetics

A
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9
Q

Describe the course of schizophrenia

A

Psychotic break → accruing morbidity (first 10 years)

(Patients do not return to previous level of functioning after each additional break)

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10
Q

Schizophrenia: physical changes to the brain (2)

A
  1. cortical gray matter loss
  2. enlargement of the third and lateral ventricles
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11
Q

Schizophrenia monthly relapse rate

A
  • 3.5% per month on maintenance medication
  • 12% per month for patients who have discontinued antipsychotic therapy

(74% are non-compliant w/tx)

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12
Q

Schizophrenia risk factor for cardiovascular disease (5)

A
  1. Sedentary lifestyle: 72%
  2. Smoking: 70%
  3. Obesity: 50%
  4. Hypertension: 20%
  5. Elevated cholesterol: >18%
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13
Q

What are the five core symptoms of schizophrenia (must have at least two for at least one month)?

A
  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Grossly disorganized or catatonic behavior
  5. Negative symptoms (diminished affect & speech, avolition)
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14
Q

4 diagnostic criteria of social and occupational dysfunction in schizophrenia:

A
  1. Self-care
  2. Occupation functioning
  3. Interpersonal relations
  4. Academic achievement

(seen since the onset of disturbance)

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15
Q

Continuous signs of schizophrenia disturbance last for at least _______

A

6 months

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16
Q

Positive symptoms of schizophrenia (4)

A
  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Catatonia

(Likely related to mesolimbic dopamine tract in the brain (excessive stimulation))

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17
Q

Negative symptoms of schizophrenia

(hint: the 4 A’s of negative symptoms)

A
  1. Alogia
  2. Affect: Flat or blunted
  3. Avolition
  4. Anhedonia
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18
Q

Alogia:

A
  • Diminished amount of spontaneous speech

Or

  • Impoverished in content with adequate amount
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19
Q

Affective flattening or blunting:

A

reduced intensity of emotional expression and response

(unchanging facial expression, decreased spontaneous movements, poverty of expressive gestures, poor eye contact, lack of voice inflections, and slowed speech)

20
Q

Avolition:

A

unable to initiate goal-directed behavior and complete it

(loss of will or drive)

21
Q

Anhedonia:

A

inability to experience pleasure

22
Q

Cognitive symptoms of schizophrenia

A
  1. Attention
  2. Memory
  3. Executive function

(part of how delusions are formed)

23
Q

Schizophrenia: mood symptoms

A
  1. Dysphoria
  2. Suicidality (1/3 attemt, 1/10 complete)
  3. Hopelessness
24
Q

List the typical stages of schizophrenia

A
  1. Prodromal phase
  2. Active phase
  3. Residual phase
25
Q

Prodromal phase of schizophrenia: onset & symptoms

A
  • Onset: over months to years
  • Sx: Subtle behavior changes: social withdrawal, work impairment, blunting of emotions, avolition, odd ideas and behavior
26
Q

In the active phase of schizophrenia, the patient develops ______ symptoms.

A

psychotic symptoms

27
Q

During the residual phase of schizophrenia, the active symptoms may be abesnt or no longer as prominent, but they do have _______ (3) symptoms.

A
  1. Role impairment
  2. Negative symptoms
  3. Attenuated positive symptoms
28
Q

Schizophrenia: factors predicting good outcome include normal health otherwise, female gender, late onset (30’s), shorter prodrome and _______ (4).

A
  1. Mood symptoms (indicate possibly bipolar, which can be stabilized)
  2. No obsessions/compulsion
  3. Married
  4. High intelligence
29
Q

Guidelines for interviewing schizophrenic patients include being attentive and respectful, structuring the conversation, having brief interactions, and providing educational approach and context the delusions as a reaction to stress. It is best to avoid ________ (2).

A
  1. arguing about delusions (do not agree or encourage them)
  2. dangerous interactions (though rare, schizophrenics are more likely than other patients to be violent)
30
Q

First line treatment when initiating therapy for acute psychosis include _____. Second-line?

A
  • antipsychotics (first or second gen), +/- benzos
  • Clozapine (risk of agranulocytosis)

(Benzos offset the side effects of antipsychotics)

31
Q

Medications for schizophrenia usually take effect within _____

A

a few days of onset of treatment

(effects are cumulative, so an adequate trial is 4 -6 weeks)

32
Q

Delusions are disturbances in _____ rather than perception.

A

thought

33
Q

______ theme is the most common delusion.

A

Persecutory

(other themes include: somatic, grandiose, religious, nihilistic or sexual)

34
Q

Delusions are firmly held beliefs that are untrue as well as contrary to _______.

A

a person’s education and cultural background

35
Q

Examples of delusions are “being controlled”, “mind reading”, or “broadcasting” as well as ______ (4).

A
  1. “reference”
  2. “thought broadcasting”
  3. “thought insertion”
  4. “though withdraawal”
36
Q

Which mental status exam components are seen with dimensions of psychosis (3)?

A
  1. speech
  2. thought association
  3. abnormal motor behavior
    4.
37
Q

Abnormal motor behaviors seen with psychosis include catatonic stupor or excitement as well as _____ (5)?

A
  1. Automatic obedience
  2. Echopraxia
  3. Negativism (lack of response or opposition to instruction)
  4. Odd mannerisms
  5. Stereotypy (rythmic, repetitive movements)
38
Q

Which three abnormal thought processes are seen with psychosis?

A
  1. Derailment / loose associations
  2. Clanging (i.e. “Slagle”, “bagel”)
  3. Thought blocking
39
Q

Which four abnormal elements of speech are seen with psychosis?

A
  1. Poverty of speech
  2. Poverty of content of speech
  3. Neologisms (made up words)
  4. Echolalia
40
Q

In a catatonic stupor a patient is _______ (3), yet fully conscious

A
  1. immobile
  2. mute
  3. unresponsive
41
Q

What is the abnormal motor behavior exhibited when a patient has uncontrolled and aimless motor activity? Sometimes bizarre and comfortable postures are maintained for long periods.

A

Catatonic excitement

42
Q

Define automatic obedience (abnormal motor behavior seen in psychosis)

A

Carries out simple commands in a robot like fashion

43
Q

Define negativism (an abnormal motor behavior seen in psychosis)

A

Refuses to cooperate with simple requests for no reason

44
Q

Define echopraxia (an abnormal motor behavior of psychosis)

A

Initiates movements or gestures of another person

45
Q

_______ & _____ are the rating scales for schizophrenia.

A
  • PANSS
  • BPRS (18 of the 30 PANSS items)
46
Q

Negative symptoms of schizophrenia are likely related decreased stimulation of the _______ tract in the brain, while positive symptoms of schizophrenia are likely related to the excessive stimulation of the ______ tract in the brain.

A
  • mesocortical dopamine
  • mesolimbic dopamine

Behavioral Medicine (35 decks)

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