Schizophrenia

Question 1

Diagnostic Criteria for Schizophrenia

Answer 1

2 or more of the following symptoms, each present for a significant portion of time during a 1 month period. At least one of 1, 2, or 3 must be present:

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behaviour
5. Negative symptoms

Question 2

4 Types of Symptoms of Schizophrenia

Answer 2

1. Positive
2. Negative
3. Neurocogntive
4. Disorganized

Question 3

Positive Symptoms of Schizophrenia

Answer 3

Excess or distortion of normal functions

Delusions
- Grandiose: the belief that one has exceptional powers, wealth, skill, influence or destiny
- Nihilistic: the belief that one is dead or a calamity is impending
- Persecutory: the belief that one is being watch, ridiculed, harmed, or plotted against
- Somatic: beliefs about abnormalities in bodily functions or structures

hallucinations

thought disturbances

Question 4

Negative Symptoms of Schizophrenia

Answer 4

Flat Affect

Alogia: reduced fluency and productivity of thought and speech

Avolition: withdrawal and inability to initiate and persist in goal-directed activity

Anhedonia: inability to experience pleasure

Question 5

Alogia

Answer 5

reduced fluency and productivity of thought and speech

Question 6

Avolition

Answer 6

withdrawal and inability to initiate and persist in goal-directed activity

Question 7

Anhedonia

Answer 7

inability to experience pleasure

Question 8

Epidemiology of Schizophrenia

Answer 8

Early adulthood

Male (estrogen protectice)

First degree relative 10x higher

Depression, diabetes, Cannabis

Question 9

Biologic Etiology of Schizophrenia

Answer 9

Neuroanatomic:
- decreased/abnormal blood flow to areas of brain
- decrease in grey matter
- thinner cortex

Neurotransmitters
- dopamine hypothesis

Also familial and neurodevelopmental theories

Question 10

Biologic Theory or + and - symptoms

Answer 10

+ = hyperactivity of mesolimbic tract

• = hypoactivity of meso-cortical tract

Question 11

Antipsychotic medications have the general effect of:

Answer 11

blocking dopamine transmission in the brain by blocking receptors

Decrease in dopamine leads to unpleasant symptoms

Atypical/newer have less effects and affect other neurotransmitter systems (serotonin)

Question 12

How long until you see changes in psychotic symptoms with medication

Answer 12

1-2 weeks

Question 13

When is clozapine initiated?

Answer 13

Clozapine may be initiated when no other antipsychotic is effective; only used when others are not effective because it requires WBC monitoring

Question 14

What are EPS symptoms caused by and how is that corrected?

Answer 14

blockage of dopamine receptors which throws off acetylcholine and dopamine in the brain, increasing acetylcholine. Symptoms are managed by re-establishing the balance between acetylcholine and dopamine by reducing the dosage of antipsychotic (increasing dopamine) or adding an anticholinergic drug (decreasing acetylcholine activity)

Question 15

Akathisia

Answer 15

physical restlessness

Question 16

Dystonic Reactions

Answer 16

intermittent/fixed abnormal postures of the eyes, face, tongue, neck, trunk, extremities

Question 17

Tardive dyskinesia

Answer 17

Later onset EPS

abnormal dyskinetic movements of the face, mouth, jaw, choreoathetoid movements of the legs, arms, and trunk

Dyskinesia: involuntary movement
Dystonia: involuntary contraction/stiffening

Question 18

Tardive dystonia

Answer 18

Later onset EPS

persistent sustained abnormal postures in the face, eyes, tongue, neck, trunk, and limbs

Question 19

Tardive akathisia

Answer 19

Later onset EPS

persisting unabating sense of subjective and objective restlessness

Question 20

Neuroleptic Malignant Syndrome

Answer 20

Severe muscle rigidity develops with elevated temperature and a rapidly accelerating cascade of symptoms (occurring during the next 48-72 hours) which can include 2 or more of the following: hypertension, tachycardia, tachypnea, prominent diaphoresis, incontinence, mutism, leukocytosis, changes in LOC, and lab evidence of muscle injury (elevated CK/myoglobin).

Question 21

Anticholinergic Crisis

Answer 21

1. neuropsychiatric signs
   confusion, recent memory loss, agitation, dysarthria, incoherent speech, pressure speech, delusions, ataxia, and periods of hyperactivity alternating with somnolence, paranoia, anxiety, or coma
2. hallucinations
   accompanied by picking, plucking, or grasping motions, delusions or disorientation
3. physical signs
   unreactive dilated pupils, blurred vision, hot m dry, flushed skin, facial flushing, dry mucous membranes, difficulty swallowing, fever, tachycardia, hypertension, decreased bowel sounds, urinary retention, nausea, vomiting, seizures, or coma

Question 22

Anosognosia

Answer 22

denial of mental illness, lack of insight

Question 23

Mood and Affect of Schizophrenic

Answer 23

Affective lability: abrupt, dramatic, unprovoked changes in the type of emotions expressed

Ambivalence: the presence and expression of 2 opposing feelings, leading to inaction

Apathy: reactions to stimuli are decreased; diminished interest and desire

Question 24

Speech of Schizophrenic

Answer 24

Dysarthria: difficulty articulating words

Dysphagia: difficulty swallowing

Question 25

Thought processes of schizophrenic

Answer 25

Bizarre delusions: sufficient enough to diagnose schizophrenia Hallucinations: most common example of disturbed sensory perception observed in patients with schizophrenia

Question 26

Communication of Schizophrenic

Answer 26

Word salad Flight of ideas Loose associations Tangentiality Echolalia

Question 27

Behavioural Issues of Schizophrenic

Answer 27

stereotypy: idiosyncratic repetitive, purposeless movements echopraxia: involuntary imitation of others movements waxy flexibility: posture held in odd or unusual fixed position for extended periods

Question 28

stereotypy

Answer 28

idiosyncratic repetitive, purposeless movements

Question 29

Echopraxia

Answer 29

involuntary imitation of others movements

Question 30

Waxy flexibility

Answer 30

posture held in odd or unusual fixed position for extended periods

Question 31

Schizoaffective Disorder

Answer 31

Varying degrees of symptoms of both schizophrenia and mood disorders beginning in youth Characterized by intervals of intense symptoms alternating with quiescent periods Episodic nature is characteristic, chronic roller coaster ride To receive diagnosis, a patient must have an uninterrupted period of illness when there is a major depressive, manic, or mixed episode along with some schizophrenic symptoms

Question 32

Delusional Disorder

Answer 32

psychotic disorder characterized by nonbizarre, logical, stable, and well-systemized delusions that occur in the absence of other psychiatric symptoms § Erotomanic § Grandiose § Jealous § Persecutory § Unspecified type § Shared delusional