schizophrenia Flashcards
(38 cards)
what is schizophrenia
-chronic, debilitating illness involving disturbances of thought, perception, speech, emotions, and behavior
-“Split Mind” – A split between intellect and affect.
-profound distortion in one’s sense of external and internal reality.
why do we need to know it
-Prevalence of 1%. 3 million Americans will develop schizophrenia during their lifetime. 100,000 patients take up 20% of psychiatric beds in the US.
-Onset typically in adolescence or young adulthood (Males: Age 18-25 years; Females: 22-32 years)
-Results in increased prevalence of substance abuse
-Results in decreased overall health
-Results in decreased lifespan:15 years
-Results in increased rate of suicide (10%)
-Accounts for approximately $85 Billion in healthcare costs each year
schizophrenia facts
-More impact/diagnosis in urban vs rural
-Winter effect (5-8%)-more schizophrenics born during winter and spring than any other time during the year-strong evidence that mothers exposure to viral infections during the second trimester increased risk of schizophrenia. Fall/early winter high incidence of infectious diseases
-Affects both sexes equally
schizophrenia is not caused by
-Poor parenting
-Poor familial relations
-Not SPLIT PERSONALITY (Dissociative ID)
-Schizophrenia is a familial disorder-heritability estimated between .60 and .90
history of schizophrenia
-Emil Kraepelin(Austrian psychiatrist): Illness develops early in life with chronic deteriorating course- looked like dementia. named it dementia praecox
-Eugene Bleuler(Swiss psychiatrist): renamed Kraepelin’s dementia praecox (paranoia, grandiose delusions, auditory hallucinations, abnormal emotional response, bizarre thoughts) as schizophrenia-1911. Combination of two greek words meaning “split mind”
-Kurt Schneider(German psychiatrist): emphasized role of psychotic symptoms: delusions, hallucinations. Called them”first rank symptoms”.
genetics
schizophrenia criteria
-1. 2 or more of the following for at least 1 month (or longer period of time), and at least one of them must be a 1, 2, or 3:
-delusions
-hallucinations
-disorganized speech
-grossly disorganized or catatonic behavior
-negative symptoms, such asdiminished emotional expression
- Impairment in 1 of major areas of functioning for a significant period of time since the onset of the disturbance: Work, interpersonal relations, or self-care.
-2. sx must last for a continuous period of at least 6 months. This six-month period must include at least one month of symptoms (or less if treated) that meet criterion A (active phase symptoms) and may include periods of residual symptoms. During residual periods, only negative symptoms may be present.
-3. Schizoaffective disorder and bipolar or depressive disorder with psychotic features have been ruled out:
twin studies
-Traits of Schizophrenic Twin versus -Unaffected Twin:
-Lower birth weight
-More physiological distress
-More submissive, tearful, sensitive child
-Impaired motor coordination noted
-only one twin affected
positive and negative symptoms
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-negative symptoms are not well treated
symptom clusters
-Positive: Excesses or distortions of normal behavior
-Negative: Deficits in normal behavior
-Cognitive: Deficits in intellectual processes
-Mood: Lability in emotional state
-Positive: Delusions, Hallucinations, Disorganized speech/thought and Behavior
-Negative: Anhedonia, Asociality, Affect, Avolition, Alogia
-Cognitive: Attention, Memory, Executive Functions, Loss of abstract thought process
-Mood: Depression, Hopelessness, Agitation, Hostility, Suicidality
delusions
-Delusions: False beliefs that are not susceptible to argument and are inconsistent with the subject’s sociocultural background. Pt will hold firmly to belief regardless of evidence to the contrary
-Bizarre: strange and completely implausible
-Non bizarre: Possible but very unlikely
-Common Types:
-Grandiose: Belief that one possesses special powers, wealth, skill, influence, or destiny.
-Paranoid/Persecutory: Belief that one is being harmed, watched, ridiculed, manipulated, discriminated against, plotted against.
-Somatic: Belief in some imaginary bodily abnormality, illness, or special attribute.
delusions examples
-Pt reports that he invented mathematics and that he is the “Chairman of Math and Science” at numerous universities. Patient presents clinician with what appears to be complex mathematical equation scribbled on napkin, but it is unclear whether this is an actual equation. He demands clinician solve it before he will answer his questions.”
-“Pt reports having nanotechnology placed in his ears by NASA so he can do ‘secret errands’ for them.”
-“Pt claims clinician is one of patient’s cousins. Clinician borrowed $227.00 at last family picnic and neglected to repay loan. Because of this offense, clinician (whom patient believes is cousin) is ‘due for a righteous beat down.’”
hallucinations
-A perceptual disturbance that occurs in the absence of external stimuli. Auditory are the most common, followed by visual.
-Common Types:
-Command: A voice is heard instructing one’s behavior. The patient may act on them in order to relieve the stress.
-Derogatory: A voice is heard making insulting, criticizing, or threatening comments.
-olfactory, visual, auditory (MC), tactile
hallucination examples
Pt complains of male voice telling him to ‘kill that bitch’ and ‘mess them up.’ He doesn’t know who the voices are referring to. Attempts to block out voices by listening to radio or watching TV, as he does not wish to follow these instructions.
Pt reports increasingly frequent dialogue between numerous voices unfamiliar to him. They call him ‘as**’ and say ‘You’re gonna get it!’”
Pt hit head against wall repeatedly while in solitary. Told to do so by ‘Max,’ a childhood friend who died when they were around 10 years old, but still ‘hangs out a lot.’ Max is the same age as patient (43 years) but is small in stature, ‘can’t grow a beard,’, and always wears jeans and a blue and red sweatshirt.”
Disorganized speech/thought
-Disorganized Speech/Thought: Disturbance in organizing ideas and speaking in a comprehensible fashion.
-Clanging: Rhyming of words; thoughts are connected only due to the sound of the words expressed. “He went in entry in trying tieing sighing dying ding-dong dangles dashing dancing ding-a-ling!” “I heard the bell. Well, hell, then I fell.“
-Flight of Ideas: Sequence of loose associations when speaker jumps to unrelated topics “I own five cigars. I’ve been to Havana. She rose out of the water, in a bikini.”
-Neologisms: Made up words that have meaning only to the patient. “I got so angry I picked up a dish and threw it at the geshinker.“
-Word Salad: Nonsensical use of words. “Why do people comb their hair?” elicits a response like “Because it makes a twirl in life, my box is broken help me blue elephant. Isn’t lettuce brave? I like electrons, hello please!”
-Loose Associations: Connections between thoughts are very weak. “He went to the ballpark and bought Frank’s beer belly home in a bag of grass seed.”
-Incoherence: Like loose associations, except the connections between thoughts are unappreciable. “Blue afraid you no carpet cat got fear bricks of orderly mess.”
disorganized thought/speech examples
-Question: “What does ‘Look before you leap mean?’”
Think before you jump, like if you’re in gym or maybe you’re just wearing shorts outside because it’s hot. You need an extension cord and boxes.”
“Leap before you creep man, leap before you creep.”
“You rub the angel’s head. He comes from the rooftop into the green and then the two snakes turn into a transcendence of night.”
Subjective: “Patient spends most of his day at home. Nonetheless, he states he ‘pimps out hookers,’ engages in drug deals, runs a stolen car ring, and has even committed murder. He controls the people who work for him through his television set…”
Objective: “Patient has very strong violent preoccupations, grandiose delusions, delusions of influence, and illogical thought content…”
disorganized/bizarre behavior
-Behavior that is socially inappropriate or out of context.
-Example of Context:
-Taking clothes totally off before taking shower is normal.
-Taking clothes totally off in the middle of this lecture is abnormal
-“Pt covering himself in his own feces.”
-“Pt seated on floor in corner of room, rocking back and forth, talking and laughing to himself.”
-“Pt wearing towel around head like turban. Has fashioned a ‘smock’ out of a sheet and wears no clothes underneath. He has on socks but no shoes.
-“Pt presents in sexually preoccupied manner.”
negative symptoms
-Anhedonia: Lack of pleasure in activities once enjoyed
-Asociality: Withdrawal from social interaction. Poor social skills, lack of friends or emotional attachments
-Affect (Flat): Face is completely devoid of emotion, yet patient still may experience them
-Avolition: Lack of interest, initiative, or ability to engage in even routine activities
-Alogia: Absence in amount or content of speech
schizophrenia criteria
-Two or more of the following symptoms, present at least for a six month period AND at least one symptom must be one of the first three (delusions, hallucinations, disorganized speech). Also, the patient must experience at least 1 month of active symptoms.
-Delusions
-Hallucinations
-Disorganized speech
-Grossly disorganized or catatonic behavior
-Negative symptoms
-Symptoms cause difficulties in school, work, interpersonal relations, or self-care.
-Symptoms persist for at least 6 months.
-Symptoms are not due to Major Depressive, Manic states.
-Symptoms are not due to the physiological effects of a substance (e.g., medication, drug abuse) or a general medical condition.
-Symptoms are not due to a Pervasive Developmental Disorder (ie Autism)
3 stages
1) Prodrome: Gradual onset of behavioral disturbances, social withdrawal, academic decline. May become irritable, suspicious, disorganized, obsessed with odd hobbies or the occult.
2) Acute: Clinically significant signs and symptoms, causing great distress. May be episodic with transient remissions or chronic.
3) Residual: Negative symptoms predominate. Appears withdrawn, preoccupied, flat or depressed. Impoverished speech and poor cognition.
psychiatric differential dx
-Brief Psychotic Disorder: Psychosis lasts no more than one month. Usually a definable stimulus.
-Schizophrenifom Disorder: Psychosis lasts between one and six months.
-Mania: Increased energy, decreased sleep, euphoria, grandiosity, pressured speech -> if you treat mania schizophrenia goes away
-Depression with Psychotic Features: Mood Congruent delusions/hallucinations or catatonia -> if you tx depression psychosis goes away
schizophrenia causes
-Genetics: Schizophrenia considered 50% genetic and 50% environmental
Dopamine Hypothesis:
-Positive Symptoms: An excess of Dopamine in the Limbic System of the brain, which regulates emotion, expression, and impulse control.
-Negative Symptoms: A deficit of Dopamine in the Frontal Cortex, which regulates attention, executive function, and motivation.
schizophrenia risk factors
-Genetics: 15% risk with schizophrenic 1st degree relative; 50% risk with schizophrenic identical twin
-Emotional Stress – Divorce, loss of job, scholastic difficulties, social difficulties, death of loved one
-Physical Stress – Medical illness, substance abuse, head injury
-Support System: Poor support system
-OB/Perinatal Complications: Hypoxia, trauma to fetal brain, ischemic injuries
-Season of Birth: Winter and early spring months
imaging findings
-Cortical Atrophy leading to enlargement of ventricles
-Cerebral gray matter decreases
-Woods(1998): cell loss in schizophrenics appears suddenly during late adolescence/early adulthood
-less grey matter
-enlarged ventricles
