What are the 4 A's originally associated as the hallmarks of schizophrenia?
Autism - social withdrawal
Ambivalence - lack of motivation
Affect - inappropriate or flat
Association - loose and disorganized
DSM5 Criteria for Schizophrenia?
Continuous signs of disturbance for at least 6 months and at least 2 or more symptoms for most of 1 month:
-grossly disorganized or catatonic behavior
-Negative symptoms (alogia, affective flattening, avolition)
Briefly describe the 5 Schizophrenia Spectrum Disorders?
1) Delusional Disorder: one or more delusions of 1 month or longer
2) Brief Psychotic Disorder: psychotic symptoms at least 1 day but less than 1 month; often in response to stressor
3) Schizophreniform Disorder: Criteria A symptoms >1 month but <6 months
4) Schizoaffective Disorder: psychotic symptoms (only for 2 weeks) + Mood disorder symptoms more of the time
5) Substance/Medication induced psychotic disorder
Positive Symptoms of Schizophrenia
Delusions - firm, false, fied ideas including ideas of reference
Disorganization - tangentially, incoherent, loose association, word salad
Grossly disorganized or catatonic behavior
Hallucinations - false perceptions
NEgative symptoms of Schizophrenia
Alogia - poverty of speech or speech content
Avolition - lack of will and motivation to do things
Negative Symptoms can be primary or secondary (secondary to antipsychotic meds)
Describe some of the other features of schizophrenia?
Relational problems - social interactions and intimacy
***Cognitive Dysfunction - attention/vigilance, processing speed, problem solving, learning and memory, social cognition
What is the Modified Da Hypothesis of Schizophrenia?
POsitive symptoms may be mediated by Da excess in Limbic regions
Negative symptoms may be mediated by decreased Da in Prefrontal areas
Side effects are caused by Anti-Da effects of medications in the BG
What are some factors predicting poor prognosis in schizophrenia?
no precipitating factors and insidious onset
Poor premorbid functioning
Withdrawn, autistic behavior
What are the first-line treatments to reduce positivy psychotic symptoms? What's the difference between the 2 categories of drugs used?
Older - Typical - 1st Generation Antipsychotics: Chlorpromazine, Perphenazine, Haloperidol all work through D2 blockade and have EPS
Newer - Atypical - 2nd generation Antipsychotics: Olanzapine, Risperidone, Quetiapine all work with varying Da affinity and have more metabolic side effects
When/who would you use Clozapine for?
Clozapine is a unique atypical that should be offered to people with persistent and clinically significant positve symptoms in spite of treatment with other antipsychotics aka non-responders
What is the model for "recovery"?
also talked about in addiction
Want symptom remission and return to functioning
is a continual PROCESS rather than an end state
Strength-based vs symptom based
Hope, Respect, Empowerment