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Flashcards in Schizophrenia Deck (29):
1

General on schizophrenai

• The prototypical psychotic illness
• Consists of several related symptom clusters
• Accounts for roughly 2.5% of total health-care expenses in the United States

2

Etiology of Schizophrenia

• Huge worldwide public health problem with devastating effects on patients and families
• Lifetime prevalence 0.6%-1.9% in various cultures—average about 1% worldwide
• Lifetime prevalence in men and women equal, but average age of onset lower in men
• Onset often in late teens—generally insidious

3

EMIL KRAEPELIN: differentiated manic- depressive illness from progressive illness he called “________”—a premature deteriorating disorder

dementia praecox

4

EUGEN BLEULER: characterized “the group of schizophrenias” as having in common a split among

affect, thought, emotion, and behavior

5

Bleuler's 4 A's

• Associations : taco bell, bell from beauty and the beast, beast mode
• Affect: disconnect from how they feel internally and outward dispay
• Autism: hard time telling whats inside vs outside; breakdown of ego boundaries
• Ambivalence: breakdowno f neural circuitry, hard time making decisions

6

KURT SCHNEIDER: characterized thought broadcasting, thought withdrawal, voices arguing or commenting, and somatic passivity as first-rank, but non- specific, symptoms

“FIRST-RANK SYMPTOMS”

7

Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):

• (1) delusions
• (2) hallucinations
• (3) disorganized speech (e.g., frequent derailment or incoherence)
• (4) grossly disorganized or catatonic behavior
• (5) negative symptoms, i.e., affective flattening, alogia, or
avolition

8

Key note for symptomatology of schizophrenai

Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other.

9

When dx schizophrenia, we say there is 'social/occupational dysfunction' What does that mean?

Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).

10

What is the duration necessary to dx someone with schizophreai

ontinuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms that meet Criterion A and may include periods of prodromal or residual symptoms.

11


• D. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out as being dx with schizophrenia because either

(1) no Major Depressive, Manic, or Mixed Episodes have occurred concurrently with the active-phase symptoms; or
(2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.

12

If a pt has a Pervasive Disorder or Autism, how can we dx them with Schizophrenia?

the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).

13

What's the difference between Positive and NEgative symptoms

Positive symptoms: delusions, hallucinations, behavioral disturbance
• Negative symptoms: social isolation, withdrawal, poor grooming, anergy, loss of interest, blunted affect

14

What cognitive symptoms are present in schizophrenia

impaired abstract thinking, impaired problem-solving, disturbed memory

15

What are the historical classificaitons of schizophrenia (eliminated in DSM 5)

• Catatonic
• Disorganized
• Paranoid
• Residual
• Undifferentiated

16

What Genetic and Anatomic changes are possible explanations for schizophrenia etiology?

Genetic predisposition important—shown in twin studies
• Anatomic changes present—enlarged lateral ventricles, increased width of third ventricle, sulcal enlargement

17

What Physiologic changes are seen in schizophrenics?

dorsolateral prefrontal cortex poorly activated; thalamus and cerebellum possibly involvedc

18

What Biochemical factors are involved in schizophrenia

—dopamine D2 receptors blocked by all antipsychotics

19

Describe what a PET scan in identical monozygotic twins looks like; one has schizophrenia, other doesn't

PET scans from a study of identical (monozygotic) twins, who are discordant for
schizophrenia (only one has the disorder) demonstrate that individuals with
schizophrenia have reduced brain activity in the frontal lobes (top of scan)

20

What is the treatment for schizophrenia

atypical antipsychotics (dopamine-serotonin antagonists)— e.g., olanzapine, risperidone, quetiapine—generally used in preference to old-style neuroleptics (dopamine antagonists)—e.g., haloperidol, chlorpromazine, fluphenazine

21

What are some concerning side effects of antipyschotic drugs

acute dystonia, akathisia, tardive dyskinesia—though less so with atypical antipsychotics

22

What are other tx options besides medication for individuals with schizophrenia

Psychosocial interventions also essential: housing, case management with emphasis on medication compliance and community involvement, supportive psychotherapy, vocational training

23

What is the prognosis for individuals with schizophrenia

• Exacerbations and remissions common
• Residual impairment the rule
• Positive symptoms less severe over time
• Negative symptoms move severe over time

24

What is the effect of schizophrenic living with family with high EE

Patients with schizophrenia living with families characterized by high expressed emotion (EE)— criticism, hostility, over involvement: tendency in studies to do more poorly over time than others

25

Long term prognosis of schizophrenics:
• ___% of patients leading somewhat normal lives
• ____% of patients experiencing moderate
symptoms
• ___% of patients significantly impaired

20-30
20-30
40-60

26


• Schizotypal (personality) disorder:
• Schizoaffective disorder:

oddness
Mood symptoms

27

• Schizophreniform disorder:
Brief psychotic disorder:

1-6 months
1 day-1 month

28

Delusional disorder:

Functioning not markedly impaired except by delusions

29

Cause of pyschosis

• Psychotic disorder due to another medical condition
• Substance/medication-induced psychotic disorder