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Flashcards in Schizophrenia Deck (36):
1

4 phases of schizophrenia

Premorbid
Prodromal
Acute or Psychotic
Stable/residual phase

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Premorbid Phase

Indications for early intervention include:
1. delayed motor milestones
2. Poor scholastic performance
3. Reduced concentration
4. Passivity
5. Depression, anxiety, irritability and/or anger
6. Sleep disturbance
7. Bedwetting
8. Social withdrawal

3

Prodromal Phase

Often ignored, may result in treatment delays:
1. Marked peculiar behavior
2. Inappropriate expression of feeling
3. Speech difficult to follow
4. Poverty of speech and thought
5. Odd ideas and ideas of reference
6. Feelings of unreality
7. Suspiciousness
8. Deterioration in role functioning

4

Acute or Psychotic Phase

Positive Symptoms
Full-blown psychosis

5

Stable/Residual Phase

Symptoms similar to schizophrenia prodromal phase

6

Genetics of Scz

1. Seemingly multigenic vulnerability to schizophrenia that is no completely expressed
2. Chromosomes 6 and 22 suggested as possible locations
3. Monozygotic twins of schizophrenics have a 35 to 50% risk, fraternal twins and other siblings have a 15% risk, children of one parent also have a 15% risk, and children with 2 schizophrenic parents have a 35% risk.

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Neurobiological Findings in Scz

Dec brain volume
Larger third ventricles
Atrophy of frontal lobe, cerebellum, hippocampus, and amygdala

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PET scans in scz

Dec blood flow to frontal cortex and overactivity in basal ganglia

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NT abnormalities in scz

Abnormal serotonin, glutamate, and GABA activity

10

Environmental/Situational Factors

Slim correlations:
Urban environments and/or high pollution
Maternal starvation and viral infections during fetal development
Children born after long labor or delivery complications
Following high fevers in childhood

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Stress Vulnerability Model of Scz

Combination of:
1. Genetic or neurodevelopmental vulnerability
2. Triggered by high exposure to psychosocial stressors

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Stressors in Scz

1. Over-involved, critical, and hostile families with high levels of expressed emotion often have more difficulty assisting the schizophrenic member with maintaining stability.

2. Even when compliant with meds stressed out people with scz become vulnerable to exacerbations

13

Protective Factors in Scz

High SES
Learned coping skills
Stable family
Higher education

14

Types of scz

Paranoid
Disorganized
Catatonic
Undifferentiated
Residual

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Paranoid Type

Preoccupied with delusions and auditory hallucinations with little disorganized or affective flattening

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Disorganized Type

Characterized by disorganized speech and behavior with flat or inappropriate affect

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Catatonic Type

Clinical picture dominated by 2 or more behavioral patterns:
1. Motor immobility cataplexy, waxy flexibility, stupor
2. Seemingly purposeless excessive motor activity
3. Extreme negativism
4. Peculiar movement, posturing, stereotype movement, prominent mannerisms or grimacing
5. Echolalia or echopraxia

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Undifferentiated Type

Meets criteria for schizophrenia but not one of other types

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Residual Type

1. Absence of prominent delusions
2. Hallucinations
3. Disorganized speech or behavior
4. Catatonic behavior but continuing evidence of negative symptoms or attenuated symptoms of scz

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Schizophreniform DO

Scz sx last between 1 and 6 months

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Brief Psychotic DO

Scz sx last between 1 day and 1 month

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Shared Psychotic Disorder

A second person develops a similar delusion in a close relationship with an individual with an established delusion

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Men and women in schizophrenia

Equal rates

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PORT Study

Recommends psychotherapeutic interventions for Schizophrenia

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PORT Study recommendations

-Assertive Community Treatment
-CBT for 4-9 months
-Alcohol and substance abuse interventions
-Skill training: Healthy lifestyle
-Trigger and relapse identification
-Family services: 6-9 months
-Group therapy: Clubhouse groups
-Self-help and support groups

26

First Choice pharma for scz

SGAs, but not Clozaril or Zyprexa because of metabolic problems

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If antipsychotic naive...

use a lower dose than someone who is more chronic a relapsing

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If pt responds initially to antipsychotic, but relapses...

try another SGA

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Treatment resistant schz:

After 2 (8-12 week) failed trials of SGAs, considered treatment resistant. Consider clozapine

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Therapeutic Clozapine (Clozaril) blood level

350 ng/mL

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SGA most likely to widen QTc interval

Geodon (Ziprasodone)

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Seroquel side effects

Cataracts in dogs

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Abilify SEs

Orthostatic hypotension

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Zyprexa primary SE

Weight Gain

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Risperdal Primary SE

Sexual Dysfunction
Hyperprolactinemia

36

Treatment for Delusions

1. Question facts presented and meaning to patient
2. Assess duration, frequency, intensity, and triggers
3. Identify emotional components and assist patient to connect with stress
4. Discuss consequences when patient is ready and not actively delusional
5. Focus on emotions, not content
6. Promote distraction and healthy ways of meeting needs and spending time.