Schizophrenia and other Psychotic Disorders

Question 1

Schizophrenia

Answer 1

characterized by: disordered thinking, emotions, and behavior

Question 2

Schizophrenia: Etiology

Answer 2

unknown

theories include:

• genetics
• biochemical
• interaction of predisposing risk and environment

Question 3

Biochemical Theories of Schizophrenia

Answer 3

dopamine: thought that excessive dopamine is cause as Levodopa can sometimes induce a psychotic rxn
serotonin: could be excess serotonin? not sure but clozaril is very effective (clozaril affects both dopamine and serotonin)

glutamate

neuroanatomy: enlarged ventricles, less brain tissue

Question 4

Genetic Factors of Schizophrenia

Answer 4

identical twins have 50% risk of schizophrenia if one twin has it

children w/ one bio parent w/ schizophrenia have 15% risk and two bio parents = 35% risk

Question 5

Immunovirologic Factors of Schizophrenia

Answer 5

virus exposure particularly in pregnancy, possibly leading to schizophrenia

cytokines > immune response

Question 6

Schizophrenia: Onset

Answer 6

dx in late adolescence or early adulthood

onset 15-25 YO men
25-35 YO women

insidious onset

it may be debilitating functionally, economically, and emotionally for individuals and their families

• sx may impair employment, education, relationships, and impact self-care
• increased risk for suicide: early on in dx, person has more insight into what is happening to them

Question 7

Phases of Schizophrenia

Answer 7

Prodromal: decrease in functional ability, may arise a year before 1st hospitalization

Active: psychotic symptoms

Residual: flat affect, social withdrawal

Question 8

Diagnostic Criteria for Schizophrenia

Answer 8

HD BS Network

Hallucinations
Delusions
Behavior disorganization
Speech/Thought Disorganization
Negative Symptoms

Question 9

Positive Symptoms

Answer 9

delusions
hallucinations
disorganized thinking or speech
disorganized behavior

Question 10

Negative Symptoms

Answer 10

5 A’s

• Affect (blunted)
• Ambivalence/Avolition (decreased motivation)
• Alogia (reduction in speech, lacks content)
• Anhedonia (decreased ability to experience pleasure)
• Asociality (decreased social interest, difficulty relating to other people)

Question 11

Schizoaffective Disorder

Answer 11

has a mood component to it

mood episode (mania or depression) concurrent with Criterion A of schizophrenia

delusions or hallucinations for two or more weeks in the absences of a major mood episode

Question 12

Schizophrenia: Criteria A

Answer 12

2 or more of the following (1 month period) at lease one must be 1, 2, or 3

1. delusions
2. hallucinations
3. disorganized speech
4. disorganized behavior
5. negative symptoms

Question 13

Brief Psychotic Disorder

Answer 13

diagnostic criteria for schizophrenia but different time frame, for brief period of time (at least 1 day but less than a month)

Question 14

Schizophreniform Disorder

Answer 14

diagnostic criteria for schizophrenia but different time frame, for brief period of time (symptoms lasting at least 1 month but less than 6 months)

Question 15

Delusional Disorder

Answer 15

overall functioning of the individual is not impaired (one or more non-bizarre delusions)

Question 16

Schizotypal Disorder

Answer 16

personality disorder that’s most closely related to schizophrenia

Question 17

Catatonia

Answer 17

psychomotor disturbance - can see decreased motor function, mutism, responds well to benzos

Question 18

Hallucinations

Answer 18

visual
auditory
olfactory
tactile
gustatory

*hallucinations related to schizophrenia are generally auditory

Question 19

Schizophrenia: Tx

Answer 19

early onset treatment: likely respond more quickly to drug therapy

mixed modalities:

• vocational counseling
• medications
• CBT for psychosis
• psychosocial

meds:
dopamine antagonists (decrease positive symptoms, help though disorders, help w/ anxiety/agitation/sleep)

Question 20

Benefits of Group Therapy

Answer 20

socialization
develop coping skills
help with interpersonal conflicts

Question 21

General SE of Dopamine Antagonists

Answer 21

• sedation
• anticholinergic
• orthostatic hypotension
• metabolic (obesity, DM, hyperlipidemia)
• photosensitivity
• EPS (dystonia, drug-induced parkinsonism, akathisia, TD)

Question 22

Dystonia

Answer 22

• acute, involuntary movement disorder
• usually involving the neck
• occurs in short period of time after antipsychotic administration

tx: anticholinergic (benzotropine) or antihistamine (diphenhydramine) IM

Question 23

Parkinsonism

Answer 23

subacute syndrome that mimics Parkinson’s disease

Question 24

Akathisia

Answer 24

subjective as well as objective feeling of inner restlessness and inability to sit still often affecting the lower extremities

should resolve after drug discontinuation

tx = propranolol

Question 25

TD

Answer 25

insidious onset and arises after prolonged tx (unlike EPS which is acute)

repetitive, involuntary, purposeless movements

most cases affect orofacial and lingual musculature

s/sx:

• rapid eye blinking
• tongue protrusion
• lip puckering or pursing
• rapid movements of the hands, arms, legs, or trunk

early detection is important as this can be permanent if not treated early

Question 26

AIMS

Answer 26

abnormal involuntary movement scale

Question 27

Neuroleptic Malignant Syndrome

Answer 27

infrequent, life-threatening

sx:
- fever
- rigid muscles
- altered consciousness

Question 28

Metabolic SEs

Answer 28

weight gain
disturbances in cholesterol
dysregulation of glucose

Question 29

Anticholinergic SEs

Answer 29

“dries you up”

dry mouth
blurred vision
constipation
urinary retention
orthostatic hypotension

Question 30

Clozaril

Answer 30

most efficacious antipsychotic medication we have now

SE: agranulocytosis (low WBC with pronounced neutrophil depletion)

• sedation
• hypotension
• weight gain
• hyper-salivation
• tachycardia
• seizure

Question 31

Prognosis for Schizophrenia

Answer 31

-suicide
-incarceration
-homelessness
-live 10-20 yrs less than their peers d/t increased risk of suicide and SE of meds (DM, high cholesterol), tobacco use disorder
-smoking
need early intervention!