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Flashcards in Schizophrenia (Exam 3) Deck (126):
1

What is schizophrenia called?

severe mental illness (SMI)

2

What does the "schiz" mean?

split: between thoughts and reality

3

How long do the problems have to be present for the diagnostic criteria for schizophrenia?

6 months

4

How long does the active period with psychotic episode have to last for the diagnostic criteria of schizophrenia?

1 month

5

Does the course include a prodromal stage for the diagnostic criteria of schizophrenia?

course may or may not include a prodromal stage

6

Can it be due to a substance for the diagnostic criteria of schizophrenia?

no

7

What is the course of schizophrenia?

not every patient diagnosed with schizophrenia manifests symptoms for life (but will always carry diagnosis)

8

What is the one-third rule?

-1/3 deteriorate for life
-1/3 have chronic episodes of schizophrenia
-1/3 show substantial improvement

9

How many people only have ONE EPISODE and no impairment in the research on relapse and remission - 5-year follow-up research results by Zubin et al., 1989?

22% one episode - no impairment and improved functioning

10

How many people are likely to have LASTING impairment
in the research on relapse and remission - 5-year follow-up research results by Zubin et al., 1989?

78% several episodes and varying degrees of lasting impairment

11

How many people are likely to have MINIMAL impairment in the research on relapse and remission - 5-year follow-up research results by Zubin et al., 1989?

35% minimal impairment

12

How common is it that a person would have ONE PSYCHOTIC EPISODE and never return to normal functioning in the research on relapse and remission - 5-year follow-up research results by Zubin et al., 1989?

8% no return after first episode

13

How common is it that a person would have SEVERAL EPISODES and never return to normal functioning in the research on relapse and remission - 5-year follow-up research results by Zubin et al., 1989?

35% no return after several episodes

14

What are the prevalence rates in the US for schizophrenia?

1%

15

What are the SES backgrounds for prevalence rates of schizophrenia?

all different SES backgrounds

16

Do you have to look at cultural sensitivity issues for prevalence rates of schizophrenia?

may need to look at cultural sensitivity issues

17

What are the prevalence rates of schizophrenia for elderly?

difficult issues with this population

18

What is the age of onset for schizophrenia?

late adolescence to early adulthood

19

What are the age ranges for schizophrenia?

17-24

20

Is schizophrenia shown earlier in men?

yes

21

Do we see schizophrenia in middle age?

not usually

22

What happens if we see schizophrenia past middle age (45)?

possibly indicative of organic damage (dementia or stroke)

23

What are the gender differences in prevalence for men and women for schizophrenia?

roughly similar prevalence rates

24

Are males diagnosed earlier or later in life with schizophrenia?

earlier

25

Does age of onset have potential prognostic value?

yes

26

Are there pathognomonic signs for the symptoms of schizophrenia?

no

27

What are the symptoms of schizophrenia during a 1-month period?

2+ more
-delusions
-hallucinations
-disorganized speech
-grossly disorganized or catatonic behavior
-negative symptoms

28

What are positive symptoms?

-behavior being produced
-better response to medications (less permanent disability)

29

What are examples of positive symptoms?

-hallucinations
-delusions
-formal thought disorder
-bizarre behavior

30

What are negative symptoms?

-not editing behaviors we expect to see
-correlated with more problems (higher rates of permanent disability)

31

What are examples of negative symptoms?

-affective flattening
-alogia
-avolition
-apathy
-anhedonia
-asociality

32

What are thought disorders?

-positive symptom
-"hallmark" of schizophrenia

33

How do thought disorders manifest?

manifest in content and form

34

How do thought disorders manifest in content?

what the thought is about

35

How do thought disorders manifest in form?

how the production of thought appears

36

What is affective flattening? (negative symptom)

no emotions

37

What is alogia? (negative symptom)

no speech

38

What is avolition? (negative symptom)

no bold directed behavior

39

What is apathy? (negative symptom)

not caring

40

What is anhedonia? (negative symptom)

loss of pleasure in doing things

41

What is asociality? (negative symptom)

not social

42

What is the major content for thought disorders?

delusions

43

What is the major form for thought disorders?

-formal thought disorders
-loose associations

44

What is delusion persecution?

belief that agency, group, or individual is out to get person (most common)

45

What is delusion grandiosity?

person is extremely special, capable of special feats (ex: god, not based on reality)

46

What is delusion reference?

events, objects, or people given unusual significance (ex: nurse may be Angel of Death)

47

What are formal thought disorders for thought disorder forms?

how the thought is expressed

48

What are loose associations for thought disorders of form?

person jumps from one topic to topic with no awareness that the topics are not related

49

What are the problems with perception for schizophrenia?

disturbances of perception (positive symptom)

50

What are the most common disturbances of perception for schizophrenia?

hallucinations

51

What are hallucinations?

perception of a stimulus where one does not exist

52

How long do disturbances of perception last for schizophrenia?

may be ongoing throughout problem and into remission

53

What are the key differentials for disturbances of perception for schizophrenia?

different types indicate different problems (psychological, substance induced, neurological)

54

What are the most common types of hallucinations for schizophrenia?

auditory hallucinations

55

What are auditory hallucinations?

-hear sounds someone sitting next to person cannot hear because there is no sound
-may be sounds or voices

56

What are command hallucinations?

can dictate what a person should do

57

What are tactile hallucinations?

feeling something that is not present (ex: tingling, burning)

58

How are tactile hallucinations induced?

substance (psychostimulants)
ex: meth, crack cocaine

59

What are visual hallucinations?

seeing what it isn't there

60

How are visual hallucinations induced?

substance induced psychosis

61

What can visual hallucinations be a sign of?

organic (neurological) mental disorder
ex: tumor

62

What are olfactory hallucinations?

perception of odors which are not present

63

How can olfactory hallucinations be induced?

-stroke
-preictal phase of seizure

64

What is the most uncommon type of hallucination?

olfactory hallucination

65

What is disturbance of affect?

-negative symptom
-disturbance in emotional experience or expression

66

What are the different types of disturbance of affect?

-restriction of affect
-blunting of affect
-flattened affect
-inappropriate affect

67

What is restriction of affect?

reductio in range of emotions

68

What is flattened affect?

complete absence of affective expression in the face or voice

69

What is blunting of affect?

reduction in intensity of affective expression

70

What is inappropriate affect?

responsiveness is inappropriate to the subject being discussed

71

What are disturbances of psychomotor behavior?

-catatonic stupor
-catatonic excitement

72

What are catatonic features?

problems with movement

73

What is catatonic stupor?

no movement, non-respondent

74

What is catatonic excitement?

agitated, intense, or exaggerated movements

75

What are disturbances in volition?

-negative symptom

-marked cessation of goal directed behavior
accompanied by apathy and a loss of a sense of meaning

-gross impairment of work and other role-functioning

76

What are impairment in relationships for schizophrenia?

-tendency to withdraw from other people
-increased isolation
-homelessness

77

What is the premorbid stage?

time prior to psychotic episode

78

What is the prodromal stage?

clear pattern of deterioration in premorbid level of functioning prior to psychotic episode

79

What is the poor prognosis of the prodromal stage?

-long, insidious downhill course
-over many years
-no clear precipitating stress
-no real time for premorbid adjustment

80

What is the better prognosis of the prodromal stage?

-if sudden onset of active psychotic episode
-may be clear precipitating stress
-longer period for good level of premorbid functioning

81

What is the active stage?

-active psychotic episode
-presence of psychotic behaviors/symptoms

82

What is the residual stage?

-gradual improvement in functioning (some impairment will follow)

-level of functioning expected for return is similar to prodromal stage

-features of the active stage will persist (not as strong)

-problems with social withdrawals remains

-compliance with and continued response to meds will predict how long this phase lasts

83

What is prognosis based on?

prodromal stage

84

What are some complications associated with schizophrenia?

-shorter life expectancy

-increased suicide rate

-general decrease in self-care/hygiene

-delusions can be self-threatening (command hallucinations)

-institutional neglect

-deprived economic circumstances

-victims of violent crime

85

Are patients diagnosed with schizophrenia dangerous?

-tend to be less violent than general population
-patients diagnosed who are paranoid can be dangerous

86

What are the schizophrenia spectrum disorders?

-schizophreniform disorder
-brief psychotic disorder
-schizoaffective disorder

87

What is schizophreniform disorder?

psychotic symptoms lasting between 1-6 months (longer than 6 months = schizophrenia)

88

What is brief psychotic disorder?

psychotic symptoms lasting <1 month

89

What is schizoaffective disorder?

symptoms of schizophrenia + additional experience of a major mood episode (depressive, manic)

90

What are some predisposing factors for schizophrenia?

-lower socioeconomic status levels (SES) associated with increased prevalence rates

-downward drift hypothesis

91

What is the downward drift hypothesis?

person with SMI will drift down to lower SES levels with progression of disorder regardless of which SES level you begin with

92

What are the concordance rate for monozygotic twins?

48%

93

What does psychotic spectrum disorders include?

other disorders such as BD and MDD

94

Are concordance rates impacted by definition of schizophrenia?

yes (psychotic spectrum disorders)

95

What are the etiological theories of schizophrenia?

-Biological Theories
-Dopamine (DA) Hypothesis

96

What is the most popular etiological theory of schizophrenia?

Dopamine (DA) Hypothesis

97

What does the Dopamine (DA) hypothesis state?

schizophrenia caused by excessive amounts of dopamine

98

What are the challenges to the DA hypothesis?

-can have psychotic symptoms in Parkinson's disease
-some patients will not respond to any antipsychotic drugs
-newer antipsychotics drugs address many more neurotransmitters than DA

99

What are the family based theories of schizophrenia?

-Schizophrenogenic Mother
-Expressed Emotion (EE)

100

What is the theory of a Schizophrenogenic Mother?

-psychodynamic concept
-mothering type (ex: overly protective of child)

101

Is there research data that supports the Schizophrenogenic Mother theory?

There are NO research data supporting that mothers cause schizophrenia

102

What is expressed emotion?

refers to the type of communication patterns between family members

103

Does data support that high EE causes first episode of schizophrenia?

Data does NOT support that high EE causes first episode of schizophrenia

104

What does the data support for high EE families?

higher relapse rates when patients released from hospital into high EE families

105

What are the different types of EE?

-hostile
-emotional over-involvement
-critical

106

Should you look at high and low EE families?

yes

107

What are the earlier treatments for schizophrenia?

-ECT
-insulin shock coma
-psychosurgery -> lobotomies (1930s-1950s)

108

Were the earlier treatments for schizophrenia effective?

not effective

109

What are the drug treatments for schizophrenia?

thorazine discovered as antipsychotic medication

110

How do thorazine and antipsychotic medications work?

-major tranquilizing properties
-DA receptor blocker

111

How do the dopamine antagonists work?

block post-synaptic receptors

112

What are the potent side effects of these drugs?

Parkinsonian symptoms (tardive dyskensia, TD)

113

What is tarive dyskensia (TD)?

-irreversible damage to nervous system
-involuntary facial movement, grimacing, tongue protrusion
-very distracting and distressing to patient

114

What are the efficacy of these drugs?

-noticeable decrease in positive symptoms
-more able to engage in social activity

115

What are the atypical antipsychotics?

-tend to act on 5-HT and DA
-some have specific bindings on DA receptors

116

Are these drugs actually "atypical"?

MOST are not "atypical" many are traditional in new brand

117

What is the efficacy of atypical antipsychotics?

NOT more effective than first generation meds

118

What are the side effects of atypical antipsychotics?

still have the same side effects as original antipsychotic

119

What is Family Therapy for the psychological approaches of schizophrenia?

focus on interaction of family members with patient (teach more effective family interactions)

120

Is Family Therapy effective at preventing relapse?

yes

121

What is the cognitive behavioral approaches for the psychological approaches of schizophrenia?

-coping skills
-daily living skills
-avoiding substance use

122

Are the cognitive behavioral approaches effective for preventing relapse?

yes

123

What is compliance therapy for the psychological approaches of schizophrenia?

aimed at understanding schizophrenia and medication compliance

124

Is compliance therapy helpful?

some indication this is helpful

125

What is milieu therapy for the psychological approaches of schizophrenia?

put person in healing therapeutic environment

126

What social skills do patients engage in during milieu therapy?

-engage in group activities
-help one another and be supportive
-act responsibly
-participate in decisions affecting functioning of ward