Schizophrenia: Prodrome Flashcards
(25 cards)
Why is pre-treatment for Schizophrenia controversial?
A) because one is treating a disease with medication that causes severe side effects, that is only a probability and false-positives may occur
B) Even predictions through genetic probability is ineffectual.
C) There is no indication how long one should be on medication and there is always the problem of adherence to medications.
Define Indicated Prevention
early intervention in patients presenting with prodromal symptoms to prevent psychosis
Benefits of reducing the Duration of Untreated Psychosis (DUP)
- Prevents or limits future severity
- Disorder is less chronic
- Prevents/limits collateral damage
Rapid intervention for 1st episode psychosis may result in ___
remission
What may still be present despite remission of symptoms?
Difficulties in everyday functioning
Defining symptom that may be present years before onset of psychosis
Social Withdrawal (as well as negative symptoms)
80-90% of people with schizophrenia reported these cognitive changes prior to psychosis
Perception,
Thinking,
Mood
Typical pattern (From prodromal to psychosis)
A) Non-specific symptoms and negative symptoms develop
Followed by B & C concurrently
B) Attenuated, mild, positive symptoms
C) Distress & decreased functioning
Assessments score for these Positive Symptoms
Unusual Thought content Suspiciousness Grandiosity Perceptual Abnormalities Conceptual Disorganization
Under The Counter, Suspicious Giant Purple Angels Chatter Dramatically
Assessments score for these Negative Symptoms
Social Isolation Avolition Decreased expression of emotion Decreased experience of emotion Decreased ideational richness Deterioration in role functioning
What is Avolition?
Lack of motivation
What is ideational richness?
Difficulty in following conversations, making sense of familiar phrases, etc.
Assessments score for Disorganization
Odd Behavior/Appearance
Bizarre Thinking
Trouble focusing
Poor hygiene
Think Bizarro superman
Assessments score for general symptoms
Sleep disturbance
Dysphoric mood
Motor disturbance
Impaired stress tolerance
Notable cognitive declines in the prodrome include:
spatial working memory
verbal declarative memory
attention
This important aspect of social cognition is impaired in every stage of schizophrenia
Facial Affect Recognition
PACE Study author
McGorrey (Australia)
PACE Study experimental group and control group
Experimental Group: Risperidone 1-3 mg / day + modified CBT
Control: needs based intervention
PACE study findings
9.7% treatment group progressed to psychosis vs. 36% in control
However, 6 months after the study concluded significance between groups disappeared as the treatment group progressing to psychosis increased to 19%
PRIME study author
McGlashan (Yale)
PRIME study experimental group and control group
Experimental Group: Olanzapine
Control Group: Placebo
PRIME study findigs
At 8 weeks Experimental group was significantly better than placebo
At 1 year the split was 16% Olanzapine group vs 35% placebo group
In Year 2 the difference between groups disappeared as 33% in the experimental group converted to psychosis.
EDIE study experimental group and control group
Experimental group: Cognitive Therapy
Control Group: monitoring
EDIE study findings
Cognitive therapy was found to significantly reduce progression to psychosis after 12 months (6% experimental group vs 22% control).
After 3 years differences between groups disappeared.
