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NMSP Exam 1 > Schizophrenia Spectrum > Flashcards

Schizophrenia Spectrum Flashcards

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1
Q

Onset of Schizophrenia is noted to be when?

A

Late adolescence

Early adulthood

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2
Q

Use of what substance is associated with a 6x increased risk of schizophrenia?

A

Cannabis

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3
Q

Are positive symptoms associated with a better or worse prognosis?

A

Better

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4
Q

Are negative symptoms associated with a better or worse prognosis

A

Worse

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5
Q

Observed concordance rate of schizophrenia is monozygotic twins

A

40-50%

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6
Q

Observed concordance rate of schizophrenia in dizygotic twins

A

10-15%

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7
Q

Schizophrenia has been associated with a number of early life complications, including what?

A

Potentially adverse events that occur during pregnancy and labor, at delivery and early in neonatal life

  • ELCs increase risk of schizophrenia by 1.5-2 fold
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8
Q

What drives the interaction between polygenic risk score and early life complications on schizophrenia risk?

A

Genes highly and differentially expressed in placenta

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9
Q

Pre-natal exposure to what during the 1st trimester appears to increase the risk of developing schizophrenia by 7-fold?

A

Influenza

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10
Q

What maternal infection encountered at any point in pregnancy is associated with a threefold increased risk of schizophrenia?

A

URI

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11
Q

What does the “revised dopamine hypothesis” for schizophrenia propose?

A
  • Hyperactive dopamine transmission in mesolimbic areas
  • Hypoactive dopamine transmission in prefrontal cortex
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12
Q

In addition to the mesolimbic areas, dopamine dysregulation is also observed in what brain regions important for emotional processing?

A
  • Amygdala
  • PFC
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13
Q

Where in the brain is the dopamine system particularly overactive in schizophrenic pt’s?

A

Hippocampus

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14
Q

What changes in cortisol have been seen in patients with schizophrenia?

A

Both heightened and decreased secretion

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15
Q

What 4 “positive” sx’s define psychotic disorders?

A
  • delusions
  • hallucinations
  • disorganized thinking (speech)
  • grossly disorganized or abnormal motor behavior
    • including catatonia
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16
Q

Delusions

  • Definition
  • Types
A

Fixed beliefs that are not amenable to change in light of conflicting evidence

  • Persecutory
  • Grandiose
  • Referential
  • Erotomanic
  • Nihilistic
  • Somatic
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17
Q

Which types of hallucinations are the most common in Schizophrenia?

A

Auditory

  • experienced as voices (familiar or unfamiliar)
  • perceived as distinct from the individual’s own thoughts
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18
Q

Hallucinations that occur while falling asleep

A

Hypnagogic

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19
Q

Hallucinations that occur while waking up

A

Hypnopomic

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20
Q

Are hypnagogic and hynopomic hallucinations indicative of psychosis?

A

No

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21
Q

What is catatonic behavior?

A

Marked decrease in reactivity to the environment

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22
Q

What is catatonic excitement?

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A

Purposeless and excessive motor activity without obvious cause

23
Q

What is negativism?

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A

Resistance to instructions

24
Q

What are examples of repeated stereotyped movements?

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A
  • Staring
  • Grimacing
  • Mutism
  • Echoing of speech
25
What 5 "negative" sx's define psychotic disorders?
* **Diminshed** emotional expression * **Avolition**: decrease in motivation to initiate and perform activities * **Alogia**: lack of speech * **Anhedonia**: inability to feel pleasure/loss of interest * -**Asociality**: lack of motivation to engage in social interaction and/or preference for solitarty activities
26
What sxs account for most of the morbidity associated with schizophrenia?
Negative symptoms
27
Of the negative sxs, which two are most prominent in schizophrenia?
1. Diminished emotional expression 2. Avolition
28
What is the diagnostic criteria for Schizophrenia?
* ≥2 of the following for _most of **1 month**_; at least **1** of the first **3 sx's** * **Delusions** * **Hallucinations** * **Disorganized speech** * Grossly disorganized or catatonic behavior * Negative sx's
29
After the diagnosis of schizophrenia in an **adult**, what is commonly experienced?
The level of functioning is far below what it was prior to onset
30
How long must there be contnuous signs of disturbance for dx of Schizophrenia?
**≥6 months;** must include at least **1 month** of sx's from criterion A: * Delusions * Hallucinations * Disorganized speech * Grossly disorganized or catatonic behavior * Negative sxs
31
If there is a history of autism spectrum disorder or a communication disorder of early childhood onset, the additional diagnosis of schizophrenia is made only if what is present?
Prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, present for **at least 1 month**
32
The _catatonic type_ of Schizophrenia has a clinical picture dominated by **at least 2** of which 5 sx's?
* **Motoric immobility** as evidenced by catalepsy or stupor * **Excessive motor activity** (apparently purposeless and not influenced by external stimuli) * Extreme **negativism** or **mutism** * Peculiarities of **voluntary movemen**t such as posturing, stereotyped movements, prominent mannerisms or prominent grimacing * **Echolalia** (repeated speech) or **echopraxia** (repeated movements)
33
What is the single leading cause of death in pt's with Schizophrenia?
**SUICIDE!** * Usually near illness onset
34
Dementia typically mimics what symptoms of schizophrenia?
Negative symptoms
35
How is a patient with schizophrenia + acute psychosis managed?
1. **Hospitilization** is needed for patient safety and to get pt stabilized 2. **IM injections:** Haloperidol, Fluphenazine, Lorazepam
36
**Stabilization phase** of schizophrenia treatment includes?
Switching to a newer, atypical (2nd gen) antipsychotic * Risperidone, Ziprasidone, Quetiapine, Olanzipine, etc.
37
**Maintenance phase** of schizophrenia treatment includes?
Keeping patients free from symptoms while avoiding incapacitating side effects
38
Which second-gen antipsychotic used for tx of Schizophrenia is more commonly associated with **QTc prolongation?**
Ziprasidone
39
Which drug class can be used for catatonic disorder of Schizophrenia?
Benzodiazepines
40
Which second-gen antipsychotic is associated with less risk of tardive dyskinesia?
Quetiapine
41
Nonpharmacologic therpaies for Schizophrenia
* Community treatment * Self-help programs * ECT
42
What is the criteria for Delusional Disorder?
* Presence of **1+ delusions** with duration of **_1 month or longer_** * Functioning is **_NOT_** impaired and behavior is not obviously bizarre or odd * Criterion A for schizophrenia has **never** been met
43
Differential diagnosis for delusional disorder
1. Alzheimer's disease 2. Huntington's disease 3. Brain tumor 4. Complex partial seizures 5. Stroke
44
What is the diagnostic criteria for Brief Psychotic Disorder?
* Presence of **1+** of the following sx's. At least **one** being the **first 3:** * **Delusions, Hallucinations, Disorganized speech,** Grossly disorganized or catatonic behavior * Duration of an episode is **at least 1 day but \<1 month**, with eventual full return to premorbid level of functioning
45
What is the diagnostic criteria for Schizophrenifrom Disorder?
* **Two (or more)** of the following, each present for a significant portion of time during a **_1-month period._** _At least **one**_ must be the **first 3 sx's:** * **Delusions, Hallucinations, Disorganized Speech**, Grossly disorganized or catatonic behavior, Negative sx's (diminished emotional expression, avolition) * Episode must last **at least 1 month but \< 6 months**
46
What is the diagnostic criteria for Schizoaffective Disorder?
* An _uninterrupted_ period of illness during which there is a **major mood disorder** (major depressive or manic) concurrent with **criterion A of schizophrenia** * **Delusions** or **hallucinations** for **_≥ 2 weeks_** in _absence_ of major mood episode (depressive or manic) * Sxs that meet criteria for major mood episode are present for the majority of the total duration of illness
47
There must be the presence of **one or both** of which **2 sx's** for diagnosis of substance/medication-induced psychotic disorder?
1. Delusions 2. Hallucinations
48
In addition to the symptoms required to make a diagnosis of Substance/medication-induced psychotic disorder, what other factors are required?
* Symptoms must have developed during or soon after substance intoxication or withdrawal or after exposure to a medication * Involved substance/medication must be capable or producing the symptoms (delusions, hallucinations)
49
What is the diagnostic criteria for psychotic disorder due to another medical condition?
Prominent **hallucinations** or **delusions** that are a _direct pathophysiological consequence_ of another medical condition
50
The clinical picture of Catatonia associated with another mental disorder ***or*** another medical condition is dominated by **three** **(or more)** of the following 12 symptoms:
* Stupor * Catalepsy * Waxy flexibility * Mutism * Negativism * Posturing * Mannerism * Stereotypy * Agitation * Grimacing * Echolalia or echopraxia
51
What characterizes attenuated psychosis syndrome?
Psychotic-like symptoms that are _below threshold_ for full psychosis (i.e. sxs are less severe and more transient, and insight is relatively maintained)
52
What is the timeline for Schizophrenia vs. Schizophreniform vs. Brief Psychotic Disorder?
* Schizophrenia: **\> 6 months** * Schizophreniform: **1-6 months** * Brief psychotic disorder: **\< 1 month**
53
Characteristics of the **"schizo spectrum":** schizoid vs. schizotypal vs. schizophrenia vs. schizoaffective
* **Schizoid:** very introverted and voluntarily withdrawals from socal interactions * **Schizotypal:** schizoid sxs + magical thinking & odd behavior * **Schizophrenia:** schizotypal + psychosis * **Schizoaffective:** schizohrenia + mood disorder

NMSP Exam 1 (6 decks)

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