Schizophrenia Spectrum/Psychosis Flashcards
(80 cards)
1
Q
What is Capgras Syndrome?
A
The belief that people in one’s life have been replaced by exact doubles (35% of such cases are organic in aetiology).
- has been seen in CNS lessons, vit B12 deficiency, hepatic encephalopathy, diabetes, and hypothyroidism. K&S, p 512
2
Q
What is Cotard’s Syndrome?
A
The belief that one is dead, or it is after the end of the world.
“In the 19th century, the french psychiatrist Jules Cotard described nihilistic delusional disorder or Cotard syndrome. Pts with this complain of having lost not only possessions, status, and strength, but also their heart, blood, and intestines. The world beyone them is reduced to nothingness”. K&S, p 510
3
Q
What is a neologism?
A
Nonsensical words condensed or combined from two or three different words.
4
Q
What is echopraxia?
A
Repetition or imitation of observed gestures or physical expressions.
5
Q
Auditory hallucinations are reported in what % of patients with schizophrenia?
A
50-70% (Andreasen and Flaunt, 1991; Hoffman et al., 2001)
6
Q
What is alogia?
A
Deficient fluency or productivity of speech or thought.
7
Q
True or false: schizoaffective disorder is more common in married females with late onset.
A
True.
- Prevalence lower in men than in women, particularly married women
- age of onset for women is later than for men, as in schizophrenia
- men with schizoaffective disorder are likely to exhibit antisocial behaviour and to have a markedly flat or inappropriate affect.
- depressive type more common in older pts and bipolar type more common in younger pts
K&S p. 501-504
8
Q
Name Eugene Bleuler (1857-1939) fundamental and accessory symptoms in schizophrenia.
A
Fundamental
- Association
- Affect
- Autism
- Ambivalence
Accessory
- Hallucinations
- Delusions
- Disorganization
- Somatization
uOttawa and K&S p.467
9
Q
What are the first-rank symptoms of schizophrenia described by Kurt Schneider (1887-1967)?
A
- audible thoughts
- voices arguing or discussing or both
- voices commenting
- somatic passivity experiences
- thought withdrawal and other experiences of influenced thought
- thought broadcasting
- delusional perceptions
- all other experiences involving volition made affects, and made impulses
K&S p. 468
10
Q
What is the peak age of onset in men and women for schizophrenia?
A
Men = 10-25 years Women = 25-35 years with a second peak occurring in middle age.
K&S p. 468
11
Q
True or false: the marriage and fertility rates among persons with schizophrenia is increasing.
A
True.
- increase in marriage and fertility = continually increasing number of children born to parents with schizophrenia.
- the fertility rate for persons with schizophrenia is close to that of the general population (fertility rate increased from before use of antipsychotics, deinstitutionalization, community care etc.)
K&S p. 469
12
Q
People with schizophrenia are more likely to have been born in what season?
A
- winter and early spring
Note: in the northern hemisphere often born in january to april. In the southern hemisphere often born july to september.
K&S p. 469
13
Q
Up to ___ % of schizophrenic patients may be dependent on nicotine. Why is this important?
A
90% (brain abnormalities in nicotinic receptors in schizophrenia)
- smoking-associated mortality
- nicotine decreases blood concentrations of some antipsychotics
- nicotine may improve some cognitive impairments and parkinsonism
- may decrease positive symptoms by its effet on nicotine receptors that reduce the perception of outside stimuli, especially noise.
K&S p. 469
14
Q
What is the connection between population density and schizophrenia prevalence?
A
Prevalence correlated with local population density in cities with more than 1 million people. Weaker correlation with smaller cities.
Also the incidence of schizophrenia in children of either one or two parents with schizophrenia is twice as high in cities as in rural communities.
K&S p. 470
15
Q
Prevalence of Schizophrenia in Specific Populations:
Population Prevalence %
- General population ?
- Non-twin sibling of schizophrenia patient ?
- Child with 1 parent with schizophrenia ?
- Dizygotic twin of schizophrenia patient ?
- Child of 2 parents with schizophrenia ?
- Monozygotic twin of schizophrenia patient ?
A
Prevalence 1 % 8 % 12 % 12 % 40 % 47 %
K&S p. 470
16
Q
PET studies of dopamine receptors document an increase in D2 receptors in the ____________ of drug-free patients with schizophrenia. There have also been reports of increased dopamine concentrations in the amygdala.
A
caudate nucleus
K&S p. 471
17
Q
One theory, based in part on the observation that patients often develop schizophrenic symptoms during adolescence, hold that schizophrenia results from _____________ of synapses during this phase of development.
A
excessive pruning
K&S p. 471
18
Q
CT scans of patients with schizophrenia have consistently shown lateral and ____ ventricle enlargement and some reduction in ______ volume.
A
third ventricle
cortical volume
K&S p. 471
19
Q
True or false: “The hippocampus is not only larger in size in schizophrenia, but is also functionally abnormal as indicated by disturbances in glutamate transmission”.
A
False
- it is smaller in size
K&S p. 472
20
Q
Some studies of the thalamus show evidence of volume shrinkage or neuronal loss, in particular sub nuclei. The total # of neurons, oligodendrocytes, and astrocytes in the medial dorsal nucleus of the thalamus is reduced by ______ % in schizophrenic patients.
A
30-45%
- the volume of the thalamus is similar in size between schizophrenics treated chronically with medication and neuroleptic-naive subjects.
K&S p. 472
21
Q
True or False: No well-controlled evidence indicates that a specific family pattern plays a causative role in the development of schizophrenia.
A
True.
- Many studies have indicated that in families with high levels of expressed emotion, the relapse rate for schizophrenia is high.
K&S p. 475
22
Q
What is criteria A for Schizophrenia in DSM-5?
A
A. TWO (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated. At least one of these must be 1, 2, or 3.
- Delusions
- Hallucinations
- Disorganized speech (e.g., frequent derailment or incoherence)
- Grossly disorganized or catatonic behaviour
- Negative symptoms (i.e., diminished emotional expression or avolition).
(note the absence of needing only 1 criteria if delusions are bizarre, or hallucinations consist of a voice keeping up a running commentary or 2 or more voices conversing which was present in DSM-IV-TR)
23
Q
What is hebephrenic schizophrenia?
A
- disorganized schizophrenia.
This wording is used in the ICD-10 as a subtype of schizophrenia.
K&S p. 476
24
Q
Name the subtypes of schizophrenia in DSM-IV TR.
A
- Paranoid type
- Disorganized type
- Catatonic type
- Undifferentiated type
- Residual type
Note the subtypes were elimated in DSM-5 due to limited validity, reliability, diagnositic stability.
25
What does the term oneiriod schizophrenic refer to?
Refers to a dream-like state in which patients may be deeply perplexed and not fully oriented to time and place. Patients are engaged in their hallucinatory experiences to the exclusion of the real world.
- look for medical/neurological causes.
K&S p. 479
26
Schizophreniform Disorder: an episode of the disorder lasts at least ___ month but less than ___ months.
at least 1 month but less than 6 months
DSM-5
27
Several studies have shown that patients with schizophreniform disorder have more affective symptoms (especially _______) and a better outcome than patients with schizophrenia.
mania
Note: Because of the generally good outcome, the disorder probably has similarities to the episodic nature of mood disorders. Some data, however, indicate a close relation to schizophrenia
Note: DSM-5 highlights its relationship to schizophrenia and does not mention any relationship to mood disorders.
K&S, p 498
28
True or False: the diagnosis of schizophreniform disorder does not require impaired social and occupational functioning.
True
DSM-5, p 97-98
29
Which is untrue?
Good prognostic features of schizophreniform disorder include:
a. onset of prominent psychotic sx's within 4 weeks of the first noticeable change in usual behaviour or functioning.
b. lack of confusion or perplexity
c. good premorbid social and occupational functioning
d. absence of blunted or flat affect
b. confusion or perplexity is a GOOD prognostic feature
DSM-IV TR and DSM-5
30
About ____ of patients with an initial diagnosis of schizophreniform disorder recover within the 6-month period and this remains their final diagnosis.
1/3
DSM-5 and K&S p. 500
31
The neurologic conditions most commonly associated with delusions affect the ______ and the ________.
limbic system and basal ganglia.
K&S, p 506
32
```
Which is untrue?
Risk factors associated with Delusional Disorder:
a. younger age
b. sensory impairment or isolation
c. family history
d. social isolation
e. personality features (e.g., unusual interpersonal sensitivity)
f. recent immigration
```
a. younger age, is untrue.
- Advanced age is a risk factor (mean age of onset is 40 yrs old).
K&S, p 506
33
Patients with delusional disorder use primarily the defense mechanisms of reaction formation, denial, and projection. Explain.
Reaction formation: defense against aggression, dependence needs, and feelings of affection and transform the need for dependence into staunch independence.
Denial: to avoid awarenes of painful reality.
Projection: consumed with anger and hostility and unable to face responsibility for the rage, they project their resentment and anger onto others and use projection to protect themselves from recognizing unacceptable impulses in themselves.
K&S, p 506
34
List the 7 subtypes of Delusional Disorder (note that they are the same in DSM-IV TR and DSM-5).
```
Erotomanic
Grandiose
Jealous
Persecutory
Somatic
Mixed
Unspecified
```
DSM-5
35
Does the jealous subtype of Delusional Disorder usually afflict men or woman?
Men, often those with no prior psychiatric illness.
K&S, p 508
36
Does the erotomanic type of Delusional Disorder usually afflict men or woman?
Women:
"such patients tend to be solitary, withdrawn, dependent, and sexually inhibited as well as to have poor levels of social or occupational functioning."
"They are generally unattractive women in low-level jobs who lead withdrawn, lonely lives; they are single and have few sexual contacts." !!! (yikes, I'm guessing a woman didn't write this).
Direct quotes from K&S, p 508.
37
The 3 main areas of content for the somatic subtype of Delusional Disorder include...?
1. delusions of infestation (including parasitosis)
2. delusions of dysmorphophobia (misshapenness, personal ugliness, exaggerated size of body parts)
3. delusions of foul body odours (sometimes called bromosis) or halitosis.
K&S, p 509
38
What are some examples of the unspecified subtype of Delusional Disorder?
- Capgras syndrome (a familiar person has been replaced by an imposter)
- Fregoli phenonenom (a familiar person can assume the guise of strangers)
- Intermetamorphosis (familiar persons can change themselves into other persons at will)
- Cotard syndrome (nihilistic delusions)
K&S, p 510
39
What symptoms are present with neuroleptic-induced Parkinsonism?
```
Muscle stiffness (lead pipe rigidity), cogwheel rigidity, shuffling gait, stooped posture, and drooling. The pill-rolling tremor of idiopathic parkinsonism is rare, but a regular, coarse tremor similar to essential tremor may be present.
The so-called rabbit syndrome, a tremor affecting the lips and perioral muscles, is another parkinsonian effect seen with antipsychotics.
```
K&S, p. 992
40
Neuroleptic-induced Parkinsonian adverse effects occur in about ___ % of patients who are treated with antipsychotics, usually within 4 to 90 days of the initiation of treatment.
15%
K&S, p 992
41
Patients who are elderly and _______ are at the highest risk for neuroleptic-induced parkinsonianism.
female
K&S, p 992
42
Neuroleptic-induced parkinsonism can be treated with ?
- anticholinergic agents (Benztropine/Cogentin)
- antihistamines (Amantadine/Symmetrel or Diphenhydramine/Benadryl)
K&S, p 992
43
Neuroleptic-induced parkinsonism is caused by the blockade of D2 receptors in the ?
- caudate at the termination of the nigrostriatal dopamine neurons.
K&S, p 992
44
The mechanism of action in neuroleptic-induced acute dystonia is thought to be ?
- dopaminergic hyperactivity in the basal ganglia.
K&S, p 992
45
The development of dystonic symptoms is characterized by their early onset during the course of treatment with neuroleptics and their high incidence in ______, in patients younger than ___ years, and in patients given high dosages of high-potency medications.
- men
- 30 years
K&S, p 992
46
Neuroleptic-induced acute dystonia include what symptoms?
- oculogyric crises, tongue protrusion, trismus, torticollis, laryngeal-pharyngeal dystonias, and dystonic postures of the limbs and trunk.
- other dystonias include blepharospasm and glossopharyngeal dystonia
- children are likely to have opisthotonos, scoliosis, lordosis, and writhing movements.
K&S, p 992
47
How do you treat neuroleptic-induced acute dystonia?
- IM anticholinergics or IV/IM diphenhydramine (50 mg).
- Diazepam 10 mg IV, amobarbital, caffeine sodium benzoate, and hypnosis have also been reported to be effective.
K&S, p 994
48
True or False?
| Middle-aged men are at increased risk of akathesia.
False.
Middle-aged WOMEN are at increased risk of akathesia.
K&S, p 994
49
What is the most efficacious drugs for treating akathisia?
Beta-adrenergic receptor antagonists
(ex. propranolol/Inderal 20-40 mg po TID)
K&S, p 994
50
Symptoms of neuroleptic-induced tardive dyskinesia include: ?
Abnormal, involuntary, irregular choreoathetoid movements of the muscles of the head, limbs, and trunk.
- perioral movements are most common (darting, twisting, protruding movements of the tongue; chewing and lateral jaw movements; lip puckering; and facial grimacing.)
- Finger movements and hand clenching
- Torticollis, retrocollis, trunk twisting, pelvic thrusting
K&S, p 994
51
Symptoms and signs of neuroleptic malignant syndrome include: ?
- Motor/Behavioural sx's: muscular rigidity, dystonia, akinesia, mutism, obtundation, agitation
- Autonomic sx's: high fever, sweating, increased HR and BP
- Lab findings: increased WBC count, increased creatinine phospohokinase, liver enzymes, plasma myoglobin, myoglobinuria.
K&S, p 995
52
Tardive dyskinesia develops in about _____ % of patients who are treated for more than a year.
10-20 %
- Women are more likely to be affected by TD than men.
K&S, p 994
53
True or False?
In neuroleptic malignant syndrome, men are affected more frequently than women, and young patients are affected more commonly than elderly patients.
True
- the mortality rate can reach 10 - 20 % or even higher when depot antipsychotic meds are involved.
K&S, p 995
54
How do you treat neuroleptic malignant syndrome?
- supportive measures (IV hydration, cooling blankets, ice packs, ice-water enema, oxygen, antipyretics)
- Bromocriptine (2.5 mg po bid or TID, max 45mg/day)
- Dantrolene (1 mg/kg/day x 8 days, then po x 7 days)
- Amantadine (200-400 m po/day in divided doses)
- ECT
- Could use benzos or levodopa/carbidopa
K&S, p 995
55
Restless leg syndrome peaks in ____ age and occurs in 5 % of the population.
middle-age
- the cause is unknown, but it is a rare side effect of SSRIs (as is nocturnal myoclonus).
K&S, p 997
56
Who coined the term 'demence precoce' in 1852 to descibe young patients with premature dementia?
Morel
- Kraepelin translated Morel's term into dementia praecox.
Note: In 1801, Pinel introduced the term 'demence' to describe the mental deterioration seen in hospitalized psychiatric patients.
uOttawa
57
Who established sub classifications of Dementia Praecox, including
- Hebephrenic (term coined by Hecker, 1871),
- Catatonic (coined by Kahlbaum 1874), and
- Paranoid (Kahlbaum 1873)?
Emil Kraepelin (1856-1926)
- He also seperated major psychotic illnesses into affective (manic-depressive) and non-affective (dementia praecox)
uOttawa
58
True or False?
Ernst Kretschmer compiled data to support the idea that schizophrenia occurred more often among persons with asthenic (i.e., slender lightly muscled physiques), athletic, or dysplastic body types rather than among persons with pyknic (i.e., short, stocky physiques). He thought the latter were more likely to incur bipolar disorder.
True
K&S
59
True or False: Schneiderian first rank symptoms should NOT be viewed as pathognomonic for schizophrenia.
True
uOttawa and K&S
60
List the Schneiderian First Rank symptoms:
A (auditory)
B (broadcasting and insertion, withdrawal)
C (control i.e. passivity experiences)
D (delusional perception)
- Note that thought blocking is not listed
uOttawa
61
In Schneiderian first ranks symptoms; auditory hallucinations consist of ...?
- voices repeating thoughts out loud
- 2 or more voices discussing the patient or arguing about him/her, referring to the patient in the third person
- voices commenting on patient's thoughts or behaviour, often as a running commentary
uOttawa
62
In Schneiderian first rank symptoms; what is meant by passivity phenomena, and delusional perception?
Passivity phenomena:
- experience of feelings, impulses, or acts being under external control (ideas or delusions). Referred to as made affect or made impulses etc.
- experience of being a passive recipient of bodily sensations imposed by some external agency (somatic hallucination)
Delusional perception:
- normal perception followed by a delusional and highly personalized interpretation
uOttawa
63
Cannon et al. 2008, using the SIPS, found which 5 features to be most predictive of progression to schizophrenia from a prodromal phase?
- genetic risk with recent deterioration
- higher levels of unusual though content (attenuated positive symptoms)
- higher levels of suspicion/paranoia (attenuated positive symptoms)
- greater social impairment
- history of substance abuse
uOttawa
64
What are the role of antipsychotic meds in the prodromal phase of schizophrenia?
- Antipsychotic meds are still in research phase for the prodrome and are NOT indicated at present.
- some early evidence for Omega 3 fish oil
- active f/u
- supportive and family therapy
- education
- monitoring of safety issues
- treat co-morbid conditions if present
uOttawa
65
Auditory hallucinations are reported in what % of patients with schizophrenia?
- 50-70% (Andreasen & Flaum 1991; Hoffman et al, 2001)
- not pathognomic
- can range from sounds to voices, muffled to clear, inside or outside the head, single or multiple voices, recognized or not, constant or not.
uOttawa
66
What are haptic/kinesthetic hallucinations?
- physically impossible sensations such as heat, cold or electric shocks, usually coming from inside the body.
uOttawa
67
Cognitive deficits in chronic schizophrenia: which cognitive domains show the largest effect size compared to controls (Heinrichs & Zakzanis, 1998)
- Global verbal memory
- Performance IQ
- Full scale IQ
- Continuous Performance test (attention)
- Word fluency (language function)
Overall: they found that neurocognitive dysfunction is a reliable finding in chronic schizophrenia (estimated 61-78% of cases); however no single cognitive domain or test is able to completely separate schizophrenia and control distributions.
uOttawa
68
Overall, individuals presenting with a first episode of psychosis tend to exhibit generalized cognitive impairment with evidence of relatively selective impairment in:
- Memory (immediate delayed verbal and visual memory)
- Attention and information processing speed
- ????
- Executive functioning (e.g. mental flexibility, conceptual reasoning, abstraction, sequencing)
However, substantial compromise in a wide range of domains which are present at onset and prior to onset.
uOttawa
69
True or False: depressive, anxiety and/or manic symptoms may be present in the acute phase of schizophrenia.
True.
- thought by many to be an inherent domain of the syndrome of schizophrenia
- often respond to tx with antipsychotics
- do not tx with a "thymoleptic" (antidepressant or mood stabilizer) unless a full mood syndrome is present for a significant length of time, or predates the onset of psychotic sx's, or is present after psychotic sx's are controlled, or there has been a full mood syndrome historically.
uOttawa
70
Risk factors for schizophrenia include: ?
- genetics
- winter birth (small relative risk on the order of 10% increase possible relation to maternal influenza in second trimester)
- maternal infections and birth complications
- advanced paternal age (>55 yrs)
- substance use (marijuana, early use, heroic dose)
- ethinicity and immigration
- autoimmune processes
- urbanicity
uOttawa
71
Expand on the reasons for ethnicity and immigration being risk factors for developing schizophrenia.
"United Kingdom, immigrants from Africa or the Caribbean and their second-generation offspring have rates of schizophrenia up to 10 times higher than those in the general populations".
"Immigrant groups who do not have black skin do not have higher rates and because second-generation is affected, the stresses of immigration are unlikely to be causative".
uOttawa
72
Expand on the evidence for autoimmune diseases/processes as a risk factor for schizophrenia
- small but consistent literature suggests persons have schizophrenia may have resistance to autoimmune disorders.
- studies have consistently shown individuals who have schizophrenia are less likely to have rheumatoid arthritis.
- other autoimmune disorders that have been linked to schizophrenia include thyroid disorders, type 1 diabetes, celiac disease
- ongoing clinical trials of anti-inflammatory and antibiotic agents for schizophrenia
uOttawa
73
Which is untrue of the prodromal course of illness in schizophrenia?
1. Cognitive deterioration begins before onset of psychosis
2. 25-50% have poor premorbid adjustment
3. Negative symptoms tend to occur approximately 6 months before the initial psychotic episode
4. Positive symptoms onset much closer to the first hospitalization
3. Negative symptoms tend to occur approximately 5 years before the initial psychotic episode.
uOttawa
74
True or False: women have higher lifetime risk of developing schizophrenia approximately 30-40% higher lifetime risk of developing schizophrnia.
False: men have higher lifetime risk
uOttawa
75
True or False:
| Premorbid social competency is among the best predictors of long-term outcome in schizophrenia.
True
uOttawa
76
True or False: schizotypal PD is more common in relatives of schizophrenic probands.
True; Absolute rates vary widely across studies, from 4.2 to 26.8%.
- Also the risk for non-schizophrenia psychotic disorders (especially schizoaffective and psychosis NOS) is increased in relatives of schizophrenia probands; 9% average.
uOttawa
77
A 22q11 microdeletion is associated with a velocranial facial syndrome. The risk of schizophrenia for a patient with 22q11 micro deletion is ___ to ____ x the general population.
25-30 x the general population.
- Rate of this micro deletion in schizophrenia is 12 to 80 x higher than the gen. pop.
- includes Proline Dehydrogenase (PRODH) varients and Catechol-O-Methyltransferase (COMT) polymorphism.
- PRODH encodes for an enzyme that could indirectly influence glutamate-mediated transmission.
- COMT has a role in dopamine catabolism. A functional polymorphism that substitutes a valine for methionine reduces the activity of the enzyme. Having more copies of the methionine allele would result in higher dopamine levels and thus might be expected to increase the risk of schizophrenia.
uOttawa
78
Risk factors of developing NMS include: ?
- underlying medical illness
- male gender
- rapid dose increase
- use of IM med
- dehydration
- extreme psychomotor abnormalities
- affective disorder
uOttawa
79
What are risk factors for developing NMS?
```
young age
male sex
dehydration
organic brain syndrome
exhaustion
agitation
rapid or parenteral antipsychotic administration
```
CHPD 18th ed.
80
What 5 characteristics define metabolic syndrome?
1. Abdominal obesity - waist circumference: Men > 102 cm (40 in)/ women >88 cm (35 in)
2. Triglycerides > 1.7 mmol/L
3. HDL cholesterol: men < 1.0mmol/L; women < 1.3 mmol/L
4. Blood pressure >130/85 mmHg
5. Fasting glucose: 5.7-7.0 mmol/L
CHPD 18th ed.
