Mental Health & wellness exam 1 Schizophrenia`

what is the diagnostic criteria for schizophrenia

duration of active psychotic sx is a month or longer. if treated then shorter. total duration of illness is 6 mo or longer. must have cognitive impairment and disorganization. idiopathic cause. dysfunction in one or more life domains.

how to describe someone who has schizophrenia

Lack of insight that sx are a product of mental illness that needs tx. deteriorating personal appearance/hygiene, depression/anxiety sx and suicidality, abnormal motor activity, doens’t stick to tx, also drug and alcohol users

what sx do we look for in schizophrenia

+ sx, - sx, cognitive dysfunction

what is psychosis

condition affecting the way brain processes info causing person to lose touch with reality. can be auditory or visual hallucinations, and delusional beliefs

what are positive sx

aka psychotic sx. something new added. hallucinations, perception changes, delusions, catatonia (manual movement)

what are negative sx

taking away something. loss of motivation, blunt affect, social withdrawal, avolition (no motivation), alogia (bad speech), anhedonia (no pleasure)

what are cognitive sx

deficits of memory, attention, reasoning or problem solving, social cognition, IQ

how to diagnose scizophrenia

looking at characteristic s/sx, the timing and course of illness, the adverse impact on functional capacity, idiopathic nature.

what schizo sx are more persistent

negative sx and cognitive deficits. positive is more episodic

what age demographic has the most severe form of schizophrenia

prior to 10 yrs old

What sex and race demographic have more sx of schizophrenia

males, who are diagnosed in adolescence or early childhood. after age 45 women are in favor. migrants more likely to have schizo.

what time of the year makes you more likely to have schizo

late winter and spring months

what is the link between pregnancy and schizo

mothers who have influenza in second trimester cause impaired fetal growth and L&D complications. maternal malnutrition and Rh incompatibility also.

what is the link between fathers and schizophrenia

older fathers cause schizophrenia

how does environment contribute to schizophrenia

higher altitudes contribute to schizo

this hypothesis is the most widely accepted hypothesis of schizophrenia cause is

dopamine hypothesis. affects motor control, sensation, behavior, cognition, motivational systems and reward systems.

What is the dopamine hypothesis

chronic adminsitration of dextroamphetamine produces psychosis similar to schizo. Inhibits reuptake.

How to explain positive sx of schizo

constantly having dextroamphetamine causes psychosis similar to schizo. also, antipsychotics dec dopamine activity which means that dopamine causes positive sx of schizo (from chlorpromazine/thorazine)

how to explain negative symptoms for schizo

reduced blood flow to frontal cortex and inconsistencies in CSF levels of dopamine metabolites indicate schizo disrupts DA function. reduced DA transmission in prefrontal cortex (D1 receptors) and inc DA in stratum (D2/D3 receptors) is an explanation for psych sx.

serotonergic hypothesis of schizo

serotonin and dopamine interact in different areas of the brain. abnormal serotonin activity is a reason for schizo. LSD-like effects happen when serotonin is blocked. Visual hallucinations, thought disorders, auditory hallucinations, bizarre behavior

how does 5-HT affinity lead to schizo

atypical antipsychotics (risperidone, quetiapine) are 5-HT antagonists. when you have a greater affinity for 5-HT compared to a D receptor you have a decreased EPS and can improve negative and cognitive sx

what is the glutamatergic hypothesis of schizo

dec glutamate levels in CSF in pts with schizo. taking a NMDA receptor antagonists (phencyclidine or ketamine) can cause positive, negative, and cognitive dysfunction sx in nl pts which is similar to schizo. compounds that enhance NMDA receptor function (glycine, d-cyclocerine) can dec neg and pos sx of schizo when also given with antipsychotics

GABAergic hypothesis

GABA in inhibitor neurotrans that when deficit can affect cell firing

Cannabinoid Hypothesis

natural and synthetic (spice, k-2) cannabis associated with psychosis. Induce full range of schizo positive, negative, and cognitive defects.when adolescents are exposed it inc risk 2-4x of developing schizo

Genetic hypothesis

fam hx of schizo is a big risk factor. 80% heritability.

How many sx need to be present in order to diagnose schizophrenia

2/5 types of sx. the 4 + sx are delusions, hallucinations, disorganized speech, and groosly disorganized/catatonic behavior. the 5th one is a negative sx like diminished emotional expression or evolution

what are the four schizo positive sx

delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior

what are schizo delusions

fixed false belief not normally held within the person, errors of influence (illogical misinterpretations of actual events)

delusion of control

thoughts feelings actions are being controlled by outside forces (chip in my brain)

delusions of grandiosity

belief of powers and gifts. (pts think they have PHDs,Drs, say things with confidence as if they’re right)

delusions of guilt

belief they committed a terrible crime and deserve punishment (they did nothing)

delusions of reference

belief that actions of others have a personal meaning to them. (something a news person said they think is speaking to them)

persecutory delusions

believe theyre being conspired against (FBI CIA aliens coming for them)

somatic delusions

someone is carrying a disease not supported by medical evidence; is bizarre (ever since covid shot i have poison gas coming out of my arm)

thought insertion, withdrawal, or broadcasting

belief that one’s own thoughts was implanted from outside orgs (insertion), someone’s thoughts were taken out of their mind (withdrawal) or someone’s thoughts can be heard via telepathy (broadcasting)

hallucinations occur how often and appear how

occur several times a day. appear in form of one or more voices that keep a commentary. can be unfriendly. command auditory hallucinations (voices tell them to do acts that can harm themselves or others)

disorganized speech/behavior

underlying impairment of thoguht process aka thought disorder. Cardinal feature of schizo. result in significant impairment and are obvious to others

unprovoked laughter, hysterics, hyperactive or violent behavior, inappropriate social behaviors, neglect of hygiene or weird clothes. this is an example of

disorganized behavior

circumstantiality as disorganized speech can be described as

excessive detail when answering a question

tangentiality as disorganized speech can be described as

deviating from the intended answer to something related but not the right answer

derailment as disorganized speech can be described as

quickly changing subjects and not answering question

illogicality as disorganized speech can be described as

illogical responses to logical questions

concrete speech as disorganized speech can be described as

can’t use abstract thinking, literal thinking. can’t interpret grass isn’t always greener on the other side

incoherence as disorganized speech can be described as

incomprehensible speech; word salad

clanging as disorganized speech can be described as

using words bc of how they sound. cart, smart, start

neologism as disorganized speech can be described as

using nonsensical words, combining parts of other words

thought blocking as disorganized speech can be described as

sudden interruption of speech or thought

what are negative synmptoms of schizo

defecit of normal function, not considered psychotic. primary don’t respond well to tx and cause more dysfunction than positive sx, secondary are side effects of depression tx, don’t stay and respond to tx of underlying issue

affective flattening as a negative sx can be described as

no outside emotions. no spontaneous movement, expressive gestures, eye contact, flat voice

avolition as a negative sx can be described as

no motivation to leave bed or get put together. loss of interest of persons surroundings. from pressure of voices

alogia as a negative sx of schizo can be described as

dec production of fluency of speech. absence of individual thought. long pauses before answering questions

anhedonia as a negative sx can be described as

absence of pleasure

attention deficits as a negative sx can be described as

cant stay engaged in activities. social withdrawal, can’t feel close to others.

what mild neurological deficits are present in a pt with schizo

abnl body movements, gait, mannerisms, or reflexes

what cognitive dysfunction is present in a pt with schizo

impaired attention, working memory, visual spatial memory, semantic memory, recall, and executive function

what can you use to support diagnosis of schizo

no labs or neuroimaging

peak age of first psychotic episode of schizo is what and what sx show first

early to mid 20s for males and late 20s for female. prodromal phase before psychotic break. people can notice something is off.

how to describe the active phase of schizo

first psychotic break aka active phase. usually happens in big life stress or substance use. the longer the psychosis is the worse tx results are. after starting tx on first episode then 1/3 of people have a good course of illness. if you tx late its too late to reverse anything

what is the residual phase of schizo

persisting schizo sx. out of 2/3 people who respond bad to initial tx, half will have stable course but still have residual effects. others will deteriorate. negative sx are less responsive to tx. positive sx are better treated

how do you diagnose someone with schizo

have a really detailed workup with constant pt interviews and additional hx from other sources. secondary cases of psychosis can be ruled out from a good hx mental status exam, physical and neuro exams and labs

substance induced psychosis disorder

recent drugs of abuse. alc, marijuana, meth, cocaine, bath salts. also can be meds like steroids, digoxin, disulfiram, varenicline

how to describe mood disorders with psychotic features

determines whether the mood and psychotic sx occurred at the same time, independent from mood sx, or whether the mood sx were brief in comparison to the total time of sx. when modo and psych sx are present at the same time a diagnosis of mood disorder w psych features OR schizoaffective disorder can be made. when the pt is finished with their sx they resume to normal function and mood. schizo pts never return to complete nl

how are different personality d/o similar to schizo (paranoid, schizotypal, schizoid, BPD)

pts are suspicious or hyper vigilant (paranoid personality d/o) with differences in appearance and behavior, perceptual distortions, and lowered capacity for close relationships (schizotypal personality d/o). can’t have relationships and go into extreme isolation (schizoid personality d/o). BPD pts are prone to stress induced paranoia and hallucinations

how are anxiety disorders similar to schizo (PTSD, OCD)

PTSD pts have hallucination like sx and fearful behavior. you can get info out of them about a past event. OCD pts have intrusive thoughts and compulsive rituals that can mimic psychosis

how do pts with hypochondriasis or body dysmorphic disorder have similar sx to schizo

both believe there is a disease or bodily defect with no real evidence. only difference is that there are no hallucinations and disorganized sx that characterize schizo

how to determine if a pt has schizo based off of their negative sx alone

you need to make sure the pt doesn’t have another condition that can be causing these sx. delirium, frontal lobe injury, space-occupying lesion, substance abuse, hypothyroidism, severe depression, bipolar mania, Parkinson’s, and antipsychotic induced akinesia

what are the five major targets of treatment for schizophrenia

positive sx, negative sx, conceptual disorganization, neurocognitive deficits, anxious/depressive sx, and suicidality.

how do positive sx (hallucinations, delusions, disorganized speech/behavior) respond to antipsychotic drug tx

respond well. severity of pos sx don’t correlate to long term functioning. you can have the worst hallucinations but with tx you can live a semi normal life

how do negative sx (anhedonia, flat affect, alogia, social withdrawal) respond to antipsychotic drug tx

harder to tx bc drug stops voices but not sadness. it can show if a pt will have long term functioning. second gen atypical antipsychotics are better at treating negative sx

what first gen/typical/conventional antipsychotics help schizo and what is the drugs MOA

aka neuroleptics. Chlorpromazine. blocks dopamine receptors. txs + sx but has antidopaminergic results (causing EPS and hyperprolactinemia). 70% of pts respond to tx as soon as 1 week, remaining 30% don’t show improvement for at least 6 weeks. lower doses are as effective as higher doses w less side effects.

side effects of neuroleptics

Neuralgic effects like EPS can happen within normal dose range. other acute effects like parkinsonism (resting tremor, bradykinesia, unstable gait), akathisia (restlessness and psychomotor agitation), dystonic reactions (sudden involuntary muscle contraction), tardive dyskinesia (involuntary movement d/o in face, so grimacing, eye blinking, sticking out tongue. irreversible and life threatening)

parkinsonism, akathisia, dystonic reactions (sudden muscle contraction). EPS happens in normal limits of dosing. tardive dyskinesia (repetitive involuntary movement like grimacing eye blinking stick out tongue), can be irreversible or life threatening. drug has affinity to other receptors like histamine causing sedation, weight gain, alpha causes orthostatic HTN, muscarinic causes blurred vision and dry mouth

what effects do 1G antipsychotics have on different neurotransmitter receptors

histamine-1 receptor block = sedation, weight gain. alpha-1 adrenergic receptor blockage = sedation, orthostatic hypotension, reflex tachycardia. muscarinic-1 cholinergic receptor = blurry vision, dry mouth, urinary retention, constipation

what are 2G antipsychotics

aka atypical antipsychotics.. less EPS and TD side effects. Clozapine is most effective, but also risperidone, olanzapine, quetiapine, ziprasidone. weak D2 receptor block with good serotonin block. preferred to be given as long-acting injections

side effects of second gen antipsychotics aka atypical

agranulocytosis. lo granulocyte count causes life threatening blood disorder that can allow for serious infection from immunosuppression. this is why Clozapine is prescribed only when typical antipsychotics have failed or pt is at hi risk of suicide. you constantly monitor CBC.

why is clozapine important

first drug to alleviate both + and - sxs in pts who don’t respond to typical antipsychotics. no EPS, TD or hyperprolactinemia but can cause agranulocytosis. reduces depression and suicidality. dec in mortality, improved cognitive function in verbal fluency, attention, and recall

what is neuroleptic malignant sydrome

idiopathic rxn to neuroleptic meds. hyperthermia, AMS, autonomic dysfunction (tachycardic, diaphoresis, tachypnea, inc BP). this happens when you inc the dose of antipsychotics

phases of schizo tx

acute, continuation, maintenence

what is the acute phase of schizo tx

fully expressed psychotic sx, pt needs to be hospitalized bc of life threatening combativeness. pt given injectable med like haloperidol and lorazepam to sedate them. once controlled they give oral 2G antipsychotic PO.

how does continuation phase of schizo tx work

most pts don’t fully respond to 2-6 wks of initial tx and can early relapse. this phase monitors adherence, response, and tolerance of drug. make sure pt doesn’t stop drugs before 4-6 wks of therapy has been used. after they are stable, continue tx for 6-8 weeks

how does maintenance tx for schizo work

preventing relapse and optimize their psychosocial functioning. monitoring comorbidities, address other psych or substance disorders. non-adherence is primary reason for relapse. most pts are tx forever

how to describe treatment refractory schizophrenia

failure of 2 therapeutic trials of antipsychotics from both classes. Clozapine helps pts that are tx resistant.

psychotherapeutic interventions, educating fam, case management can help schizo pts how

cognitive behavioral therapy, social skill training, cognitive remediation, acceptance and commitment therapy, psychotherapy. also important to maintain a calm household so inform families. if pt doesn’t have a home or finances case management can help these people

how do most schizo pts result in their tx

there is some remission but pt has other residual sx and dysfunction. pt can also have periodic sx exacerbation. the sooner you attack the problem the more likely the pt can live a nl life on meds. under half of pts still have psychotic sx. low grade residual sx can impact work, relationships, self care, living independently

pt is 22 year old female, normal ct/mri, has sx of catatonia, paranoia, depression, schizoaffective diagnoiss, atypical sx and confusion. pt has kept the same job. sx were quick to present and progressed quickly. she’s felt like her sx have been going on for 2 mo. will the course of tx provide a better or poorer outcome for the pt

better

pt is 16 yr old male. ct shows dilated ventricles. pt has sx of depression, flat affect, anhedonia, catatonia, and OCD sx. he has had 4 different jobs in the past 6 mo. his sx have been persistent but haven’t been expressed until recently, in which they are very serious. he has been feeling like this for years. will the course of tx provide a better or poorer outcome for the pt.

poorer