schizophrenic and other psychotic disorders

Who came up with the word "schizophrenia" and in what year?

1908, Eugene Bleuler

What does the word "schizophrenia" mean?

Greek schizo (split) phren phren (mind)

causes of schizophrenia

combination of genetics, biochemical dysfunction, physiological factors, and psychosocial stress

physiological factors can even be caused during

utero/exposures

schizophrenia has no ___ but many ____

cure, treatments

schizophrenia hospitalizations are

lengthy (longer than bipolar/MDD)

schizophrenia has approximately ___ % prevalence

1

Sometimes those with schizophrenia are "in remission." what does this mean?

no symptoms of psychosis for 10 years

__% of individuals with schizophrenia commit suicide

10

__-__% make at least one attempt

20-40

why do 10% of individuals with schizophrenia commit suicide

command auditory hallucination (voices telling you to do something)

risk factors for schizophrenia and suicide

male gender, under 45, depressive symptoms, hopelessness, unemployment, recent hospital discharge

substance and schizophrenia

comorbidity high with substance-related disorders

substance and schizophrenia nicotine dependence percentage

80-90%

Causes of Schizophrenia

uncertain, more than likely a combination of influences, genetics, chemical disturbances (excess dopamine), viruses, anatomical abnormalities (smaller frontal lobe), physical conditions

genetics

1% in general population 5-10% in families

excess dopamine

A lot of drugs target this

viruses

women who have the flu during pregnancy, child is more likely to develop schizophrenia

physical conditions

epilepsy, neuromuscular diseases, birth trauma, head injuries, alcohol use, tumors, stroke, parkinsons, more

symptom onset

late adolescence to early adulthood (may occur later in middle/late)

schizophrenia is usually diagnosed when?

in the late teens to early thirties

schizophrenia tends to emerge earlier in ___ and when?

males, late adolescence to early twenties

when does schizophrenia emerge in females

early twenties- early thirties

if a patient with 1st symptoms of schizophrenia is at 45, then we would need to rule out what first?

parkinsons

schizophrenia has ____ and ____ than can be caused by med changes or traumatic events

remissions, excacerbations

during the remission period, the patient usually continues to hhvave

flat affect and impairment in role functioning

what is not common in schizophrena?

a full return to premorbid condition

definition of schizophrenia

A brain disorder that affects how people think, feel, and perceive. The hallmark symptom is psychosis, such as experiencing auditory hallucinations (voices) and delusions (fixed false beliefs)

hallucinations and delusions can also be

visual, olfactory, tactile, respiratory

for those experiencing delusions and hallucinations, the nurse should not

argue with the patient, but ask them if they think it could be a paranoia

for those with schizophrenia their interpersonal cues and relationships are often

off

schizophrenia mood symptoms

patients often seem cheerful or sad in a way that is difficult to understand; they often are depressed (sad- may not meet criteria for MDD)

schizophrenia characteristics that first appear

schizoid personality: odd, introverted, seen as a teenager

schizophrenia signs and symptoms

indifferent to social relationships, limited range of emotions, lack of close relationships, "loners", cold and aloof, social withdrawal, impairment of role functioning, peculiar or eccentric, blunted or inappropriate affect, communication disturbances, bizarre ideas, unusual perceptual experiences, lack of interest/initiative

what is the most common symptom

lack of interest/initiative

DSM-V criteria for schizophrenia

Two or more of the following are present for a significant portion of time during a 1-month period (or less if successfully treated) and at least one must be delusions, hallucinations, disorganized speech

disorganized speech

frequent derailment or incoherence

other characteristic besides delusions, hallucinations, or disorganized speech

grossly disorganized or catatonic behavior, negative symptoms (diminished emotional expression or avolition)

catatonia

neuropsychiatric syndrome that disrupts a person's movement, speech, and behavior, causing a lack of or excessive, purposeless movement

catatonia symptoms

not responding to other people or environment, not speaking, holding their body in an unusual position, rejecting people who try to adjust their body, agitation, repetitive and seemingly meaningless movement, mimicking someone else's speech, mimicking some elses movements

why do they mimic someone else's speech or movement

they have a weak sense of self and they feel pressured trying to speak, so it makes them feel more comfortable to just repeat what someone else says

sign of catatonia: when you take someone's arm and move it to a position and their arm

stays there

social/occupational function has to be

off to meet criteria

social/occupational function is off for

a significant portion of the time

since the onset of the disturbance, the level

of functioning in 1 or more major areas

(eg, work, interpersonal relations, or

self-care) is below the level achieved

before onset.

When the onset is in childhood or adolescence, the expected level of interpersonal, academic or occupational

functioning is

not acheived

for schizophrenia we have to rule out

mood/depression

why do we have to rule out depression with schizophrenia diagnosis

it is a different diagnosis like schizoaffective disorder

schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either

1. no major depressive, manic, or mixed episodes have occurred concurrently with the active-phase symptoms

2. any mood episodes that have occurred during were attributed to schizophrenia (symptoms of sadness, elevated mood from psychosis)

we also have to rule out

medical/drugs

the disturbance is not attrubuted ti the physiologic effects of a _____ (ex.___) or another ____

substance (ex. drug abuse or a medication) or another medical condition

schizoaffective disorder

has features of both schizophrenia and a mood disorder (depression or bipolar)

the diagnosis of schizoaffective disorder is made when a patient has

features of both schizophrenia and either depression or bipolar but does not strictly meet diagnostic criteria for either alone

To confirm the diagnosis of schizoaffective disorder, what is important?

ongoing reevaluation over the course of the illness

schizoaffective depressive type

all criteria for schizophrenia and all criteria for MDD

schizoaffective bipolar type

all criteria for schizophrenia and all criteria for bipolar 1

what branch of schizoaffective disorder is very common

schizoaffective bipolar type

what diagnosis looks very similar to schizoaffective bipolar type

bipolar 1 with severe psychotic features

brief psychotic disorder symtpoms

must persist for at least one day but resolve in less than 30 days

for brief psychotic disorder, the patient can not

use substance or have another medical condition, no bipolar or depression with psychosis

brief psychotic disorder is a though disorder in which a person will experience

short term, gross deficits in reality testing, manifested with at least one symptom of delusions, hallucinations, disorganized speech, or disorganized or catatonic behavior

Folie a deux

rare psychiatric syndrome where delusions pass from one individual tp another

Folie a deux is where two people

share the same delusion or delusional system and support one another in this belief

those who have Folie a deux ussually have

an unusually close relationship

in order to have Folie a deux what must exist

temporal or contextual evidence that indicates the delusion was induced in the passive member by contact with the active partner

delusional disorder

presence of one or more delusions with a duration of one month or longer, criteria for schizophrenia have never been met

delusional disorder: Hallucinations, if present are

not prominent and are related to the delusional theme (ex. sensation of being infected with insects is associated with the delusions of infestation)

delusional disorder symptoms

persecutory, referential, grandiose, eotomania, nihilistic, somatic

persecutory

belief one is going to be harmed by individual, organization or group

referential

belief gestures, comments, or environmental cues are directed at oneself

grandiose

belief the individual has exceptional abilities, wealth, or fame

erotomania

false belief that another individual is in love woth them

nihilistic

conviction that a major catastrophe will occur (tornado, bomb, etc)

somatic

belief focused on bodily function or sensation

bizarre delusion example

belief that someone has removed an organ from your body without any physical evidence of procedure

non-bizarre delusion examples

being followed, being loved, having an infection, deceived by one's spouse

loose associations (derailment)

speech in which ideas shift from one unrelated subject to another, lack of connection between ideas

neologisms

newly coined or meaningless words

concrete thinking

literal interpretations

how to test for concrete thinking

make a joke and see how they take it

clang associations

rhyming, words are governed by sounds

clang association example

butt, mutt, gut, sometimes at the end of a sentence

word salad

groups of random words

circumstantially

delayed in reaching the point (they still reach the point jsut take forever to get there)

tangentiality

never gets to the point

mutism

refusal/inability to speak

Perseveration

persistently repeats word/idea

different types of hallucinationa

auditory (command), visual, tactile, gustatory, olfactory

Auditory Hallucinations questons

Are you hearing voices? what are they saying to you?

a lot of times auditory hallucinations are like

a conversation between 2 people

tactile

touch

gusatory

taste

olfactory

smell

gustatory and olfactory have to be

on going

illusions are

misperceptions/misinterpretations of real external stimuli

illusion example

seeing the cup slide across the table

affect terms

inappropriate, flat, blunted, constricted, full

inappropriate affect

Incongruent with circumstances, ex. something sad is happening and patient is laughing

flat affect

virtually no outward emotion

blunted affect

very little outward emotion

constricted affect

show some emotion but less than most other people