Week 2 lecture SChizophrenia

What type of disorder is schizophrenia

Psychotic disorder, which is a disorder in thought processing making it difficult to understand what is reality or not

Disorder of thoughs perception and behavior

Diruption between thought and reality

Is schidozprenia curable

No it is lifelong can be improved has perioids of exhasuration and remission

Is schizophrenia usually seen alone or comorbidlly with other disorders

Seen highly with other psychiatric disorders that involve substance abuse

What are the 5 common core symptoms of schizophrenia

Delusions

Hallucinations

Disorganized thoughts

Abnormal motor movements

Negative symptoms like anhedonia anergia

How long does a brief psychotic disorder last for

LEss than one month

What happens during a brief psychotic disorder

Hallucinations: Seeing/ hearing things that are not ther

Delusions: Fixed false beleifi

How long do you have to have schizophrenic symptoms to be dx with schizo-phreniform

More than 1 month less than 6 months

What is the timeline to be dx with schizophrenia

Have symptoms that last more than 6 months

Whats the differentece between negative and postive symptoms in schizophrenia

negative: loss of normal emotion causing loss of daily functions

Postive: additions to life causing excess distortions in normal reality

What is anhedonia

Lack of pleasure in things that used to bring pleasure

What is Flat affect

lack of emotional expression

Minimal facial responsiveness

What is apathy

Lack of intetrest or enthusiasm in events or tings

What is angergia

Lack if energy

What is alogia

lack of speech

What is avolition

Lack of motivation

What are teh postive symptoms of schizophrenia

hallucinations

Delusions

Disordered behavior

Disorganized speech

What are cluster A personality disorders

Schizo-affective disorder

Schizoid

What is schizo affective disorder

schizophrenia + mood disorder like depression/biopolar

What is schzoid

Detatchment from relationships, loner, zero relationships a

Difference between psychosis and schizophrenia?

Psychosis is a collection of symptoms similar to schizophrenia, its not a disease

Schizophrenia has psychosis symptoms + other things like disorganized thinking and impaired functioning

Schizophrenia has recurring psychotic episoides

Is pychosis a disease or symptoms

Its a collection of symptoms

What % of the world has schizophrenia?

1%

Are there any non modfiable that effect is a person gets schizophrenia llike race gener age

No But males tend to have an earlier onset

are suicide and schizophrenia linked

Yes approx 10-50% of schizophrenia pts attemps to suicide at some point and 10% are succesful in it

What is the prodomal phase of schizophrenia?

This is the onset phase where subtle changes in behavior and mood occur

Symptoms are not clear bc they come and go

What is the acute phase in schizophrenia?

This is where the Pt gets hospitilized and given medication bc their symptoms are severe adn clear

What is the stabilization phase in schizophrenia?

Acute postive symptoms stop graduly allowing pt to return back to baseline and recovery begins

What is the maintenance phase of schizophrenia?

Pt has a long term plan for treatmnet,

This is where it is importnat to know risk factors for treatment on adherance like stigma, medication non adherence and ioslaitoin

What is the pathophsyilogy cause of schizophrenia

Not exactly known but suspected genetic, neurobiological, cultural, psychological, and strucutural abnormalities

What is the dopamine hypothesis for etiology of schizophrenia?

Excess dopamine in limbic area

Deficient dopamine in prefrontal cortex

Dysregulated opamine in other areas

What is the theory on glutamate and NMDA receptors for causes of schizophrenia

Excess glutamate

How does genetics relate to schizophrenia etiology

Higher risk if first degree relative is dx

In a schizophrenic pt what would you expect to see in their anatomical brain scans

Decreased gray and white matter specifically in front lobe

Decreased Brain volume

Lower Blood flow

What are random risk factors that can cause schizophrenia?

Prenatal stress/infection

HEad injuries in infancy/childhood

Adnvaced parental age

immune triggers

immigrant refuggees

urban enviormental

drug use: Cannabis, Methamphetamine

Stress

What is the accronym for postive symptoms of schhizophrenia?

HDDSB

Hallusinations

Delusions

Disorganized speech

Disorganized behavior

What is the acronym for the negative symptoms of schizophrenia?

6 A’s

Anhedonia

Flat Affect

Apathy

Anergia

Alogia

Avolition

What are hallucinations

sensory expereiences that appear real

Can be many types

What is a auditory hallucination

Hearing voices or sounds that are not there
Most common type for schizophrenic patients

What is a visual hallucination

Seeing people, sillhouettes, shadows, are things thare not present

What is a olfactory hallucination what what is it linked in

Smelling odors that arent present

Linked to epilepsey

What is tactile hulutinations, what is it associated with

Feeling sensations that arent there like crawling under th skin burning shock

Assoicated with substance abuse

When interacting with a patient what are some behaviors form them that indicate they are experiencing hallucinations

Laughing/talking to oneself

Difficuluty answering questions or conversing

Difficulty paying attention

shifting eyes

moving head side to side

What is a delusion

False fixed belief that has no logic or is not real

What is a percecusion delusion

Beliving that one is being singled out for harm being hurt

What is a ideas of reference delusion

Ordinary everyday thinks are over reacted upon and belief that eveyrthing is relate to them

What is grandeur delusion

a belief that they are the best in teh world they hold extreme power

What is somatic delusions

Feeling that body parts are physically hurt rotting diease infected

What is nihilistic delusions

Belief that something bad is going to happen like catasprohpne or things are died

What is control delusion

Soemthing elsese other then thmselves have control over their life body actiosn and thoughts

What is religious delusion

False belifs that are centered around religoious thoughts

What is systematized delusion

A bunch of delusions that are interconnected to have one overall big delusion

What are some speech patterens seen in disorgnaized speech for schizophrenic pts

Loose assoicaitions

circumstantiallity

tangentaility

Word salad

Neologism

echolalia

clang associations

What is loose assoicatrions type of speech disorganized in schizophrenia

Fragmented flow of thinking where ideas jump around

What is circumstantiality speech disorder in schizophrneia?

Person give excessive information before envetually coming back to the main point

What is tangentiality speech disorder in schizophrenia

Goes on a tangent but does not come back to the main point

What is neologism speech disoorder in schizophrenia

Words invented by the patient and only has meaning to the patient and no one else

What is word salad speech disorder in schizophrenia

Can say words but they are random and do not make sense

What is echolalia speech disorder in schizophrenia

REpeating waht soemone said

What are the bizzare behaviours that schizophrenia pts have

Paranoia: Irratioinial distrust in other/things

Personal Boundary Difficulties : Depersonalization

Derealization: Feeeling like things arent real

Bizzare behavior: Clothing, social events, repeitive behaviors

What are the cognitive symptoms of schizophrenia

disordered thinking

Inanbility to make decusions

Poor problems solving ability

difficultuy concerntration

memory defiicites

What are affective symptom issues related to schizophrenia

depression

anxeity

suicdialy

dysphoria

What are the common comorbid disorders that are assosicated with schizophrenia

Substance abuse: drugs alcohol

Psychiatric disorder: panic, PTSD, GAD, SI

Mood Disorder: Depression, OCD

Medical illnesses: Type 2 diabetes, obestiy

What is Catatonia?

Specific type of schizophrenia

Extreme motor agitation or extreme motor retardation

What happens in the withdrawal phase of catatonia

patient does not move eat or speak (extreme motor retardation)

robot like response

bizzard posturing

How do you communicate to a patient with schizophrenia symptoms like psychosis

1) Speak Directly, Calmly and honestly

Validate their feelings, do not chalange them, but do not agree or play into their delusions

Valudate thier feelings of mistrist or emtoinal reaction

ask how they are feeling

Is there a diagnostic test for schizophrenia?

No you jsut have to make the DSM - 5 MSE

LAb test andother tes are used to rule other anything else that may present ones condiation like schizophrenia

How long much a person have schizophrenic symptoms to be dx with schiiphrenic

6 months with 1 month of active schizophrenic smpytoms

What are the general intervention goals for pts facing schizophrenic

Decreasing their anxiety and establishing test

Assisting Client to define and test reality

encoursing interactions iwht others

ensuring saftey of client and others

Meeting clients self care needs

promoring adaptive fmaily coping

demonstrating an ability to relate to other statusfcatory

What is dopamines role in schizophrenia

Excess dopamine causes schizophrenia

How do antipsychotics work, what specific receptors do they bind to

Binding to D2 receptors blocking it’s activity

What do typical antipsychotics 1 st genertation target to treat

Targets the postive symptoms of schizophrenia

What are the major side effects of 1st typical antipsychostics

Extrapyramidal symptoms (EPS)

Tardive Dyskinesia (TD)

What do atypical 2nd generation antipsychotics target

Both negative and psotive symptoms of schizophrenia

What are the side effects of 2nd generation antipsychotic atypical

LEss eps but more metabolic side effects

What receptors does first generation antiphysocic medication block

D2, H2, Alpha - 1, Musarinic (M1)

What effect does antipsychotics have on D2 receptor?

Blocking it produces an antipsychotic effect

What effect does antipsychotics have on H1 receptor?

Sedattion weight gain

What effects do antipsyhotics have on ALpha 1 receptor

ORhostatic hypotension

What effects do antipsychotics have on Muscarinic M1 Receptor

Produces Anticholinergic effects

When do EPS (Extrapyramidal sympotoms) occur and is it reversible

Early in disease and it is typically reversible

What are some signs of EPS ?

Dystonia: Involuntary muscle spasms on neck, eyes, face , tounge

Akathisia: Inhibility to stil still

Parkinsonism: Tremor, Rigidity, BRadykinesia

What is Dystonia in EPS

Involuntary msucle spasms on neck eyes face tounge

What is Akathisia in EPS and how will a PT describe this

Inhibility to sit still, Pt willl report internal restlessness

What is Parkinsonism in EPS

Bradykinesia

Tremor

Rigidity

What is the standard protocol when a patient is exhibiting extrpyramidal symptoms

Stop drug and switch to different drug

What is Tardive dyskinesia?

Side effect of antipychotic

Permanent uncontrollable abnormal movements

When does Tardive dyskinesia occur and is it permenant

6 months and it is permenant and irreversble

What is the AIMS scale used for

Assesment for tardive dyskinesia

How do atypical second generation antipyschotics work

They antagonize D2 receptors

They antagonize 5-HT2A Serotonin receptors

What are the postive and drawbacks of second generation medication

Positive: Less EPS and TD

Negative: Increased Metabolic side effects (metabolic syndrome)

What happens in metabolic syndrome in second generation antiphyscitoics

Obesity: BMI > 25

Elevated Triglycerides: >150

Decreased HDL <40

Hypertension > 160/ >90

Elevated fasting glucose

What % of schizophrenic pts are likely to develop metabolic syndrome

50% meaning it is important to