mental health exam 2

schizophrenia spectrum disorders

-includes schizophrenia, schizoactive disorder, delusional disorder, schozotypal disorder, brief psychotic disorder, schizophreniform disorder, and substance-induced psychotic disorder

-chronic, more severe disorder

-GOAL: RECOVERY

central theme of schizophrenia spectrum disorders

-PSYCHOSIS (universal symptom)

psychotic symptoms

-hallucinations

-delusions

-disorganized thoughts, speech, or behavior

emil kraepelin

first described disorder as “dementia praecox”

eugen bleuler

-determined the presence of several types of schizophrenia

where did the word schizophrenia come from?

greek words SKHIZO (split) and PHREN (mind)

-pieces of the mind aren’t fitting together

schizophrenia

-requires comprehensive, multidisciplinary tx

-severe deterioration of social and occupational functioning

of all mental illnesses, schizophrenia causes more…

-lengthy hospitalizations

-chaos in family life

-exorbitant costs to people and governments

-fears

(GOES HAND-IN-HAND W/ DEPRESSION)

epidemiology of schizophrenia

-lifetime prevalence: about 1%

-age of consent (usually late adolescence or early adulthood)

-gender differences (earlier diagnosis and poor prognosis in men)

-ethnic and cultural differences (racial groups have varying rates, but black men are more predisposed)

-familial differences (1st degree biologic relatives = 10x greater risk)

-if genetically predisposed, traumatic event can trigger outbreak of symptoms

biologic influences of schizophrenia

-neuroanatomic findings (enlarged lateral and third ventricles, total brain volume overall decreased)

-genetics (first-degree biologic relatives)

-neurodevelopment (early neurodevelopment may lead to dysfunction)

-neurotransmitters, pathways, receptors (excess DOPAMINE, serotonin, glutamate and GABA, NMDA)

psychosocial theories for schizophrenia

-childhood trauma

-sociocultural factors (downward drift hypothesis)

-stressful life events may be associated with exacerbation of symptoms and increased rates of relapse

downward drift hypothesis

poor social conditions seen as consequence of, rather than a cause of, schizophrenia

clinical course of schizophrenia

-prodromal period (can last a couple weeks to YEARS)

-acute illness period (active psychosis)

-stabilization period

-maintenance and recovery period (can last months to years)

-relapses

diagnostic criteria for schizophrenia

2 or more of the following must be present (one of the two symptoms must include one of the top three)

-delusions

-hallucinations

-disorganized speech

-disorganized or catatonic behavior

-negative symptoms

SYMPTOMS MUST CONTINUE FOR AT LEAST 6 MONTHS

positive symptoms (schizophrenia)

-delusions

-hallucinations

-SOMETHING THERE THAT SHOULDN’T BE (extra)

positive symptoms: DELUSIONS

-grandiose (famous, special powers/abilities, rich)

-nihilistic (feel like they don’t exist)

-persecutory (paranoid, spying, poisoning, someone after them)

-somatic (feel things in/on their body, chip in their brain)

positive symptoms: HALLUCINATIONS

-auditory (most common, first ask “what are you hearing?”)

-visual (bugs, figures, shadows, “what do you see?”)
-tactile (bugs crawling on them)

-gustatory

-olfactory

negative symptoms

-LESS THAN NORMAL FUNCTION

-alexithymia

-apathy

-avolition

-ambivalence

-anhedonia

-alogia

-anergia

alexithymia

inability to detect/express emotion

apathy

lack of interest

avolition

lack of motivation

ambivalence

difficulty making decisions

anhedonia

lack of pleasure in things they used to love

alogia

lack of speech fluency

anergia

lack of energy

echolalia

person copying you VERBATIM

circumstantiality

talking in a circle, answer eventually

loose associations

one thought leads to another, loosely related

tangentiality

tangent, never answer questions/point

flight of ideas

go from thought-to-thought (not related)

word salad

words mixed up, no meaning behind them (cat, house, pond)

neologisms

using made-up words

paranoia

someone’s out to get them, sense of impending doom

referential thinking

-aka: ideas of reference

-someone thinks that something irrelevant means something to them (sirens sounding specifically to warn them, etc)

autistic thinking/concrete thinking

black-and-white, cut dry thinking

verbigeration

repeat something over and over again

metonymic speech

use wrong word but it’s related to the topic

“eat my menu”

clang association

repeat similar sounding words, “I’m fine, line, dine, etc”

stilted language

“it’s great to meet you on September 3rd, on Thursday, in room 2131…” SUPER FORMAL AND DETAILED

pressured speech

talking extremely fast

aggression/agitation

occurs during psychosis

catatonia

extra movements

catatonic excitement

completely still

echopraxia

Pt doing exactly what you’re doing

regressed behavior

child-like behavior

stereotypy

stereotypical, repetitive movements

hypervigilance

in psychosis, think someone is going to hurt them

waxy flexibility

body parts stay stationary instead of bending/flexing