Schizophrenia Spectrum and Bipolar Disorders

What key clinical features characterize schizophrenia spectrum disorders?

They are characterized by psychosis, altered cognition, altered perception, and/or an impaired ability to determine what is or is not real.

What are the diagnostic criteria and common themes associated with Delusional Disorder?

False thoughts or beliefs that have lasted $1\text{ month}$ or longer, which are not severe enough to impair functioning. Themes include grandiose, persecutory, somatic, and referential.

What is the symptom presentation and duration required for a diagnosis of Brief Psychotic Disorder?

Sudden onset of at least one symptom among delusions, hallucinations, disorganized speech, or disorganized/catatonic behavior, lasting longer than $1\text{ day}$ but no longer than $1\text{ month}$, with an expected return to normal functioning.

How does Schizophreniform Disorder differ from schizophrenia regarding duration and functioning?

Its symptoms are exactly like schizophrenia but have lasted less than $6\text{ months}$; impaired social or occupational functioning may not be apparent, and the individual may or may not return to their previous level of functioning.

What characterizes Schizoaffective Disorder?

A major depressive, manic, or mixed episode occurring concurrently with symptoms that meet the criteria for schizophrenia, not caused by substance use or a general medical condition.

What are common comorbid conditions associated with schizophrenia spectrum disorders?

Substance abuse disorders (especially nicotine dependence), anxiety, depression, suicide, physical illness, and polydipsia.

What are the four phases of schizophrenia and their key characteristics?

1. Prodromal: Onset with mild changes.
2. Acute: Exacerbation of symptoms.
3. Stabilization: Symptoms diminishing and movement toward previous level of functioning.
4. Maintenance or residual: A new baseline is established.

What are positive symptoms of schizophrenia, and what alterations do they include?

Symptoms reflecting an excess or distortion of normal functions, including alterations in reality testing (delusions), alterations in speech, concrete thinking (inability to think abstractly), and alterations in perception and behavior.

What is word salad?

The most extreme form of associative looseness, presenting as a jumble of words meaningless to a listener.

What are clang associations, neologisms, and echolalia?

Clang associations are words chosen based on sound. Neologisms are words that have meaning for the patient only. Echolalia is the pathological repetition of another's words.

Which abnormal speech patterns are categorized under alterations in speech in schizophrenia?

Circumstantiality, tangentiality, cognitive retardation, pressured speech, flight of ideas, and symbolic speech.

What disorders or distortions of thought occur in schizophrenia?

Thought blocking, thought insertion, thought deletion, magical thinking, and paranoia.

What types of alterations in perception can occur in schizophrenia?

Hallucinations (auditory, visual, olfactory, gustatory, tactile, and command), illusions, depersonalization, and derealization.

Which behavioral alterations are associated with schizophrenia?

Catatonia, motor retardation, motor agitation, stereotyped behaviors, waxy flexibility, echopraxia, negativism, impaired impulse control, gesturing or posturing, and boundary impairment.

What are negative symptoms of schizophrenia, and which specific symptoms do they encompass?

The absence of essential human qualities, including anhedonia, avolition, asociality, affective blunting, apathy, and alogia.

How can affect be described when evaluating negative symptoms?

As flat, blunted, constricted, inappropriate, or bizarre (affect is the outward expression of a person's internal emotional state).

What are the primary cognitive symptoms seen in schizophrenia?

Concrete thinking, impaired memory, impaired information processing, impaired executive functioning, and anosognosia.

Why is assessment for depression crucial when evaluating affective symptoms in schizophrenia?

Depression may herald impending relapse, increases substance abuse, increases suicide risk, and further impairs functioning.

What are the priority outcome goals for Phase I (acute), Phase II (stabilization), and Phase III (maintenance) in schizophrenia?

Phase I: Patient safety and medical stabilization. Phase II: Help patient understand illness and treatment, stabilize medications, and control or cope with symptoms. Phase III: Maintain achievement, prevent relapse, and achieve independence and a satisfactory quality of life.

What is the mechanism of action, clinical advantage, and disadvantages of First-Generation Antipsychotics (FGAs)?

They are dopamine $D_2$ receptor antagonists that target positive symptoms. Advantage: less expensive than second-generation. Disadvantages: extrapyramidal side effects (EPS), anticholinergic side effects, tardive dyskinesia, weight gain, sexual dysfunction, and endocrine disturbances.

What are examples of long-acting injectable first-generation and second-generation antipsychotics?

First-generation: haloperidol and fluphenazine decanoate. Second-generation: olanzapine pamoate and paliperidone palmitate.

What is the receptor target and main adverse risk profile of Second-Generation Antipsychotics (SGAs)?

They are serotonin ($5\text{-HT}_{2A}$) and dopamine ($D_2$) antagonists (e.g., clozapine). They treat both positive and negative symptoms with minimal/no EPS or tardive dyskinesia, but have a tendency to cause significant weight gain and risk of metabolic syndrome.

What are examples and characteristics of Third-Generation Antipsychotics (TGAs)?

Aripiprazole (Abilify), brexpiprazole (Rexulti), and cariprazine (Vraylar). They are dopamine system stabilizers with little risk of EPS or tardive dyskinesia that may improve positive, negative, and cognitive symptoms.

What are the clinical signs of anticholinergic toxicity?

Reduced or absent peristalsis (can lead to bowel obstruction), urinary retention, mydriasis, hyperpyrexia without diaphoresis (hot dry skin