Schizophrenia and Other Psychotic Disorders

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What some other psychotic disorders we have learned other than Schizophrenia?

Schizophreniform disorder
Schizoaffective disorder
Delusional disorder
Shared Psychotic disorder
Psychotic disorder NOS
Culture-Bound syndromes

What is the lifetime prevalence of Schizophrenia?

1%

Approximately ____% of schizophrenics will not get treated

50%

For schizophrenia, the male/female ratio is equal but ______ ____ __________ differs.

age of onset (more males are affected earlier in life)

If someone is born in the ________ season, they are more likely to become affected.

Winter

True or False: Schizophrenics are not likely to become drug users.

False: they are MORE likely to become drug users!

There is a likelihood of re-admittance to hospital within two years of first episode in ______% of schizophrenics.

40-60%

_____% of psychiatric beds are occupied by schizophrenic patients.

50%

_____% concordance with monozygotic twin of schizophrenic patient.

50%

Dads over ____ are more likely to produce children with schizophrenia.

60

____% of schizophrenics attempt suicide.

50%

Who called schizophrenia 'Dementia Precox'?

Emil Kraepalin (he also used the term 'paranoia' to identify a separate group 'characterized by persistent persecutory delusions

What does precox mean?

early onset

Who came up with 'schizophrenia'?

Eugene Bleuler ('Schizo' (schism) was used because he felt it represented the breaks between thought and reality)

What are some examples of Positive Symptoms?

hallucinations, delusions, racing thoughts

What are some examples of Negative Symptoms?

Apathy, lack of emotion, poor or non-existent social functioning

Cognitive Symptoms may be apparent in both the _________ and _________ categories.

positive and negative. Cognitive symptoms include disorganized thoughts, difficulty concentrating or following instructions, and memory problems.

What is a negative symptom?

traits/characteristics found in normal persons but lacking in schizophrenics--indicates a lack of something or something missing (i.e. blunted affect, loss of desire, lack of emotion, etc.)

What is a positive symptom?

symptoms apparent in schizophrenics but not in a 'normal' population (i.e. hallucinations)

What is a delusion?

a false belief not shared by culture (aliens are secretly running the USA)

What is an illusion?

the misperception of real stimuli (for a second there I thought that tree was an alien)

What is a hallucination?

a sensory impression or activation without actual stimuli (the aliens are talking to me all the time)

75% of hallucinations in schizophrenia are ______________.

auditory

What does anhedonia mean?

not taking pleasure in pleasurable things

What does avolution mean?

the lack of desire to pursue a meaninful goal

What does alogia mean?

not being able to speak?

What is the flattened affect?

also called the 'blunted affect'; it is the failure to express feelings either verbally or non-verbally; expressive gestures are rare and there is little animation in facial expression

What are the different criterias for diagnosing Schizophrenia?

Criterion A: Delusions, Hallucinations, Disorganized Speech, Grossly disorganized or Catatonic behavior, Negative symptoms
Criterion B: Social/occupational dysfunction
Criterion C: Duration must be of six months
Criterion D: No diagnosis of schizoaffective disorder or mood disorder (not better accounted for by some other condition)
Criterion E: Not due to drugs or medical condition

What are some of the Subtypes of Schizophrenia?

Paranoid Schizophrenia, Disorganized Schizophrenia, Catatonic Schizophrenia, Undifferentiated Schizophrenia, Residual Type Schizophrenia, Simple Schizophrenia, Deficit Schizophrenia

What subtype of Schizophrenia is characterized by delusions of persecution or grandeur?

Paranoid Schizophrenia

What subtype of Schizophrenia has an older age of onset than other subtypes?

Paranoid (this is why paranoid patients sometimes manage better because of more developed social skills/interactions)

What subtype of Schizophrenia is a marked regression to primitive, disinhibited, messy behavior?

Disorganized Schizophrenia (age of onset typically under 25; patients tend to be active but in an 'aimless' manner and 'act silly')

What subtype of Schizophrenia is described as having stupor, negativism, rigidity, posturing, excitement, and mutism?

Catatonic Schizophrenia

What subtype of Schizophrenia is a rare condition nowadays in industrialized countries?

Catatonic Schizophrenia

What subtype of Schizophrenia meets criterion A but is not easily classified as another subtype?

Undifferentiated Schizophrenia (it is kind of like the 'NOS' category)

What subtype of Schizophrenia involves the continuing presence of schizophrenic disturbance without 'a complete set of active symptoms'?

Residual type of Schizophrenia

What subtype of Schizophrenia involves a gradual loss of drive and ambition and social withdrawal? These individuals are not 'heavily psychotic, and hallucinations/delusions are not persistent.

Simple Deteriorative Disorder (Simple Schizophrenia)

What subtype of Schizophrenia has long lasting negative symptoms (blunted affect, poverty of speech, decreased social drive and interactions, etc.?

Deficit Schizophrenia

Most schizophrenics will end up showing __________ symptoms.

Negative

Patients with Simple Schizophrenia and Deficit Schizophrenia mainly display __________ symptoms.

Negative

What is the dopamine (DA) hypothesis?

over-activity of DA systems-->it states that drugs that increase DA activity (AMPH) can cause schizo-like symptoms, and anti-psychotic drugs are D2R antagonists.

Excess Dopamine activity correlates with __________ symptoms.

positive

What is an example of a long time anti-psychotic D2 antagonist that blocks the effect of the endogenous transmitter?

Haldol (haloperidol) --> a 'typical' anti-psychotic

Dopamine intake will ___________ the likelihood of schizophrenia.

increase

If a specific drug works on dopamine, it is a ___________ antipsychotic.

typical

If a specific drug works on serotonin, it is a ___________ antipsychotic.

atypical

What are some examples of neurotransmitters that are correlated with schizophrenia?

serotonin (5-HT), GABA, Glutamate, Acetylcholine, and dopamine

What is 5-HT another name for?

Serotonin

What is DA?

Dopamine

Excess Serotonin levels are correlated with ___________ symptoms.

positive AND negative

GABA is an _______________ transmitter.

inhibitory

GABA interacts with both _________ and __________ systems.

5-HT (serotonin) and DA (dopamine) systems

What is the Glutamate antagonist that can induce a schizophrenia-like condition?

Phencyclidine

Decreased acetylcholine and decreased ____________ receptors has been correlated with hallucinations in Schizophrenics.

nicotinic (this is perhaps why schizophrenics self medicate by smoking)

Schizophrenics have deficits in following a moving finger and thus have deficits in __________ ___________ eye movements.

smooth pursuit

_____% of schizophrenics show saccadic eye movements (jumpy eye movements when asked to follow a moving finger).

80%

When faced with a cognitive task, normal individuals show ____________ activity in the prefrontal cortex, whereas schizophrenics show ____________ activity.

increased (hyperfrontality), decreased (hypofrontality)

What does hypofrontality mean?

decreased activity in the frontal lobes

Schizophrenics show hypofrontality, __________ size of ventricles, and __________ size of limbic structures (emotional circuitry)

increased, decreased

True or False: it is easy to test for Schizophrenia

FALSE: it is very hard to test for Schizophrenia for many reasons (i.e. it is unethical to leave them unmedicated)

In chronic Schizophrenics, you see a progressive loss of cortical ________ matter.

gray

True or false: All 'schizophrenic symptoms appear in other disorders'.

True! Thus, there is no single sign or symptom that is pathognomonic for schizophrenia, symptoms may also change over time. SO.... the patient history becomes very important!

What term means that a sign/symptom is unique to one disease?

pathognomonic

What does it mean when something is premorbid?

It is preceding the disease

What does it mean when something is prodromal?

it is an early, nonspecific symptom(s) that may indicate the start of a disease

The mental status of schizophrenics is so __________ it can't be summarized in one or two sentences. However more specific areas can be discussed like hallucinations, illusions, and homicide/suicide/violence.

variable

What are the most common type of hallucinations?

Auditory (visual come second); other sensory hallucinations may suggest a medical/neurological condition

What is the type of hallucination in which you have altered states of your body organs (i.e. your brain is on fire)?

Cenesthetic type

What are illusions?

distortions of real images or sensations (i.e. based on something real)

True or False: Violence is uncommon among untreated Schizophrenic patients.

False: Violence is very common among untreated Schizophrenic patients!

____________ is the leading cause of death among untreated schizophrenics.

Suicide. However, they are no more likely to commit homicide than your average student

True or False: In Schizophrenics, orientation and memory are frequently intact.

TRUE

True or False: a typical Schizophrenic patient does not do well recognizing he/she has a condition.

True. Thus, poor compliance with treatment and medication is common.

What are some signs that indicate someone might have Schizophrenia?

1) motor disorders, tics, hypertonicity (rigidity), lack of coordination, fine motor skill problems
2) higher blinking rate than normal (^DA)
3) frequent lack of prosody (could involve non-dominant parietal lobe)

What are some conditions/diseases that may be associated with Schizophrenia? (conditions/diseases that have comorbidity)

1) Obesity: higher average BMI in patients
2) Diabetes, COPD, heart disease: much higher smoking rate in patients, etc.
3) HIV: due to increased risk behavior

What are some drugs that cause symptoms similar to Schizophrenia?

Cocaine or AMPH-induced psychosis, PCP, alcohol, or barbiturate withdrawal

What are some diseases that cause symptoms similar to Schizophrenia?

HIV, encephalitis, Huntington's, Wilson's disease (problems with copper accumulation), Wernicke-Korsakoff

If it causes brain damage or dysfunction, it could result in symptoms similar to Schizophrenia

What are some psychiatric disorders that cause symptoms similar to Schizophrenia?

Schizophreniform disorder, Brief psychotic disorder, Schizoaffective disorder, Delusional disorder, and malingering (pretending to have an illness to avoid work, etc.)

A schizophrenic will first be diagnose with _______________ then _______________ THEN Schizophrenia.

1) Brief Psychotic disorder then
2) Schizophreniform disorder THEN
3) Schizophrenia

What are some examples of mood disorders?

depression, mania, bipolar, anxiety

For someone to have Schizophreniform disorder, symptoms must be present for more than _______ but less than _________.

more than 1 month but less than 6 months

For someone to have Brief Psychotic disorder, symptoms must be present for more than ________ but less than _________.

more than a day but less than a month

For someone to have Schizoaffective disorder, they must have Schizophrenia PLUS a _________ or __________ syndrome.

manic or depressive
ex: bipolar, depression, anxiety, mania, etc.

For someone to have a delusional disorder, they must have delusions without ______________.

hallucinations (they must have delusions without the other symptoms of Schizophrenia)

Typically, Schizophrenic symptoms begin in _________________.

adolescence

After the onset of symptoms in Schizophrenics, what phase follows?

Prodromal phase (often brought on by major changes like going to college, etc.)

Prodromal phase: a clear deterioration in function before the active phase of mental disturbance

After the Prodromal phase, what type of symptoms usually follow?

Psychotic

In general, Schizophrenic patients subsequently undergo a series of ___________ and ___________.

recoveries and relapses

What is the course of Schizophrenia? (what phase comes first, second, third?)

1) Prodromal Phase: may consist of decreased social activities, new/changing interests in religion, occult, philosophy (i.e. seeking answers because they are thinking differently)
2) Active Phase: the psychotic episode
3) Residual Phase: the period between psychotic episodes, usually negative symptoms (where the active symptoms aren't really present)

5-10 years after initial hospitalization, only _______ of patients are considered to have 'good outcomes'.

10-20%

____% or more of patients remain significantly impaired for the remainder of their lives.

60%

Only _____% of schizophrenics are considered to lead 'normal' lives.

20-30%

What are the possible treatments for Schizophrenia?

antipsychotic drugs but also therapies/interventions/etc to help increase the degree of recovery

True or False: Pharmacotherapy (antipsychotic drugs like dopamine and serotonin) are sufficient to treat Schizophrenics.

False: they are good, but NOT sufficient

For treating Schizophrenia, single approaches do not generally work. Why is that?

because Schizophrenia is a complicated disorder and is multifaceted (to treat, you must attack it at every angle)

_________ drugs are used to treat the positive symptoms of Schizophrenia. What are some examples of these drugs?

Typical (dopamine) drugs
Examples:
Chlorpromazine (Thorazine)
Haloperidol (Haldol)
Perphenazine (Etrafon, Trilafon)
Fluphenazine (prolixin)

__________ drugs are used to treat the negative symptoms of Schizophrenia or to treat people who have had Schizophrenia for a long duration of time. What are some examples of these drugs?

Atypical (serotonin) drugs
Examples:
Clozapine (Clozaril)
Risperidone (Risperdal)
Olanzapine (Zyprexia)

True or False: Atypical drugs are generally preferred for initial treatment over typicals, but they are more expensive and have other issues (weight gain).

True

__________ can be very effective for treatment resistant schizophrenics, but has serious potential side effects for your heart (agranulocytosis and myocarditis)

Clozapine

Antipsychotic meds produce side effects. What are some examples of these side effects?

Extrapyramidal Side Effects (EPS) and movement disorders such as Tardive Dyskinesia (constant movements of tongue, lips, face, trunk, and extremities)

Schizophreniform Disorder is very similar to Schizophrenia except for 3 main differences. What are those differences??

1) Symptom duration must be more than one month, but less than 6 (symptoms for more than 4-6 months-->person has Schizophrenia)
2) Long term prognosis is generally good
3) Patients tend to have more affective symptoms (i.e. mania), so the condition may be more similar to mood disorder

A Schizoaffective person usually has a noticeably stronger mood component than a _________ but not a noticeably stronger mood component than a ___________.

Schizophrenic, Schizophreniform individual

Individuals with Schizophreniform may have more than one episode. Approximately _____% go on to develop Schizophrenia.

70%

True or False: Treatment for Schizophreniform disorder is essentially the same for Schizophrenia.

True

What is the lifetime prevalence for Schizophreniform disorder?

Around 0.1%

________ disorder has features of both Schizophrenia and affective (mood) disorders.

Schizoaffective

What is the lifetime prevalence for Schizoaffective Disorder?

less than 1%

Schizophrenia has the highest prevalence, __________ has second highest, _____________ has 3rd highest.

Schizophreniform, Schizoaffective

A patient with Schizoaffective disorder must be in one of these categories....

1) Schizophrenic with mood symptoms
2) Having a mood disorder and also Schizophrenia
3) Both mood disorder and Schizophrenia
4) Having a 3rd psychosis unrelated Schizophrenia or mood disorders
5) Disorder in on a continuum between Schizophrenia and mood disorders
6) Some combination of the above

For someone to have delusional disorder, they must have 'non-bizarre' delusions for at least ___________.

one month

Usually people are diagnosed with Delusional Disorder when Criterion ___ for schizophrenia are not met.

Criterion A (Delusions, Hallucinations, Disorganized Speech, Grossly disorganized or Catatonic behavior, Negative symptoms)

What is considered a bizarre delusion?

a delusion that involves a totally implausible phenomenon (bizarre delusions are common in Schizophrenia)

T or F: In delusional disorder, functioning is impaired and behavior is obviously odd/bizarre.

False: functioning is not impaired and behavior is not obviously odd or bizarre.

T or F: Delusional disorders usually affect the quality of life.

False: Delusional disorders usually do not affect the quality of life

What is a delusion?

a belief not believed by most of society

What is considered a non-bizarre delusion?

a delusion that is 'believable' and could happen in real life

What are some types of Delusional Disorders?

1) Jealous
2) Erotomanic
3) Grandiose

In what type of delusional disorder does one believe that their partner is being unfaithful?

Jealous (delusional disorder); this disorder can have a very sudden onset with no prior psychiatric history--can potentially be dangerous; this is not normal jealousy, this is jealousy that is implausible (there is no reason for the person to be jealous)

In what type of delusional disorder does one fall in love with someone and start to believe that someone loves them back (when they, in reality, do not love them back)?

Erotomaniac (delusional disorder)

In what type of delusional disorder does one often show 'paradoxical conduct'?

Erotomaniac (delusional disorder); paradoxical conduct: any denials or negative reactions from the 'love' are interpreted a positive

In what type of delusional disorder does one have a delusion of inflated worth, power, and knowledge (megalomania)?

Grandiose

What is megalomania?

the delusion of having inflated worth, power, and knowledge.

In what type of delusional disorder does one believe that their thoughts, feelings, and actions under someone else's control?

Of being controlled (delusional disorder)

In what type of delusional disorder does one feel like they are being attacked, cheated, harassed, harmed, etc.?

Persecutory (sometimes these individuals become obsessed with pursuing litigation against their supposed harassers)

In what type of delusional disorder does one feel like their thoughts are being broadcasted out loud?

Thought broadcasting

In what type of delusional disorder does one feel like their thoughts are inserted into their mind?

Thought Insertion

What is another name for the jealous type of delusional disorder?

Othello Syndrome

Is the jealous syndrome more common in men or women?

men

The typical patient of this delusional disorder would be a lonely, unattractive woman in a low-level job. (read this notecard as if you were on jeopardy ;)

Erotomanic

What is a term for the lack of desire to pursue meaningful goals?

avolution

What is a term for the complete lack of speech?

alogia

What is the term for the inability to experience pleasure?

anhedonia

What is the type of delusional disorder where one has a delusion pertaining to the appearance or functioning of the body?

somatic delusion

What is Delusional Parisitosis and what type of delusional disorder is it?

where a person is convinced that their body is infested with parasites---it is a SOMATIC delusional disorder

What is the type of delusional disorder where one has the idea that events/things/etc. in the person's immediate vicinity have some sort of unusual significance?

"Of Reference" delusional disorder

What type of delusional disorder is this an example of?
"I'm starting to think that music is basically being aimed at me to communicated something, i.e. someone must've called the radio station and requested these songs because they wanted to say something to me. Or, some kind of synchronicity or divinity is trying to communicate or influence me"

"Of Reference" delusional disorder

Delusional disorders can be Mood _____________ or Mood ____________.

Congruent, Incongruent

Someone manic is having delusions of grandiosity. Would they be considered mood congruent or incongruent?

mood congruent

Someone depressed is having delusions of grandiosity. Would this be considered mood congruent or incongruent?

mood incongruent

What type of delusional disorder is where one person begins to believe/share another person's delusion?

shared psychotic disorder (patients usually have known each other a long time and the secondary person is typically gullible, less intelligent, with low self esteem).

If they had a delusional disorder NOS, this disorder would be it, as it's not a delusion of one person alone.

Shared Psychotic Disorder

Brief Psychotic Disorder lasts at least ________ but not more than _______.

1 day, 1 month

True or False: In brief psychotic disorder, patients show full remission.

True

Brief psychotic disorders are more common in younger or older people?

younger (20-30)

True or False: Brief psychotic disorder has an abrupt onset and typically follows major life stressors.

True

What are some psychotic disorders NOS?

Autoscopic and Postpartum psychosis

In which NOS psychotic disorder does a patient see a 'phantom' of themselves, colorless and transparent (it is very rare)?

Autoscopic disorder

Which NOS psychotic disorder occurs soon after birth (to the mother, not the baby)?

Postpartum psychosis

What drugs can cause psychosis?

amphetamine, cocaine, and PCP

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