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Behavioral Dynamics - Schizophrenia

Terms in this set (56)

What is Psychosis?
Psychosis is a symptom of mental illness rather than the name of a medical condition
What are examples of Psychotic symptoms?
Hallucinations, delusions, abnormal emotions, cognitive problems, and abnormal behaviors
What two psychiatric disorders can produce psychotic symptoms?
1. Schizophrenia
2. Mood disorders (bipolar)
Schizophrenia:
A clinical syndrome characterized by a mixture of clinical features referred to as psychosis
What is the DSM V criteria for Schizophrenia?
two or more of the following over a 6mo period with at least 1 month of active symptoms
-- delusions

-- hallucinations

-- disorganized speech

-- grossly disorganized or catatonic behavior

-- negative symptoms (affective flattening)

clinical diagnosis based on S/S, time course, functional capacity adverse impact, and idiopathic nature
What is the most common age of onset of schizophrenia and who is it most common in?
-- Most common in men

Men: 18-25 years
Women: 25-35 years
T/F schizophrenia is more common if born in the late winter to early spring in a densely populated urban in a developed country
True
What are the hypothesis about the etiology of Schizophrenia?
1. Neurochemical abnormalities
2. Structural Brain abnormalities
3. Functional brain abnormalities
4. Genetics
What is the most widely accepted neurochemical abnormality hypothesis?
Dopamine (DA)
Supportive evidence for the Dopamine theory
-- administration of D-amphetamine, which increases the release of DA, caused psychosis similar to schizophrenia

-- some antipsychotic drugs ↓ DA activity
What evidence is there against the dopamine theory?
-- drugs acting on other transmitter systems (hallucinogens/dissociative anesthetics) can cause psychotic symptoms

-- no postmortem studies of patients with schizo have abnormalities in DA receptors or affinities for DA
Supportive Evidence for the Glutamate theory for Schizophrenia
-- Decreased glutamate in CSF

-- Drugs like PCP & Ketamine (antagonists of glutamate receptors (NMDA)) induce psychosis which mimic schizo

--Compounds that enhance NMDA can help positive and negative symptoms of schizo
Supportive Evidence for the GABA hypothesis of Schizophrenia?
-- decreased GABA in those with schizo

-- post mortem studies show ↓ in GABA function
With Schizophrenia Glutamate and GABA are ______________, while dopamine and serotonin are ________?
Glutamate and GABA are down, while dopamine and serotonin are up
Schizophrenia Hypothesis: Structural Brain Abnormalities
-- Lateral 3rd ventricles enlarge, volume ↓ in medial temporal lobe
-- ↓ number of glial cells, myelinated fiber pathways of white matter
Schizophrenia Hypothesis: *Functional Brain Abnormalities
-- most show deficits on standard neuropsychological tests

-- PET and fMRI (functional MRI) show abnormal brain activation

-- Abnormalities occur during storage of info or retrieval of info
T/F there is clear evidence that genetic factors increases the risk of developing schizophrenia.
True - However, environmental factors are also believed to be involved
Define positive Clinical symptoms
Addition of an abnormal behavior (ex: delusions, hallucinations)
What are examples of Positive clinical symptoms
1. Delusions
2. Disorganized Speech
3. Hallucinations
4. Disorganized Behavior
5. Catatonic Behavior
Positive symptoms - Delusions
-- Fixed, false beliefs that persist despite contradictory evidence

-- Most often delusions have the form of distorted and highly illogical misinterpretations of actual events or experiences
Positive symptoms - Delusions of Control
belief one's thoughts, feelings or actions are controlled by outside forces/agencies
Positive symptoms - Delusions of grandiosity
belief one has extraordinary power, gifts, or abilities that are clearly exaggerated and often bizarre
Positive symptoms - Delusions of Guilt
believe one has committed a terrible act or crime. Often, w/ a belief this will lead to terrible outcomes, that they are deserving of punishment
Positive symptoms - Delusions of reference
belief actions/remarks of others/external events have significant personal and private meaning for the patient
Positive symptoms - Persecutory delusions
belief one is being conspired against/threatened by others including individuals, organizations, religious figures, extraterrestrials
Positive symptoms - Somatic delusions
belief that one is carrying a severe disease or other malfunction not supported by medical evidence, and are often bizarre and attributed to outside forces
Positive symptoms - Delusions - Thought Insertion
own thoughts have been implanted by an agency
Positive symptoms - Delusions - Withdrawal
thoughts have been taken out of their mind
Positive symptoms - Delusions - Broadcasting
can be heard by others via telepathy or passive means
Positive symptoms - Hallucinations:
-- prominent, occurs several times a day

-- form of ≥1 voice running commentary on the patient's everyday activities

-- Can be unfriendly, insulting or accusatory

-- occasionally command to perform acts resulting in harm to themselves or others

-- Can experience visual, olfactory, gustatory, somatosensory or tactile hallucinations, these hallucinations should raise suspicion for a general medical cause
Positive symptoms - Disorganized Speech
-- inability to process stimuli accurately and link thoughts or ideas in a coherent/logical manner
Positive symptoms - Disorganized Behavior
-- causes impairment to observer (unprovoked outbursts of laughter, hyperactivity, agitation, or violent)
-- Neglect hygiene or odd clothing choices
⭐Positive symptoms - Catatonic Behavior
-- extreme hypoactivity/immobility with little responsiveness to external stimuli

-- rigidity

-- maintaining odd facial expressions

-- waxy flexibility includes moving in any position the provider puts them in

-- echopraxia mimics every move that is made by the provider

-- repetitive but purposeless movements

-- absent or minimal verbal response
Negative Clinical Symptoms of Schizophrenia
1. Affective Flattening
2. Avolition
3. Alogia
4. Anhedonia
5. Attention deficits
6. Social withdrawal
Negative Clinical Symptoms - Affective Flattening
-- absence of outward emotional reaction to stimulus

-- decrease in or absence of spontaneous movement, expressive gestures, eye contact, shifts in vocal inflections
Negative Clinical Symptoms - Avolition
-- Lack of motivation for initiating/completing tasks

-- reflective loss of drive and interest in one's surroundings
Negative Clinical Symptoms - Alogia
low production in fluency and spontaneous speech
Negative Clinical Symptoms - Anhedonia
diminished or absent capacity to experience pleasure
Negative Clinical Symptoms - Attention Deficits
Can't maintain engagement in goal activity or task
Negative Clinical Symptoms - Social Withdrawal
diminished capacity to feel close to others
What is the goal of Schizophrenia treatment
To reduce symptomatology and to maximize functioning. To achieve this several targets have been identified: Positive and Negative Symptoms
T/F Positive symptoms such as hallucinations and delusions respond well to antipsychotic drug treatment?
TRUE
T/F Negative symptoms of schizophrenia respond well to pharmacology therapy?
False - Atypical antipsychotic drugs have been found to be slightly beneficial
⭐do positive or negativee* symptoms correlate significantly with long-term functional incapacity?
Negative symptoms
What is the mainstay of treatment for schizophrenia?
pharmacotherapy
Schizophrenia Prognosis
Schizophreniform Disorder
-- Same diagnostic evaluation as schizophrenia, but total duration of illness is >1 mo, but <6 mo before recovery

-- about ⅓ recover within 6 months;Today I love Tuesday morning exactly whatever you've any get here and it ⅔ will progress to Schizophrenia or schizoaffective disorder
Schizoaffective Disorder
-- Combo of schizo symptoms (hallucinations or delusions) and mood disorders (mania/depression)

2 subtypes
-- Bipolar-type schizoaffective disorder, includes manic or a mixed episode
-- Depressive
Treatment of Schizoaffective Disorder?
-- Antipsych drug therapy (atypical) needed
-- Added mood stabilizers for hx of mania
-- Antidepressants may help but should stop if mania symptoms occur, can accentuate mania
What are the types of delusional disorders?
-- Erotomanic type: another person, usually of higher status, is in love with the individual

-- Grandiose type: inflated worth, power, knowledge, identity, special relationship to deity/famous person

-- jealous type: individual's sexual partner is unfaithful

-- persecutory type: person (or someone to whom the person is close) is being malevolently treated in some way

-- somatic type: person has some physical defect or general medical condition

-- mixed type: characteristic of ≥1 of the above types but no one theme predominates
Clinical Presentations of delusional disorder
-- Non Bizarre delusions occurring for ≥1mo
- Involve situations that occur in real life, being followed, poisoned, infected, deceived by a spouse

-- Despite the delusions patients can function normally
What population are you likely to see an increase in Psychotic disorder?
Increased frequency is observed in populations that have experienced
significant life stresses (e.g., immigrants, refugees, military recruits, and persons who have experienced a disaster such as an earthquake or hurricane).
Clinical Presentation and diagnosis of Psychotic Disorder
-- presence of ≥1 of the following symptoms that have occurred for less than 1 month with eventual full return to premorbid level or function
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
what is a secondary psychotic disorder?
Prominent hallucinations or delusions which history, physical exam,
or labs find symptoms directly related to a medical condition
Clinical Presentation of a Secondary Psychotic Disorder
-- Hallucinations or delusion but depends on underlying condition

-- Smell and taste hallucinations from basal lesions

-- ETOH withdrawal can cause tactile hallucinations

-- Visual hallucinations induced by DPA agonists, sympathomimetics, anticholinergics, or hallucinogens
What medical conditions can be associated with psychotic symptoms
Brain neoplasm, CVA, dementias, HIV/AIDS, parkinson disease, seizure disorder, Encephalitis
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