Term
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Definition
significant IMPAIRMENT IN REALITY TESTING, as evidences by (at lest 1):
-hallucinations
-delusions
-thought disorganization
-grossly disorganized behavior |
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Term
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Definition
| false sensory perceptions |
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Term
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Definition
| failure of thoughts to go logically from A-->B |
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Term
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Definition
(in order of frequency)
auditory
visual
olfactory
tactile (haptic)
gustatory
(auditory and visual do NOT always mean psychosis; sleep/wake, grief) |
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Term
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Definition
**FALSE BELIEF that is based on INCORRECT INFERENCE about external reality
firmly held despite obvious evidence to the contrary
not sanctioned by the individual's culture |
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Term
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Definition
(in order of frequency)
persecutory
referential
religious
control
grandoise
somatic
jealous
erotomatic |
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Term
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Definition
belief that one is being malevolently treated in some way (paranoia)
generally tied to social cues |
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Term
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Definition
neutral occurrences are seem as directed toward oneself
e.g. getting a special message from a TV commercial, song |
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Term
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Definition
thoughts, feelings, or body feel controlled or manipulated
can be feeling of putting thoughts into head or taking thoughts out |
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Term
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Definition
belief that one's body is defective, has been changes, or is diseased
e.g. delusion that worms are eating away at intestines |
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Term
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Definition
belief that one's sexual partner is unfaithful based of INCORRECT INFORMATION
e.g. green car drove by = infidelity |
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Term
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Definition
| belief that another (often famous) person is in love with one |
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Term
| disorganized thoughts or behavior |
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Definition
| meaningless or chaotic speech, loos associations, bizarre behavior, poorly directed behavior, catatonia |
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Term
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Definition
-state of immobility
-not paying attention to environment
-often cognitively hyperaware
motor features:
-automatic obedience (finger lift test)
-negatism |
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Term
| historical background/descriptions of schizoprenia |
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Definition
Kraepelin's "Dementia Praecox"= early dementia; collapse of one's sefl/life
Bleuler's coining term "schizophrenia" = "split-head" signifying split in internal perception of reality with what's actually happening |
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Term
| *basis of schizophrenia diagnosis (as stated in DSM-III)* |
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Definition
**combination of:
ACTIVE PSYCHOSIS (over a sustained period of time)
FUNCTIONAL DETERIORATION |
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Term
| current DSM-IV diagnostic criteria of schizophrenia |
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Definition
at least 2 psychotic symptoms for one month
social or occupational dysfunction
6 months duration of symptoms
exclusions of schizoaffective and major mood disorders, substance abuse and medical conditions, PDD
*diagnosis is based on recognitions of a cluster of symptoms |
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Term
| subtypes of schizophrenia |
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Definition
paranoid type
disorganized type
catatonic type
undifferentiated type
residual type |
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Term
| paranoid type schizophrenia |
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Definition
major symptom is delusions and/or hallucinations
preoccupation with one or more delusions or frequent auditory hallucinations
NO prominent disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect
fair the best, e.g. can keep a job, etc. |
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Term
| disorganized type schizophrenia |
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Definition
prominent disorganized speech, disorganized behavior AND flat or inappropriate affect
fair the worst |
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Term
| catatonic type schizophrenia |
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Definition
motoric immobility, catalepsy (waxy flexibility) or stupor
excessive, purposeless motor activity
extreme negatism (motiveless resistance to instructions) or mutism
peculiarities or voluntary movement or posture, sterotyped movements, prominent mannerisms, or prominent grimacing
echolalia or echopraxia |
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Term
| undifferentiated type schizophrenia |
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Definition
most common subtype (and most patients gravitate toward this over course of illness)
some elements of more than one type
no one type predominates |
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Term
| residual type schizophrenia |
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Definition
absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior
continuing evidence of disturbance as: negative symptoms, attenuated psychotic symptoms, odd beliefs, unusual perceptual experiences |
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Term
| categories of schizophrenic symptoms |
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Definition
positive symptoms
negative symptoms
cognitive impairment |
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Term
|
Definition
symptoms that are added on to normal behavior
-delusions
-hallucinations
-thought disorganization |
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Term
|
Definition
symptoms taken away from normal behavior
-blunted affect (common)
-alogia
-avolition/apathy
-anhedonia/asociality
-inattention |
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Term
|
Definition
reduced amount of speech, reduced content of ideas, thought blocking, long latency
negative symptom |
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Term
|
Definition
poor grooming and hygiene, impersistence at school or work, low energy
negative symptom |
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Term
|
Definition
loss of recreational interests, decreased sexual activity, absence of intimacy and personal relationships
passive withdrawal
negative symptom |
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Term
| cognitive impairment symptoms of schizophrenia |
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Definition
cognitive impairment occurs across all areas of cognitive function and persist throughout life
-memory
-executive function
-language
-attention |
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Term
|
Definition
**symptoms are present long before psychotic onset (prodromal symptoms)
**peak age male: 17-30; female: bimodal, 20-40 and smaller peak at 50 |
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Term
| *prodromal symptoms of schizophrenia* |
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Definition
prodromal symptoms may be present form birth or may precede psychosis by months or years
*poor social adjustment; few friends
*poor school and work performance; low IQ
*negative symptoms
*peculiarities of thought or behavior |
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Term
| good prognostic features in schizophrenia |
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Definition
(many!) in general:
-later onset
-acute onset
-obvious precipitating factors, stressor |
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Term
| poor prognostic features in schizophrenia |
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Definition
(many!) in general:
-early onset
-insidious onset
-no precipitating factors
-preponderant negative symptoms |
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Term
|
Definition
10% recover completely
10-15% respond only to clozapine
20% relapse in 1 year with antipsychotics
30% do not respond to standard antipsychotics
75% relapse in 1 year if untreated |
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Term
| clinical course of schizophrenia |
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Definition
-prodromal symptoms predate diagnosis by months-years
-positive symptoms occur episodically (good w/ tx)
-negative symptoms are more chronic and progressive, deteriorate between episodes (poor w/ tx)
-cognitive symptoms tend to be present from birth (poor w/ tx)
-residual symptoms tend to remain even when other symptoms are well controlled |
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Term
| main causes of dysfunction in schizophrenia |
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Definition
counterintuitive...
negative symptoms
cognitive symptoms - highly correlated with social and occupational dysfunction |
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Term
| complications with schizophrenia |
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Definition
suicide (5-10%, usually in higher functioning individuals)
depression (50%, RULE not exception)
homelessness (30-35% of homeless)
crime (4x increase in violent acts)
substance abuse (>90% smoke) |
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Term
| *prevalence* and social distribution of schizophrenia |
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Definition
**1% lifetime risk of schizophrenia in all populations**
over-representation of lower SES probably from downward drift |
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Term
| genetic factors in schizophrenia |
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Definition
10% risk to 1st degree relative
50% risk to MZ twins
many genes linked to single families, but not across families |
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Term
| prenatal and perinatal complications that may contribute to schizophrenia |
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Definition
2nd trimester (when CNS develops) viral infections; winter births
toxic exposure
birth injuries; perinatal anoxia |
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Term
| environmental factors contributing to schizophrenia |
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Definition
adolescent substance abuse
medical and psychosocial stressors
-->won't affect unless there is previous genetic "hit" |
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Term
| multi-hit hypothesis of schizophrenia epidemiology |
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Definition
vulnerability increases with more high-risk genetic variant
vulnerability incresaes with more environmental insults
-schizophrenia develops when the COMBINATION of genetic vulnerability and environmental insults crosses a critical threshold- |
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Term
| pathophysiology of schizophrenia |
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Definition
cause is unclear
Dopamine clearly plays a big role; DA model:
-increased subcortical dopamine activity leads to psychosis
-decreased prefrontal dopamine activity leads to negative and cognitive symptoms
also:
-structural correlates
-functional correlates
-developmental abnormalities
-gluamate/GABA involvement |
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Term
| evidence for the involvement of dopamine (DA) in the pathophysiology of schizophrenia |
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Definition
increased DA receptors at autopsy
DA agonists and re-uptake blockers worsen psychosis
all effective antipsychotic meds block post-synaptic DA actions
good responders to antipsychotic meds have progressive decrease in plasma HVA (a DA metabolite) while poor responders do not |
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Term
| structural brain correlates to pathophsyiology of schizophrenia |
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Definition
altered brain morphology
increased ventricle-to-brain ratio in 50%
not associated with any specific structure or pathway
5-10% reduction in neuronal mass: fewer dendritic connections, SAME # of neuronal cell bodies |
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Term
| functional brain correlates to pathophsyiology of schizophrenia |
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Definition
inappropriate brain activation
auditory hallucinations are associated with spontaneous activation of the primary auditory cortex and speech areas |
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Term
| developmental abnormalities correlated to pathophsyiology of schizophrenia |
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Definition
aberrant neuronal processing in late adolescence and young adulthood:
-synaptic pruning
-programmed cell death
-experience-modultaed neuronal proliferation
-axonal myelination |
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Term
| glutamate/GABA hypothesis in pathophysiology of schizophrenia |
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Definition
alterations in glutamate neurotranmission involving NMDA receptor
aberrant GABA neurotransmission in the dorsolateral prefrontal cortex |
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Term
| psychopharmacological treatment of schizophrenia |
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Definition
antipsychotic medications:
1st generations - 70% pts response
2nd gen ("atypical") - 70% respond to first line choice, 35-50% of those that don't respond to other meds respond to clozapine |
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Term
| *psychosocial interventions in the treatment of schizophrenia* |
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Definition
**Case management** is essential for other interventions to be successful -- help with finances, housing, social support network
social skills training to help with functioning
vocational rehabilitation
family psychoeducation
supportive psychotherapy |
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Term
| psychosis in a manic episode |
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Definition
psychosis during a manic episode is the RULE, not exception
occurs in ~80% of manic episodes - lifetime risk *1%
often mood congruent
may include catatonia
insight tends to be good between episodes, but very poor during the episodes
treat with antipsychotics and mood stabilizers |
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Term
| major depressive episode with psychotic features |
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Definition
10% of depressed patients develop psychotic features - lifetime risk *1%
often congruent with mood
ECT treatment is effective in 80-90% of patients
tx with antipsychotic + antidepressant works in ~50% |
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Term
|
Definition
periods of psychosis without mood symptoms AND periods of psychosis with mood symtpoms
psychotic and mood symptoms are both prominent during the course of the illness
less common than schizophrenia
tx with antispsychotics + mood stabilizer/antidepressant |
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Term
|
Definition
isolated *NON*-bizarre delusions, without other symptoms or impairments
onset in middle or late life
rare, lifetime risk 0.05$
variable course
tx with antipsychotics, but don't respond well compared to other psychotic disorders |
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Term
| examples of nonbizarre delusions |
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Definition
| being followed, poisoned, infected, loved at a distance, deceived by sig other, having a disease |
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Term
|
Definition
psychosis that quickly resolves, with no residual impairment
major presenting factor is a personality disorder (esp. paranoid, borderline, histrionic, narcissstic, shizotypal)
rapid onset and rapid resolution
symptoms often remit with supportiv care, often also use antipsychotics |
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Term
| shared psychotic disorder |
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Definition
| a delusion that develops in the context of a close relationship to another person with an established delusion |
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Term
| substance-induced psychotic disorder |
|
Definition
most common cause of psychosis in the ER setting
intoxication
withdrawal (alcohol, sedatives, hypnotics, anxiolytics)
medical treatment (high-dose steroids, L-Dopa) |
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Term
| psychotic disorder due to a general medical condition |
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Definition
any common conditions that can affect the brain
delirium
dementia |
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