Exam 4 didactic
ABNORMAL MOTOR BEHAVIOR What are characteristics of disorganized or abnormal motor behavior (including catatonia)?
(DSM-5, p. 88) Grossly disorganized or abnormal motor behavior may manifest itself in a variety of ways, ranging from child-like "silliness" to unpredictable agitation; problems may be noted in any form of goal-directed behavior, leading to difficulties in performing activities of daily living. Catatonic behavior is a marked decrease in reactivity to the environment. This ranges from resistance to instructions (negativism); to maintaining a rigid, inappropriate or bizarre posture; to a complete lack of verbal and motor responses (mutism and stupor). It can also include purposeless and excessive motor activity without obvious cause (catatonic excitement). Other features are repeated stereotyped movements, staring, grimacing, mutism, and the echoing of speech.
LOOSE ASSOCIATIONS, TANGENITALITITY, INCOHERENCE Related to disorganized thinking, describe looseness of associations, tangenitality, and incoherence.
(DSM-5, p. 88) Loose associations → switching from one topic to another Tangenitality→ answers to questions may be obliquely related or completely unrelated Incoherence→ speech that is so severely disorganized that it is nearly incomprehensible and resembles receptive aphasia in its linguistic disorganization. (or word salad)
PSYCHOSIS ABNORMALITIES What 2 conditions are defined by abnormalities limited to one domain of psychosis?
(DSM-5, p. 89) Two conditions are defined by abnormalities limited to one domain of psychosis: delusions or catatonia.
SCHIZOPHRENIA FUNCTIONAL CONSEQUENCES What are the functional consequences of schizophrenia?
(DSM-V, p. 104) Schizophrenia is associated with significant social and occupational dysfunction. Making educational progress and maintaining employment are frequently impaired by avolition or other disorder manifestations, even when the cognitive skills are sufficient for the tasks at hand. Most individuals are employed at a lower level than their parents, and most, particularly men, do not marry or have limited social contacts outside of their family.
DELUSIONAL DISORDER DX/CLINICAL/ASSOCIATED FX What are the diagnostic/clinical and associated features of delusional disorder?
(DSMV 90) -Presence of one delusions with a duration of 1 month or longer -Schizophrenia has never been met -apart from the impact of the delusion(s) or its ramifications, functioning is not markedly Impaired and behavior is not obviously bizarre or odd -If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusion periods -the disturbance is not attributable to the physiological effects of a substance or another Medical condition and is not better explained by another mental disorder, such as body Dysmorphic disorder or OCD
DELUSIONAL THEME SPECIFIERS What are the specifiers used to document a patient's delusional theme?
(DSMV 90) -erotomanic, grandiose, jealous, persecutory, somatic, mixed, unspecific What are the central themes to the subtypes of delusional disorder? (DSMV 90) -erotomanic - another person is in love with the individual (I love with a famous person or Complete stranger) -grandiose - having some great talent or insight or having made some important discovery -jealous - is that of an unfaithful partner -persecutory - belief of being conspired against, cheated, spied on, followed, poisoned, maliciously maligned, harassed or obstructed in pursuit of long term goals -somatic - involves bodily functions or sensations. Mostly common issue is the individual emits Foul odor
DELUSIONAL DISORDER CRITERIA What is the DSM 5 diagnostic criteria for delusional disorder?
(DSMV 90-91) A. The presence of one (or more) delusions with a duration of 1 month or longer. B. Criterion A for schizophrenia has never been met. C. apart from the impact of the delusions or tis ramifications functioning is not markedly impaired and behavior is not obviously bizarre or odd. D. if manic or major depressive episodes have occurred these have been brief relative to the duration of the delusional periods. E. the disturbances is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder such as body dysmorphic disorder or obsessive-compulsive disorder. MUST SPECIFY SUBTYPE.
BRIEF PSYCHOTIC DISORDER CRITERIA What is the DSM 5 diagnostic criteria for brief psychotic disorder? (
(DSMV 94) Presence of one or more of the following symptoms. At least one of these must be 1,2 or 3: 1. Delusions, 2. Hallucinations, 3. Disorganized speech 4. Grossly disorganized or catatonic behavior. Duration of an episode of the disturbance is at least 1 day but less than 1 month. With eventual full return to premorbid level of functioning. The disturbance is not better explained by MDD, Bipolar disorder with psychotic features or another psychotic disorder.
SCHIZOPHRENIFORM DSM 5 CRITERIA What is the DSM 5 diagnostic criteria for schizophreniform disorder?
(DSMV 97) -This disorder is distinguished by its difference in duration: the total duration of the illness, including prodromal, active and residual phases, is at least 1 month but less than 6 months. The duration requirement for schizophreniform disorder is intermediate between that for brief psychotic disorder, which lasts more than 1 day and remits by 1 month and schizophrenia, which lasts for 6 months. The diagnosis must meet the following two conditions: 1) When an episode of illness last between 1 and 6 months and the individual has already recovered and 2) The individual is symptomatic for less than 6 months duration required for the diagnosis of schizophrenia but has not yet recovered. If the disturbance last more than 6 months the diagnosis should be changed to schizophrenia.
SCHIZOPHRENIFORM SPECIFIERS What are the specifiers used for patients with schizophreniform disorder?
(DSMV 97) With good prognostic features, Without good prognostic features and Catatonia
ANHEDONIA Anhedonia
Loss of interest in and withdrawal from all regular and pleasurable activities. Often associated with depression.
SCHIZOPHRENIA DSM 5 CRITERIA What is the DSM 5 diagnostic criteria for schizophrenia?
(DSMV 99) A. Two or more of the following, each present for a significant portion of time during a 1-month period (or less if successfully tx'ed). at least one of these must be 1,2, or 3. 1. delusions 2. hallucinations 3. disorganized speech (frequent derailment or incoherence.) 4. grossly disorganized or catatonic behavior. 5. negative symptoms ( diminished emotional expression or avolition) B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas such as work, interpersonal relations, or self care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence there is failure to achieve expected level of interpersonal, academic, or occupational functioning.) C. Continuous signs of the disturbance persist for at least 6 months. this 6-months period must include at least 1 month of symptoms (or less if successfully treated) that meet criterion A (active-phase symptoms) and may include periods of prodromal or residual symptoms. during these prodromal or residual periods, the signs of the disturbance ma be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (odd beliefs unusual perceptual experiences) D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active phase symptoms or 2) if mood episodes have occurred during active phase symptoms they have been present for a minority of the total duration of the active and residual periods of the illness. E. The disturbance is not attributable to the physiological effects of a substance (a drug of abuse a medication) or another medical condition F. if there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional dx of schizophrenia is made only if prominent delusions or hallucinations in addition to the other required symptoms of schizophrenia, are also present for at least 1 month ( or less if successfully tx)
SCHIZOPHRENIA DX/CLINICAL/ASSOCIATED FEATURES What are the diagnostic/clinical and associated features that support a diagnosis of schizophrenia?
(DSMV 99-101) *Diagnostic features*- characteristic symptoms involve a range of cognitive, behavioral, and emotional dysfunctions, but no single symptom is pathognomonic of the disorder. diagnosis involves the recognition of a constellation of s/s associated w/ impaired occupational or social functioning. individuals with the disorder will vary substantially on most features as schizophrenia as heterogeneous clinical syndrome *clinical features*- motor coordination, sensory integration, motor sequencing of complex movements, left, right confusion, and disinhibition of associated movements(eyes), minor physical anomalies of the face and limbs may occur., *Associated features*- may display inappropriate affect, a dysphoric mood that can take the form of depression, anxiety, or anger; a disturbed sleep pattern; and a lack of interest in eating or food refusal. depersonalization, derealization, and somatic concerns may occur and sometimes reach delusional proportions. anxiety and phobias are common. cognitive deficits are common and strongly linked to vocational and functional impairments. these deficits can include decrements in declarative memory working memory language function and other executive functions as well as slower processing speed. abnormalities in sensory processing and inhibitory capacity as well as reductions in attention are also found. some may lack insight or awareness of their disorder is typically a symptom rather than a coping skill. anosognosia (lack of awareness of illness) is a common predictor of nonadherence to tx and predicts higher relapse rates increased number of involuntary tx poorer psychosocial function aggression and a poorer course of illness. aggression is more frequent in younger males, with past hx of males, non-adherence with tx, substance abuse, and impulsivity. usually those with schizophrenia are not aggressive and are frequently victimized. Changes are evident in white matter connectivity, gray matter volume in the prefrontal and temporal cortices.
DELUSIONAL DISORDER DIFFERENTIAL DX What differential diagnosis should be considered for patients presenting with symptoms of delusional disorder?
(DSVM 93, Sadock Pp336-337) -OCD, Delirium, major neurocognitive disorder, psychotic disorder due to another medical Condition and substance/medication induced psychotic disorder, schizophrenia and schizophreniform disorder, depressive and bipolar disorders and schizoaffective disorder, malingering disorder, factitious disorder, mood disorders, somatoform disorders and paranoid personality disorder.
SCHIZOPHRENIA DIFF DX What differential diagnosis should the clinician consider for patients presenting with symptoms of schizophrenia?
(Saddock, pg 316-317) A wide range of no psychiatric medical conditions and a variety of substances can induce symptoms of psychosis and Catatonia (Table 7.1-3). First,clinicians should aggressively pursue an undiagnosed no psychiatric medical condition, second, attempt to obtain a complete family history, third, consider the possibility of a no psychiatric medical condition. (DSM-V pg 104) Major depressive disorder or bipolar disorder with psychotic or catatonic features, schizoaffective disorder, schizophreniform disorder and brief psychotic disorder, delusional disorder, schizotypal personality disorder, OCD and body dysmorphic disorder, PTSD, Austism spectrum or communication disorders, Other mental disorders associated with psychotic episode.
SCHIZOPHRENIA PSYCHOSOCIAL OPTIONS What psychosocial treatment options are available for patients with schizophrenia?
(Saddock, pg 321-323) Variety of methods to increase social abilities, self sufficiency, practical skills and interpersonal communication. The goal is to enable persons who are severely ill to develop social and vocational skills for independent living. These include social skills training, family-oriented therapies, National alliance on mental illness, case management, assertive community treatment, group therapy, cognitive behavioral therapy, individual psychotherapy, personal therapy, dialectical behavior therapy, vocational therapy, art therapy, cognitive training.
SCHIZOPHRENIFORM VS SCHIZOPHRENIA How does schizophreniform disorder differ from schizophrenia?
(Saddock, pg 327) Patients with schizophreniform disorder have symptoms that last for at least 1 month but less than 6 months. Patients return to their baseline level of functioning after the disorder has resolved.
CIRCUMSTANTIALITY define Circumstantiality
(Sadock 202) is the result of a non-linear thought pattern and occurs when the focus of a conversation drifts, but often comes back to the point. In circumstantiality, unnecessary details and irrelevant remarks cause a delay in getting to the point. If someone exhibits circumstantial speech during a conversation, they will often "talk the long way around" to their point, which can be seen in contrast to linear speech, which is direct, succinct, and to the point.
4 A'S OF SCHIZOPHRENIA What are the Four A's of schizophrenia?
(Sadock, p. 300) Bleuler identified specific fundamental (or primary) symptoms of schizophrenia to develop his theory about the internal mental schisms of pts. These symptoms included associational disturbances of thought, especially looseness, affective disturbances, autism, and ambivalence, summarized as the four A's: associations, affect, autism, and ambivalence.
DEMENTIA PRECOX What is dementia precox?
(Sadock, p. 300) Kraepelin translated Morel's démence précoce into dementia precox, a term that emphasized the change in cognition (dementia) and early onset (precox) of the disorder. Pts with dementia precox were described as having a long-term deteriorating course and the clinical symptoms of hallucinations and delusions.
SCHIZOPHRENIA NICOTINE How does nicotine impact treatment of the schizophrenic patient?
(Sadock, p. 302) Up to 90% of schizophrenia patients may be dependent on nicotine. Nicotine decreases the blood concentrations of some antipsychotics. Increased prevalence in smoking is due, at least, in part, to brain abnormalities in nicotine receptors. A specific polymorphism in a nicotine receptor has been linked to a genetic risk for schizophrenia. Nicotine administration appears to improve some cognitive impairments and parkinsonism in schizophrenia, possibly because of nicotine-dependent activation of dopamine neurons. Recent studies have also demonstrated that nicotine may decrease positive symptoms such as hallucination in schizophrenia patient by its effect on nicotine receptors in the brain that reduce the perception of outside stimuli, especially noise. In that sense, smoking is a form of self-medication.
SCHIZOPHRENIC SYMPTOMOLOGY DOPAMINE ROLE What role does dopamine play in schizophrenic symptomology?
(Sadock, p. 303) Simplest formulation→ schizophrenia results from too much dopaminergic activity. The dopamine hypothesis theory evolved from two observations: First- the efficacy and the potency of many antipsychotic drugs (i.e. the dopamine receptor antagonists [DRAs] are correlated with their ability to act as antagonists of the dopamine type 2 (D2) receptor. Second- drugs that increase dopaminergic activity, notably cocaine and amphetamine, are psychotomimetic. The basic theory does not elaborate on whether the dopaminergic hyperactivity is due to too much release of dopamine, too many dopamine receptors, hypersensitivity of the dopamine receptors to dopamine, or a combination of these mechanisms. Which dopamine tracts in the brain are involved is also not specified in the theory, although the mesocortical and mesolimbic tracts project from their cell bodies in the midbrain to dopaminoceptive neurons in the limbic system and the cerebral cortex. Excessive dopamine release in pts with schizophrenia has been linked to the severity of positive psychotic symptoms. PET studies of dopamine receptors document an increase in D2 receptors in the caudate nucleus of drug-free patients with schizophrenia; also reports of increased dopamine concentration in the amygdala, decreased density of the dopamine transporter, and increased numbers of dopamine type 4 receptors in the entorhinal cortex.
SCHIZOPHRENIA ABNORMAL EYE MOVEMENT OF What eye movement dysfunction can be seen in patients with schizophrenia?
(Sadock, p. 305) the inability to follow a moving visual target accurately the defining basis for the Disorders visual pursuing and its inhibition saccadic eye movement in patients with schizophrenia. Eye movement dysfunction may be attributed marker for schizophrenia; it is independent of drug treatment and clinical state, and it is also seen in first-degree relatives of probands with schizophrenia. Various studies have reported abnormal eye movements, and 50% to 85% of patients with schizophrenia compared with about 25% psychiatric patients without schizophrenia and fewer than 10% non psychiatric ill control subjects because eye movement is particularly controlled by centers in the frontal lobes of disorder in eye movement is consistent with theories that implicate a frontal lobe pathological process and schizophrenia The inability to follow a moving visual target accurately is the defining basis for the disorders of smooth visual pursuit and disinhibition of saccadic eye movements seen in pts with schizophrenia. It may be a trait marker for schizophrenia. Various studies have reported abnormal eye movements in 50-85% of pts with schizophrenia compared with about 25% of psychiatric pts without schizophrenia.
SCHIZOPHRENIA MC THOUGHT DISORDER What is the most common thought disorder seen in schizophrenic patients?
(Sadock, p. 313) Disorders of thought content reflect the patient's ideas, beliefs, and interpretation of stimuli. Delusions are an example of a disorder of thought content are varied in schizophrenia and may assume persecutory, grandiose, religious, or somatic forms. (Not sure, but I think this is correct...any other ideas?)
DELUSIONS BIZARRE When is a delusion considered bizarre?
(Sadock, p. 313) Pts may also worry about life-threatening but bizarre and implausible somatic conditions, such as the presence of aliens inside the pt's testicles affecting his ability to father children.
DELUSIONS TYPES What are the types or themes of commonly occurring delusions?
(Sadock, p. 313) Pts may believe that an outside entity controls their thoughts or behavior or, conversely, that they control outside events in an extraordinary fashion. Pts may have an intense and consuming preoccupation with esoteric, abstract, symbolic, psychological, or philosophical ideas.
SCHIZOPHRENIA VIOLENT ACTS What patients with schizophrenia are more likely to commit violent acts?
(Sadock, p. 314) patients with schizophrenia are more violent as a group than the the general population. This is particularly a problem for patients with fairly type, may act quite suddenly and impulsively on a delusional idea. Patients with paranoia to the intelligent and capable of forming plans; therefore, they represent a much greater risk than individuals were disorganized and cannot plan effective attack. By earlier beliefs command hallucinations do not appear to play a particularly important role violence. Violence between patients in hospitals frequently result from the attacking patients mistaken belief that another patient is behaving in a threatening layer getting physically too close. Studies have revealed that violence in a hospital setting can result from underdiagnosed neuroleptic acute akathisia persistently violent patients often do well in special training units that provide a more structured program and a less crowded environment. Patients who fail to respond to this kind of care usually neurological signs. In addition to their diagnosis. Unfortunately, it is exceedingly difficult to prevent most schizophrenic homicides because there is usually no clear warning. Most of the homicides comes a horrifying surprise. Patients who are known to be paranoid with homicidal tendencies should not will be allowed to move about freely as long as they retain the delusions and aggressive tensions Violent behavior (excluding homicide) is common among untreated schizophrenia patients. Delusions of a persecutory nature, previous episodes of violence, and neurological deficits are risk factors for violent or impulsive behavior.
SCHIZOPHRENIA NEUROBIOLOGICAL HYPOTHESES What are the neurobiological hypotheses of schizophrenia?
(sadock 304) -Potential neuropathological basis for schizophrenia in the limbic system and the basal ganglia, including neuropathological or neurochemical abnormal in the cerebral cortex, the thalamus and the brainstem. The loss of brain volume widely reported in schizophrenic brains appears to result from reduced density of the axons, dendrites and synapses that mediate associative functions of the brain.
SCHIZOPHRENIA SUICIDE RISK What is the risk of suicide in patients with schizophrenia?
(Sadock, p. 314)(DSM-V, p. 104). Suicide is the single leading cause of premature death among people with schizophrenia. Suicide attempts are made by 20 to 50% of the patients, with long-term rates of suicide estimated to be 10-13%. Often, suicide in schizophrenia seems to occur "out of the blue," without prior warnings or expressions of verbal intent. The most important factor in suicide is the presence of a major depressive episode. Epidemiological studies indicate that up to 80% of schizophrenia patients may have a major depressive episode at some time in their lives. Some data suggest that those patients with the best prognosis (few negative symptoms, preservation of capacity to experience affects, better abstract thinking) can paradoxically also be at highest risk for suicide. Other possible contributors to the high rate of suicide include command hallucinations and drug abuse. DSM-V states approximately 5-6% of individuals with schizophrenia die by suicide (may be an underestimation), about 20% attempt suicide on one or more occasions.
SCHIZOPHRENIA FUNCTIONAL LEVEL CHANGES How does the functional level change for a schizophrenic patient with each exacerbation of symptoms?
(Sadock, p. 317-318) More than 50% of patients can be described as having a poor outcome, with repeated hospitalizations, exacerbations of symptoms, episodes of major mood disorders, and suicide attempts. 20-30% of all schizophrenia patients are able to lead somewhat normal lives. About 20-30% of patients continue to experience moderate symptoms, and 40 -60% of patients remain significantly impaired by their disorder for their entire lives.
THOUGHT CONTENT CHARACTERISTICS What are the characteristics of a patient with disturbances in thought content?
(Sadock, p.313) Disorders of thought content reflect the patient's ideas, beliefs, and interpretations of stimuli. Delusions, the most obvious example of a disorder of thought content, are varied in schizophrenia and may assume persecutory, grandiose, religious, or somatic forms. Patients may believe that an outside entity controls their thoughts or behavior or, conversely, that they control outside events in an extraordinary fashion (causing the sun to rise and set or by preventing earthquakes). Patients may have an intense and consuming preoccupation with esoteric abstract, symbolic, psychological, or philosophical ideas. Patients may also worry about allegedly life-threatening but bizarre and implausible somatic conditions, such as the presence of aliens inside the patient's testicles affecting his ability to father children. Loss of ego boundaries describes the lack of a clear sense of where the patient's own body, mind, and influence end and where those of other animate and inanimate objects begin. For example, patients may think that other persons, the television, or the newspapers are referring to them (ideas of reference). Other symptoms of the loss of ego boundaries include the sense that the patient has physically fused with an outside object (tree or another person) or that the patient has disintegrated and fused with the entire universe (cosmic identity). With such a state of mind, some patients with schizophrenia doubt their gender or their sexual orientation.
DELUSIONS DEFINITIONS What are delusions?
(Sadock, p.330) Delusions are false fixed beliefs not in keeping with the culture; it is an example of a disorder of thought content. Delusions may assume persecutory, grandiose, religious, or somatic forms.
EMILE KRAEPELIN Review Emile Kraepelin.
(sadock 300) - more concerned with course and prognosis - created the original subtypes of schizophrenia. -Patients with dementia precox were described as having a long term deteriorating course and the clinical symptoms of hallucinations and delusions. Kraepelin distinguished these patients from those who underwent distinct episodes of illness alternating with periods of normal functioning, which he classified as having manic-depressive psychosis. Another separate condition called paranoia was characterized by persistent persecutory delusions.
SCHIZOPHRENIA EPIDEMIOLOGY What are the epidemiological characteristics of schizophrenia?
(sadock 301) men have an earlier onset of schizophrenia than in women, the peak age of onset from is 25 to 35 years. However, schizophrenia equally prevalent in men and women hospital records suggest that the incidence of schizophrenia in the US has probably remain unchanged for the past hundred years and possibly throughout the entire history of the country despite the social, economical population changes suicide is a common cause of death among schizophrenia patients about 50% of patients with schizophrenia attempt suicide at least once in a lifetime and 10 to 15% schizophrenics died by suicide during 20 are followed. The lifetime prevalence of schizophrenia is usually between 1 and 1.5% of the population consistent with that range. The national Inst. of mental health sponsored epidemiological catchment area study report a lifetime prevalence of 1.3% an important epidemiological factor in schizophrenia is that some regions of the world have an unusually high prevalence of this disorder. Certain researchers have interpreted an equity evidence supporting an infectious cause for schizophrenia. Others emphasize genetic or social factors different patients occupy 50% of mental health beds. Female patients with schizophrenia are no more likely to commit suicide than are male patients. The risk factors are equal. There is a difference in prevalence of schizophrenia. According to season the northern hemisphere schizophrenia occurs more often among people born from January to April not July to September. The latter timers refers to seasonal preferences for the disorder in the southern production rates among people schizophrenia have been increasing in recent years because of newly introduced medications, and changes in laws and policies the hospitalization for community-based care. The fertility rate among people schizophrenia. However, is only approaching the rate for the general population is not exceeded -In the US, the lifetime prevalence of schizophrenia is about 1%, which means that about one person in 100 will develop schizophrenia during their lifetime. In the US, about 0.05% of total population is treated for the schizophrenia in any single year and only about half of all patients with schizophrenia obtain treatment, despite severity of the disorder.
SCHIZOPHRENIA ETIOLOGICAL RISK FACTORS What are the etiological factors for developing schizophrenia?
(sadock 303) -The likelihood of a person having schizophrenia is correlated with the closeness of the relationship to an affected relative (first or second degree relative). In the case of monozygotic twins who have identical genetic endowment, there is an approximately 50% concordance rate. There's a high rate of schizophrenia among biological relatives of an adopted-away person who develops schizophrenia, compared with adoptive, nonbiological relatives who rear the patient. Some data indicate that the age of the father has a correlation with development of schizophrenia. It was found that those born from fathers older than the age of 60 years were vulnerable to developing the disorder.
SCHIZOPHRENIA PREFRONTAL/LIMBIC SYSTEM THEORIES Describe the prefrontal cortex and limbic system theories of schizophrenia.
(sadock 304) -Functional deficits in the prefrontal brain imaging region have also been demonstrated. It's been noted that several symptoms of schizophrenia mimic those found in persons with prefrontal lobotomies or frontal lobe syndromes. Because of its role in controlling emotions, the limbic system has been hypothesized to be involved in the pathophysiology of schizophrenia. Studies of postmortem brain samples from schizophrenia patients have shown a decrease in the size of region, including the amygdala, hippocampus and the parahippocampal gyrus.
SCHIZOPHRENIA MRI/NEUROANATOMICAL ABNORMALITIES/EEG CHANGES What neuroanatomical abnormalities can be found in patients with schizophrenia? What EEG changes are found?
(sadock 305) - prefrontal cortex and limbic system hypothesis are the predominant neural theories of schizophrenia demonstration of decreased volumes of prefrontal gray or white matter prefrontal cortical interneuron abnormalities distributed prefrontal metabolism and blood flow decreased volumes of hippocampal and entorhinal cortex, and disarray or abnormal migration of hippocampal and entorhinal neurons provide strong support for the involvement of these brain regions in the pathophysiology of schizophrenia. In the context of neural circuit hypothesis linking the prefrontal cortex of limbic systems, studies demonstrating the relationship between hippocampal morphological abnormalities in disturbances in prefrontal cortex metabolism or function are particular= interesting - MRI studies demonstrate that monozygotic twins were discordant for schizophrenia. Virtually all the affected twins of larger cerebral ventricles is in there and nonaffected twin, MRI is used in schizophrenia research because it's resolution. Is superior to that of CT the abnormalities reported in CT studies of patients with schizophrenia have also been reported and other neuropsychiatric conditions and are unlikely to be specific for pathophysiological processes underlying schizophrenia. PET studies have shown evidence of impaired activation of certain brain areas after psychological tests stimulation in schizophrenic functional MRI has shown differences in sensory motor cortex activation in a decreased blood flow in the occipital lobes in patients with schizophrenia - studies using MRI have found evidence in patients with schizophrenia for decreased cortical gray matter, especially in the temporal cortex decrease volume of limbic system structures (the amygdala, hippocampus (hippocampus), and increased volume of the basal ganglia nuclei. These findings are consistent with the findings of neural pathological examinations this morning tissue including Walter structural examination, which in some cases so loss misalignment of cells altered intracellular structure abnormal protein expression or gliosis -EEG studies indicate that many schizophrenic patients have abnormal records, increased sensitivity to activation procedures (frequent spike activity after sleep deprivation), decreased alpha activity, increased theta and delta activity, possibly more epileptiform activity than usual and possibly more left-sided abnormalities than usual. Schizophrenic patient also exhibit inability to filter out irrelevant sounds and are extremely sensitive to background noise.
SIMPLE DETERIORATIVE DISORDER What is Simple Deteriorative Disorder and what types of individual develop this disorder?
(sadock 310) -Is characterized by a gradual, insidious loss of drive and ambition. Patients with this disorder are usually not overtly psychotic and do not experience persistent hallucinations or delusions.Their primary symptom is withdrawal from social and work-related situations.
LOOSENESS OF ASSOCIATIONS Define Looseness of associations
(sadock 313) a manifestation of a thought disorder whereby the patient's responses do not relate to the interviewer's questions, or one paragraph, sentence, or phrase is not logically connected to those that occur before or after.
TANGENTIALITY define Tangentiality
(sadock 313) is the tendency to speak about topics unrelated to the main topic of discussion. While most people engage in tangentiality from time to time, constant and extreme tangentiality may indicate an underlying mental health condition, particularly schizophrenia
SCHIZOPHRENIA COMORBID DISORDERS What are the common comorbid disorders seen in patients with schizophrenia?
(sadock 315-316 DSM-V, pg 105) Over half of individuals with schizophrenia have tobacco use disorder and smoke cigarettes regularly. Comorbid it's with anxiety disorders is increasingly recognized in schizophrenia. Rates of OCD and panic disorder are elevated. Schizotypal or paranoid personality disorder may sometimes precedes the onset of schizophrenia.
SCHIZOPHRENIA CHANGES WITH AGE What symptom changes can be expected as the schizophrenic patient ages?
(sadock 317) positive symptoms tend to be less severe with time, but the socially debilitating negative or deficit symptoms may increase in severity.
SCHIZOPHRENIA PROGNOSTIC INDICATORS What are the prognostic indicators for patients with schizophrenia?
(sadock 318, table 7.1-4) *Good prognosis* - late onset - obvious precipitating factors - acute onset - good premorbid social sexual and work histories - mood disorder symptoms especially depressive - married - family hx of mood disorders - good support system - positive symptoms *Poor Prognosis* - young onset - no precipitating factors - insidious onset - poor premorbid social sexual and work hx - withdrawn, autistic behavior - single, divorced, widowed - family hx of schizophrenia - poor support system - negative symptoms - neurological s/s - hx of prenatal trauma - no remission in 3 years - many relapses - hx of assaultiveness
SCHIZOPHRENIFORM EPIDEMIOLOGY What are the epidemiological characteristics of schizophreniform disorder?
(sadock 327) The initial symptoms profile is the same as that of schizophrenia in that two or more psychotic symptoms (hallucinations, delusions, disorganized speech and behavior or negative symptoms. Also, an increased likelihood is found of emotional turmoil and confusion, the presence of which may indicate a good prognosis. In a small series of of first admission patients with schizophreniform, ¼ had moderate to severe negative symptoms. By definition, patients with schizophreniform disorder return to their baseline within 6 months.
SCHIZOPHRENIFORM DISORDER RISK FACTORS What are some common risk factors for developing schizophreniform disorder?
(sadock 327) -Several studies have shown that the relatives of patients with schizophreniform disorder are at high risk of having other psychotic disorders. Relatives of patients with schizophreniform disorders are more likely to have a mood disorders than are relatives of patients with schizophrenia.
SCHIZOPHRENIFORM DISORDER DIFFERENTIAL DX What differential diagnosis would the clinician consider for patients presenting with symptoms of schizophreniform disorder?
(sadock 329) (DSMV 98-99) -A detailed history of medication use including OTC's and herbals. Also rule out schizophrenia, mood disorders, delirium, depressive disorder, brief psychotic disorder, delusional disorder, schizotypal, schizoid, paranoid personality disorders and other medical conditions.
DELUSIONAL DISORDER EPIDEMIOLOGY What are the epidemiological characteristics of delusional disorder?
(sadock 330) -underreported because delusional patients rarely seek psychiatric help -prevalence is 0.2% to 0.3% and rare than schizophrenia -1 to 3 cases per 100,000 persons -mean age is 40 yrs, but the range age is 18 to 90's -men are more likely to have disorder than women -many patients are married and employed, some association is seen in recent immigration Low socioeconomic status
DELUSIONAL DISORDER DIFFERENCE FROM SCHIZOPHRENIA AND MOOD DISORDERS In what ways do delusional disorder differ from schizophrenia and mood disorders?
(sadock 330, 337) an issue that is central to attributing conversations whether delusional disorder represents the separate group of conditions or is an atypical form of schizophrenic in mood disorders. The relevant data come from a limited number of studies and are inconclusive. Epidemiology data suggest that delusional disorder is a separate condition; it is far less prevalent in schizophrenia for mood disorders; the age onset is later than in schizophrenia, although men tend to experience that only said earlier age than women; and the sex ratio is different from that of mood disorder, which occurs disproportionately among women findings from family or genetic studies also support the theory that delusional disorder is a distinct entity that delusional disorder is simply an unusual form of schizophrenic or mood disorders, the incidence of these latter conditions and family studies of delusional disorder patient probands should be higher than that of the general population. However, this is not been a consistent finding a recent study concluded that the patient does more likely to have family members who show suspiciousness, jealousy, secretiveness, even paranoid illness than families of controls other investigative efforts have found paranoid personality disorder, avoidant personality disorder to be more common in the relatives of patients with delusional disorder, than the relative control subjects were schizophrenic patients in recent study documented modest evidence for increased risk of alcoholism among the relatives of patients with delusional disorder compared with probands with schizophrenia, probands with psychotic disorder not otherwise specified, and probands with schizophreniform disorder. Investigations into the patient's natural history. Also, when or to suggestion that delusional disorder is a distinct category: age of onset appears to later than schizophrenia and outcome is generally better for delusional patients with disorder than for those with schizophrenia. Although fraught with methodological shortcomings premorbid personality data indicate that people schizophrenia in those with delusional disorder differ early in life. The former are more likely to be introverted schizoid and submissive in the latter extroverted dominant and hypersensitive patient with delusional disorders may have below average intelligence precipitating factors, especially relevant to social isolation, consciousness and immigration are more closely associated to disorder and schizophrenia is characteristic support the environmental factors play an important etiological role -delusional disorder is much more rarer than either schizophrenia and mood disorders with A later onset than schizophrenia and a much less pronounced female predominance than mood disorders.
DELUSIONAL DISORDER HALLUCINATION TYPES What are the most common types of hallucinations in patients with delusional disorder?
(sadock 331) -generally, and Delusional disorders, the patient's delusions are well systemized and have been developed logically. The persons may experience auditory or visual hallucinations, but these are not prominent features. Tactile or olfactory hallucinations, may be present in prominent if there related to the delusional content were seen. Examples are the sensation of being infested by bugs or parasites, associated with delusions of infestation, and the belief that one's body odor is about, associated with somatic delusions. The persons behavioral and emotional responses to the delusion appear to be appropriate. Impairment of functioning is not marked personality deterioration is minimal if it occurs at all behavior is neither obviously odd nor bizarre -Patients with delusional disorder do not have prominent or sustained hallucinations. A few Delusional patients have other hallucinatory experiences-virtually always auditory rather than visual.
DELUSIONS SUBTYPE CHARACTERISTICS What are the clinical characteristics of each subtype of delusions?
(sadock 333-336) -persecutory - associated with querulousness, irritability and anger and the individual who acts out his or her anger may be assaultative or even homicidal -jealously - delusional disorder with delusions of infidelity has been called conjugal paranoia. Eponym Othello Syndrome has been used to describe morbid jealousy that can arise from Multiple concerns. Condition is difficult to treat and may only diminish with separation, Divorce or death of the spouse. -erotomanic - also been referred to as de Clerambault Syndrome or psychose passionelle. A delusional conviction of amorous communication, object of much higher rank, object first To fall in love, object first to make advances, sudden onset (within 7 days), object remains Unchanged, patient rationalizes paradoxical behavior of object, chronic course and absence of Hallucinations. Patient generally unattractive women in low-level jobs who lead withdrawn, lonely lives, they are single and have few sexual contacts. -somatic - also called monosymptomatic hypochondriacal psychosis. The three main types: Delusions of infestation, delusions of dysmorphophobia, such as of misshappenness, personal Ugliness or exaggerated size body parts and delusions of foul odors or halitosis. Earlier age of onset (mean age 25), male predominance, single status and absence of past psychiatric treatment. -grandiose - megalomania has been noted. -mixed - applies to patients with 2 or more delusional themes. -unspecific - is reserved for cases in which the predominant delusion cannot be sub-typed Within the previous categories *Capgras Syndrome* is the belief that a familiar person has been Replaced by an imposter. Predominantly in women and have had associated paranoid Features and included feelings of depersonalization or derealization. Maybe short lived, Recurrent or persistent.
DELUSIONAL DISORDER RISK FACTORS What are the risk factors for developing a delusional disorder?
(sadock 3330) (sadock 331 table 7.4-1) - because of delusional disorder is the epidemiological and clinical literature suggests that certain risk factors may be relevant to the etiology and his or further research elaboration. These factors are found below. They are risk factors predictors for simple characteristics or markers of the disorder *familial psychiatric disorders including delusional disorders is the best documented risk factor. At present* -Advanced age. -Sensory impairment or isolation -family history -social isolation -personality features (unusual interpersonal sensitivity) -recent immigration -have a heterogeneous group of conditions with delusions as predominant symptoms -central concept about the cause of delusional disorder is its distinctness from schizophrenia and the mood disorders. -most convincing data from family with increased prevalence of delusional disorder (suspiciousness, jealousy and secretiveness) -Advanced age, sensory impairment or isolation, family history, social isolation, personality features (unusual interpersonal sensitivity) and recent immigration
CLERAMBAULT'S SYNDROME/EROTOMANIA What does Clerambault's syndrome refer to?
(sadock 334) -also referred as erotomania, the patient has the delusional conviction that another person, Usually of higher status is in love with him or her
PSYCHOTIC DISORDER CHARACTERISTICS What are the characteristics of shared psychotic disorder? (sadock 336)
(sadock 336) -characterized by the transfer of delusions from one person to another. Both party persons are Closely associated for a long time and typically live together in relative social isolation. In its Most common form, the first individual (primary case) is often chronically ill typically is the Influential member of a close relationship with more suggestible person (secondary case) who Also develops the delusion. The secondary case is is frequently less intelligent, more gulliable, more passive or more lacking in self esteem than the person in the primary case. If the pair Separates, the secondary person may abandon the delusion, but this outcome is not seen Uniformly. The most commons relationships (sister-sister,husband-wife, mother-child). Almost all cases involve members of a single family.
DELUSIONAL DISORDER TX OPTIONS What are the treatment options for patients with delusional disorder?
(sadock 338-339) (Table 7.4-4 sadock 338) the use of individual therapy in the treatment of patients delusional disorder seems to be more effective than group therapy. The essential element effective psychotherapy is to establish the relationship in which the patient begins to trust therapist initially, the therapist should neither agree with your challenge the patient's solutions. Although therapist must ask about a delusion to establish its extent persistent questions about it should probably be avoided. The physicians may stimulate the motivation to receive help by assessing a willingness to help the patient with his or her anxiety, irritability without suggesting that the delusions be treated. But the therapy should not actively support the notion that the delusions are real. A useful approach in building a therapeutic alliance is to empathize with the patient's internal experience of being overwhelmed by persecution. It may be helpful to make such comments as"you must be exhausted considering what you have been through" without agreeing with every delusional misperception. Therapist acknowledged that from the patient's perspective perceptions create much distress entertain the possibility of doubt about his or her perceptions when family members are available clinicians may decide to involve them in the treatment -Individual therapy seems to be more effective than group, insight-oriented, supportive, Cognitive and behavioral therapies are often effective. Seen in outpatient but if clinicians should consider hospitalization for several reasons. In an emergency situation, severely agitated patients should be given an antipsychotic drug IM. Antipsychotic drugs are the treatment of choice for delusional disorder. Start off with a low dose of Haldol 2 mg or Risperdal 2 mg and Increase Dose slowly. Pimozide has been effective against delusional disorder, especially patients with somatic delusions. If antipsychotics have no benefit, Lithium, Tegretol, Depakene can be used on a trail bases. -Patients with delusional disorder respond less well generally to electroconvulsive treatment patient psychotic features. Some patients respond SSRIs is embodied disorder with concerns DRAs, particularly Pimozide, SDAs, and SSRIs are pharmacological agents with reports of successful use in delusional disorder -Little is known about the incidence, prevalence and sex ratio of schizophreniform. Most common in adolescents and young adults and less than half as common as schizophrenia. Fivefold greater in men than women. 1 year prevalence rate of 0.09% and lifetime prevalence rate of 0.11% have been reported. Relatives of patients with schizophreniform disorders are more likely to have a mood disorders than are relatives of patients with schizophrenia.
BRIEF PSYCHOTIC DISORDER EPIDEMIOLOGY What are the epidemiological characteristics of brief psychotic disorder?
(sadock 339) the course of brief psychotic disorder is found in the diagnostic criteria. It is a psychotic episode that last more than 1 day but less than a month with the eventual return to premorbid level of functioning. Approximately 50% of patients diagnosed brief psychotic disorder retain this diagnosis. The other 50% people evolve into either schizophrenia or a major affective disorder. There are no apparent distinguishing features, among brief psychotic disorders. Acute onset schizophrenia and mood disorders with psychotic features on initial presentation several prognostic features have been proposed characterized the illness, but they are consistent across studies. The good prognostic features are similar to those found in schizophrenia including acute onset of psychotic symptoms, or emotional turmoil at the height of the psychotic episode good premorbid functioning, the presence of effective symptoms in a short duration of symptoms. There is a relative dearth of information on the reoccurrence of brief psychotic episodes, however, so the course and prognosis of this disorder have not been well characterized -The exact incidence and prevalence of brief psychotic disorder in not known, but it is generally considered uncommon. The disorder occurs more often among younger patients (20's and 30's) than older patients, more common in women than men, seen in patients with low socioeconomic classes and in those who have experienced disasters or major cultural changes (immigrants). Persons who have gone through major psychosocial stressors may be at greater risk for subsequent brief psychotic
BRIEF PSYCHOTIC DISORDER RISK FACTORS What are the risk factors for developing brief psychotic disorder?
(sadock 339) The cause of brief psychotic disorder is unknown. Patients who have a personality disorder may have biological or psychological vulnerable for development of psychotic symptoms, particularly those with borderline, schizoid, schizotypal or paranoid qualities. Psychodynamic formulations have emphasized the presence of inadequate coping mechanisms and the possibly if secondary gain for patients with psychotic symptoms.
BRIEF PSYCHOTIC DISORDER PROGNOSIS FACTORS What factors indicate a good or poor prognosis for brief psychotic disorder?
(sadock 340 Table 7.5-1) -good prognostic features for brief psychotic disorder include good premorbid adjustment, few premorbid schizoid traits, a severe precipitating stressor, the sudden onset of symptoms, affective symptoms, confusion and perplexity during psychosis, little effective blunting, a short duration of symptoms, and absence of schizophrenic relatives -approximately half of patients who are first classified as having brief psychotic disorder later display chronic psychiatric syndromes such as schizophrenia and mood disorders. Patients with brief psychotic disorder, however, generally have good prognoses and european studies have indicated that 50% to 80% of all patients have no further major psychiatry problems. The length residual symptoms is often just a few days.
BRIEF PSYCHOTIC DISORDER DIFFERENTIAL DX What differential diagnosis should the clinician consider for individuals presenting with symptoms of brief psychotic disorder?
(sadock 340, DSMV 96) sharing rapid onset of symptoms. Brief psychotic disorder must be differentiated from substance-induced psychotic disorder and psychotic disorders due to a general medical condition. A thorough medical evaluation, including a physical examination laboratory studies in brain imaging helps rule out many of those conditions with only cross-sectional information, free psychotic disorders difficult to differentiate from other types of functional psychosis. The relationship between brief psychotic disorder in both schizophrenia and affective disorders remains uncertain. The DSM has made the distinction between brief psychotic disorder and schizophrenia form disorder clear by now requiring a form of a psychotic symptoms from the latter if psychotic symptoms are present longer than one month, a diagnosis of schizophreniform disorder, schizoaffective disorder, schizophrenia, mood Disorders with psychotic features, delusional disorders and psychotic disorder not otherwise specified, must be entertained. If psychotic symptoms of sudden onset are present for less than one month in response to the stressor, the diagnosis of brief psychotic disorder Is strongly suggested. Other diagnosis is to differentiate include factitious disorder, malingering, and severe personality disorder, with consequent transient psychosis possible. Schizophreniform, Schizoaffective, Schizophrenia and Mood disorder, Substance related disorder, Other medical conditions, Personality disorders, Malingering and Factitious disorder and Delusional disorder
HALLUCINATIONS NORMAL RANGE When are hallucinations considered within the range of normal experience?
*HYPNAGOGIC* Hallucinations that occur as one is falling asleep *HYPNOPOMPIC* Hallucinations that occur as one is waking up these are said to within th normal range of experiences.
SCHIZOPHRENIA SUBTYPES CHARACTERISTICS What are the characteristics of the various subtypes of schizophrenia?
*Paranoid schizophrenia* -- a person feels extremely suspicious, persecuted, or grandiose, or experiences a combination of these emotions. *Disorganized schizophrenia* -- a person is often incoherent in speech and thought, but may not have delusions. *Catatonic schizophrenia* -- a person is withdrawn, mute, negative and often assumes very unusual body positions. *Residual schizophrenia* -- a person is no longer experiencing delusions or hallucinations, but has no motivation or interest in life. *Schizoaffective disorder*--a person has symptoms of both schizophrenia and a major mood disorder such as depression.
EUGEN BLEULER
- more concerned with understanding the underlying psychological mechanism - saw symptoms in a continuum with normal behavior
VERBIGERATION define Verbigeration
? GOOGLE stereotypy in speech; stereotyped and meaningless repetition of words and phrases, as seen in some cases of schizophrenia; see also perseveration and logorrhea. Called also cataphasia.
PSYCHOTIC DISORDER CLINICAL/DX/ASSOCIATED FX What are the clinical/diagnostic and associated features of brief psychotic disorder?
An episode of the disturbance lasts at least 1 day but less than 1 month and the individual eventually has a full return to the premorbid level of functioning. Patients experience emotional turmoil or overwhelming confusion. They may have rapid shifts from one intense affect another. The level of impairment may be severe and supervision may be required to ensure that nutritional and hygienic are met and that the individual is protected from the consequences of poor judgement, cognitive impairment or acting on the basis of delusions. Increased risk of suicidal behavior and particularly during the acute episode.
HALLUCINATIONS TYPES What are the types of hallucinations?
Auditory hallucinations: Hearing voices Visual hallucinations: Seeing wisps or shadows Tactile hallucinations: These involve feeling things on your skin and body that aren't there Olfactory hallucinations: Some people smell things Gustatory hallucinations: Taste things usually poison Proprioceptive hallucinations: This was covered under the category of sleep paralysis
HALLUCINATIONS ABNORMAL What types of hallucinations are unusual?
Tactile, olfactory, and gustatory hallucinations are unusual; their presence should prompt the clinician to consider the possibility of an underlying medical or neurological disorder that is causing the entire syndrome.
SCHIZOPHRENIA COGNITIVE SYMPTOMS What are the cognitive symptoms of schizophrenia?
For some people, the cognitive symptoms of schizophrenia are subtle, but for others, they are more severe and patients may notice changes in their memory or other aspects of thinking. Similar to negative symptoms, cognitive symptoms may be difficult to recognize as part of the disorder. Often, they are detected only when specific tests are performed. Cognitive symptoms include the following: Poor "executive functioning" (the ability to understand information and use it to make decisions) Trouble focusing or paying attention Problems with "working memory" (the ability to use information immediately after learning it) Poor cognition is related to worse employment and social outcomes and can be distressing to individuals with schizophrenia.
ALOGIA Alogia
Inability to speak because of a mental deficiency or an episode of dementia.
COSMIC IDENTITY Cosmic identity
Kaplan sadock 313 form of loss of ego boundaries, the sense that the patient has physically fused with an outside object (tree or another person) or that the patient has disintegrated and fused with the entire universe.
5 DOMAINS OF PSYCHOTIC DISORDERS Abnormalities in one or more of 5 domains are key features in psychotic disorders. What are those 5 domains?
DSM5 87 -Delusions - Hallucinations - disorganized thinking (speech) - grossly disorganziced or abnormal motor behavior (catatonia) - negative symptoms
HALLUCINATION MOST COMMON TYPE What is the most commonly occurring type of hallucination?
DSM5 PG 87 auditory hallucination is the most common in schizophrenia
HALLUCINATIONS What are hallucinations?
DSM5-87 Hallucinations are perception like experiences that occur without an external stimulus. They are vivid and clear with the full force and impact of normal perception and not under voluntary control.
SCHIZOPHRENIA RISK FACTORS What are the risk factors for the development of schizophrenia?
Having a schizophrenic family member, especially having one or 2 schizophrenia parents were a monozygotic twin who is schizophrenic, increases the risk for schizophrenia. Other risk factors include (1) having lived through a difficult obstetrics delivery, presumably with trauma to the brain (2) having for unknown reasons. A deviant course of personality maturation and development has produced an excessively shy, daydreaming withdrawal frameless child; an excessively compliant good or dependent child; a child with idiosyncratic thought processes; a child who is particularly sensitive to separation; a child who is destructive, violent, and cordial, and prone to truancy in or anhedonia child (3) having a parent who has paranoid attitudes and formal disturbances of thinking:(4) having low levels of monoamine oxidase type B in the blood platelets (5) having abnormal pursuit eye movement (6) having taken a variety of drugs, particularly lysergic acid diethylamide (LSD), amphetamines, cannabis, cocaine, phencyclidine, and (7) having a history of temporal lobe epilepsy, Huntington's disease, homocystinuria, folic acid deficiency, or the adult form of meta-chromatic leukodystrophy. None of those risk factors in their bleak occurs in schizophrenic patients; they may occur in various combinations. The vast majority of people who ingest psychotomimetic drugs do not become schizophrenic. Not every schizophrenic patient had abnormal pursuit eye movements and some wall relatives of schizophrenic patients may also have abnormal pursuit eye movement. Although the precise cause of schizophrenia isn't known, certain factors seem to increase the risk of developing or triggering schizophrenia, including: Having a family history of schizophrenia Exposure to viruses, toxins or malnutrition while in the womb, particularly in the first and second trimesters Increased immune system activation, such as from inflammation or autoimmune diseases Older age of the father Taking mind-altering (psychoactive or psychotropic) drugs during teen years and young adulthood born in winter and early spring. In the northern hemisphere, including the US persons with schizophrenia or more often for the months from January to April in the southern who is fair persons with schizophrenia are more often born in the months from July to September there are no data to suggest that being born abroad as a respect for developing schizophrenia. Some studies show that the frequency of schizophrenia is increased after exposure to influenza not parainfluenza
DERAILMENT Define Derailment
In psychiatry, derailment (also loosening of association, asyndesis, asyndetic thinking, knight's move thinking, or entgleisen) is a thought disorder characterized by discourse consisting of a sequence of unrelated or only remotely related ideas. The frame of reference often changes from one sentence to the next.
SCHIZOPHRENIA NEGATIVE SYMPTOMS What are the negative symptoms of schizophrenia?
Negative symptoms are associated with disruptions to normal emotions and behaviors. These symptoms are harder to recognize as part of the disorder and can be mistaken for depression or other conditions. These symptoms include the following: "Flat affect" (reduced expression of emotions via facial expression or voice tone) Reduced feelings of pleasure in everyday life Difficulty beginning and sustaining activities Reduced speaking People with negative symptoms may need help with everyday tasks. They may neglect basic personal hygiene. This may make them seem lazy or unwilling to help themselves, but the problems are symptoms caused by schizophrenia.
NEOLOGISM Neologism
New word or phrase whose derivation cannot be understood; often seen in schizophrenia. Has also been used to mean a word that has been incorrectly constructed but whose origins are nonetheless understandable, but such constructions are more properly referred to as word approximations.
DELUSIONAL DISORDER EROTOMANIC TYPE what are the factors that contribute to the erotomanic type of delusional disorder.
Patients with erotomania have delusions as lovers most frequently. The patient is a woman, but men are also susceptible to the delusion. The patient believes that is your usually more socially prominent in herself is in love with her the onset can be set in the delusion becomes central focus of the patient's existence patients with are mania frequently show certain characteristics there generally but not exclusively women may be considered unattractive in appearance are in low-level jobs and laid withdrawn lonely lives being single and having to contact the slick secret lovers were substantially different from themselves. They exhibit what has been called a paradoxical conduct the delusional phenomenon of interrupting all denial of love as secret affirmations of love the course may be chronic recurrent brief separation from the love object may be the only satisfactory intervention. Although men are less commonly affected by his may be aggressively possible. Finally in the pursuit of love appellations predominate the object of aggression may not be the love individual that companions are protectors of the love object who are viewed as trying to come between lovers the tendency toward violence among men with are to mania may be initially to police rather than psychiatric contact in certain cases, resentment and rage response and absence of reaction from all forms of blood communication may escalate to the point that the love object is in danger
SCHIZOPHRENIA POSITIVE SYMPTOMS What are the positive symptoms of schizophrenia?
Positive symptoms are psychotic behaviors not generally seen in healthy people. People with positive symptoms may "lose touch" with some aspects of reality. For some people, these symptoms come and go. For others, they stay stable over time. Sometimes they are severe, and at other times hardly noticeable. The severity of positive symptoms may depend on whether the individual is receiving treatment. Positive symptoms include the following: Hallucinations are sensory experiences that occur in the absence of a stimulus. These can occur in any of the five senses (vision, hearing, smell, taste, or touch). "Voices" (auditory hallucinations) are the most common type of hallucination in schizophrenia. Many people with the disorder hear voices. The voices can either be internal, seeming to come from within one's own mind, or they can be external, in which case they can seem to be as real as another person speaking. The voices may talk to the person about his or her behavior, command the person to do things, or warn the person of danger. Sometimes the voices talk to each other, and sometimes people with schizophrenia talk to the voices that they hear. People with schizophrenia may hear voices for a long time before family and friends notice the problem. Other types of hallucinations include seeing people or objects that are not there, smelling odors that no one else detects, and feeling things like invisible fingers touching their bodies when no one is near. Delusions are strongly held false beliefs that are not consistent with the person's culture. Delusions persist even when there is evidence that the beliefs are not true or logical. People with schizophrenia can have delusions that seem bizarre, such as believing that neighbors can control their behavior with magnetic waves. They may also believe that people on television are directing special messages to them, or that radio stations are broadcasting their thoughts aloud to others. These are called "delusions of reference." Sometimes they believe they are someone else, such as a famous historical figure. They may have paranoid delusions and believe that others are trying to harm them, such as by cheating, harassing, poisoning, spying on, or plotting against them or the people they care about. These beliefs are called "persecutory delusions." Thought disorders are unusual or dysfunctional ways of thinking. One form is called "disorganized thinking." This is when a person has trouble organizing his or her thoughts or connecting them logically. He or she may talk in a garbled way that is hard to understand. This is often called "word salad." Another form is called "thought blocking." This is when a person stops speaking abruptly in the middle of a thought. When asked why he or she stopped talking, the person may say that it felt as if the thought had been taken out of his or her head. Finally, a person with a thought disorder might make up meaningless words, or "neologisms." Movement disorders may appear as agitated body movements. A person with a movement disorder may repeat certain motions over and over. In the other extreme, a person may become catatonic. Catatonia is a state in which a person does not move and does not respond to others. Catatonia is rare today, but it was more common when treatment for schizophrenia was not available.
HALLUCINATIONS-ASSESSMENT How do these hallucinations impact assessment?
Pt can feel guarded and paranoid with disease process that cause hallucinations making the interview more challenging
SCHIZOPHRENIFORM DX/CLINICAL/ASSOCIATED FX What are the diagnostic/clinical and associated features of schizophreniform disorder?
SADOCK (327) - an acute psychotic disorder that has a rapid onset and lacks a long prodromal phase. - pts may experience functional impairment at the time of an episode they are unlikely to report a progressive decline in social and occupational functioning. - initial symptom profile is the same as schizophrenia in that 2 or more psychotic symptoms (hallucinations, delusions, disorganized speech and behavior, or negative symptoms) must be present. - schneiderian first rank symptoms are frequently observed. - increased likelihood of emotional turmoil and confusion, which may indicate a good prognosis. - negative symptoms may be present, but are rare and considered poor prognostic indicators. - by definition pt with schizophreniform disorder should return to their baseline state within 6 months - some illness are episodic, if combined duration exceeds 6 months schizophrenia should be considered.
WORD SALAD define Word salad
SADOCK 202 a confused or unintelligible mixture of seemingly random words and phrases, specifically (in psychiatry) as a form of speech indicative of advanced schizophrenia.
POVERTY OF CONTENT define Poverty of content
SADOCK 312 is a general lack of additional, unprompted content seen in normal speech. As a symptom, it is commonly seen in patients suffering from schizophrenia, and is considered as a negative symptom.
POVERTY OF THOUGHT define Poverty of thought
SADOCK 312 Poverty of thought is a global reduction in the quantity of thought and thought perseveration refers to a pattern where a person keeps returning to the same limited set of ideas." -
RACING THOUGHTS define Racing thoughts
SADOCK 313 refers to the rapid thought patterns that often occur in manic, hypomanic, or mixed episodes.
LACK OF ORIENTATION DIFFERENTIAL. What differential diagnoses should be considered when a patient has a lack of orientation?
SADOCK 315 lack of orientation should prompt the clinician to investigate other possibilities of medical or neurological brain disorders. -substance abuse - epilepsy - neoplasm, CVD, trauma to frontal or limbic region - acute intermittent porphyria - AIDS - VIT B12 deficiency - carbon monoxide poisoning - cerebral lipoidosis - creutzfeldt-jakob disease - fabry's disease - fahr's disease - hallervorden-spatz disease - heavy metal poisoning -herpes encephalitis - homocystinuria - homocystinuria - huntington's disease - metachromatic leukodystrophy - neurosyphilis - normal pressure hydrocephalus -pellagra - systemic lupus erythematosus - wernicke-korsakoff syndrome -wilson's disease pts with schizophrenia may give bizarre answers to orientation such as I am christ. psych: - atypical psychosis - autistic disorder - brief psychotic disorder - delusional disorder - factitious disorder with predominantly psy s/s - malingering - mood disorders -normal adolescence - OCD -personality disorder (schizotypal, schizoid, borderline) -schizoaffective - schizophrenia - schizophreniform disorder
ECHOLALIA define Echolalia
Sadock 1197 meaningless repetition of another person's spoken words as a symptom of psychiatric disorder. Echoing of another's speech[9] that may only be committed once, or may be continuous in repetition. This may involve repeating only the last few words or last word of the examiner's sentences. This can be a symptom of Tourette's Syndrome
IDEAS OF REFERENCE define Ideas of reference
Sadock 313 describe the phenomenon of an individual's experiencing innocuous events or mere coincidences and believing they have strong personal significance. It is "the notion that everything one perceives in the world relates to one's own destiny."
SCHNEIDERIAN FIRST RANK SYMPTOMS. what are schneiderian first rank symptoms
The first-rank symptoms of schizophrenia include: auditory hallucinations: thought withdrawal, insertion and interruption. thought broadcasting. somatic hallucinations. delusional perception. feelings or actions experienced as made or influenced by external agents.
FLIGHT OF IDEAS BIPOLAR VS PSYCHOSIS Flight of ideas - how do these differ in patients with psychosis vs Bipolar?
a rapid shifting of ideas with only superficial associative connections between them that is expressed as a disconnected rambling from subject to subject and occurs especially in the manic phase of bipolar disorder. They differ because those with schizophrenia or psychosis are less likely to demonstrate awareness or concern about the disordered thinking
AVOLITION Avolition:
decrease in the motivation to initiate and perform self-directed purposeful activities.
FORMAL THOUGHT DISORDER How does the clinician know that an individual has a formal thought disorder? (DSM-5, p. 88)
disorganized thinking(formal thought disorder) is typically inferred from the individual's speech - it may switch from one topic to another (derailment or loose associations) - answers may be obliquely related or completely unrelated (tangentiality) - speech may be so severely disorganized that it is nearly incomprehensible and resembles receptive aphasia( incoherence or word salad) -because mildly disorganized speech is common and nonspecific, the symptoms must be severe enough to substantially impair effective communication.
KURT SCHNIEDER
divided symptoms infor first and second rank symptoms 1. first rank symptoms. - audible thoughts - voices arguing or discussing or both - voices commenting - somatic passivity experiences - though withdrawal and other experiences of influenced though - thought broadcasting - delusional perceptions - all other experiences involving volition made affects and made impulses. 2. second rank symptoms - other disorders of perception - sudden delusional ideas - perplexity - depressive and euphoric mood changes - feelings of emotional impoverishment - several others
LOSS OF EGO BOUNDS Loss of ego boundaries
kaplan sadock 313 The condition where a person lacks a clear sense of where his own mind and body end where these features are in other objects. EGO-BOUNDARY LOSS: "Ego boundary loss is where we lose sight of the sense of our mind and body and its influence
ASOCIALITY Asociality
lack of motivation to engage in social interaction, or a preference for solitary activities. (nonsocial, unsocial, and social disinterest).
INCOHERENCE define Incoherence
lacking normal clarity or intelligibility in speech or thought
ECHOPRAXIA Echopraxia
meaningless repetition or imitation of the movements of others as a symptom of psychiatric disorder
DIMINISHED EMOTIONAL EXPRESSION Diminished emotional expression:
negative symptom of schizophrenia. Affective flattening; poor eye contact; reduced body language
SCHIZOPHRENIA- TOKEN ECONOMY PROGRAM
promotes learning behaviors enhance patients functioning
STEREOTYPIES define Stereotypies
sadock 1107/1194 is a repetitive or ritualistic movement, posture, or utterance. Stereotypies may be simple movements such as body rocking, or complex, such as self-caressing, crossing and uncrossing of legs, and marching in place.
CLANG ASSOCIATION define Clang association
sadock 202 In psychology and psychiatry, clanging refers to a mode of speech characterized by association of words based upon sound rather than concepts. For example, this may include compulsive rhyming or alliteration without apparent logical connection between words.