1What are key facts about prevalence with schizophrenia?
Gender equal
Earlier onset in men (10-25) while women onset peaks between 25-35
2What are the key ages to know when presenting symptoms align with schizophrenia onset but are likely associated with a differential?
<10 or >60
3What symptoms are considered "positive" in schizophrenia?
Hallucinations
Delusions
Disorganized Behavior
Grandiosity
Hostility
Mania
Suspicions
4What neurotransmitter is associated w/ the positive symptoms of schizophrenia?
Dopamine in the mesolimbic pathway
5What pathway is associated with EPS & TD symptoms?
Nigrostriatal
6What pathway is associated with the adverse effects of hyperprolactinemia from some medications?
Tuberoinfundibular
7What symptoms are considered "negative" in schizophrenia?
Flat affect
Poverty of speech (alogia)
Avolition (lack of motivation)
Apathy
Anhedonia
Abstract Thinking Problems
Poor Attention
8What symptoms associated with schizophrenia respond best to antipsychotic treatments?
Positive symptoms
9What neurotransmitter is associated w/ the negative symptoms of schizophrenia?
< in dopamine in the mesocortical pathway
10What does the mesolimbic pathway control?
Motivation
Emotions
Reward
Associated w/ the positive symptoms of schizophrenia
11What class of medications reduces the positive symptoms of schizophrenia?
D2 antagonists
12Hypofunction of the mesocortical pathway leads to what symptoms of schizophrenia?
Negative
13What is a potential side effect of D2 antagonists
Pseudoparkinsonism
14What is the effect of dopamine release in the tuberofindibular pathway?
Inhibits prolactin release
15What does the mesocortical pathway control?
cognition
executive function
emotions
affect
16What season of birth is most highly associated with those who may develop schizophrenia?
Winter to early spring months
17What other "birth" factors may >risk of development of schizophrenia?
Gestational birth complications
Exposure to influenza
Maternal starvation during pregnancy
RH Factor
18What substance is most highly abused with patients with schizophrenia?
Tobacco (other illicit drug use is also high)
19What is one important factor to educate patients about regarding treatment of schizophrenia and tobacco use?
Tobacco can alter the way that the medications are metabolized which can lead to <effectiveness or >side effects from medications started during hospitalizations where the pt is not allowed to smoke
20What are considerations about use of cannibis and symptoms of schizophrenia?
Can worsen positive symptoms and auditory hallucinations can be difficult to control
Young males may develop schizophrenia symptoms with repeated, heavy use of cannibis
21What is the core cause of schizophrenia?
Too much dopamine
22What additional neurotransmitters play a role in schizophrenia?
Serotonin
Norepinephrine
GABA
Glutamate
23What neurotransmitter is closely linked to the symptom of anhedonia?
Norepinephrine
24What role does GABA play in the symptoms associated w/ schizophrenia?
Reduction of GABA=regulatory effect on dopamine activity=hyperactivity of dopaminergic neurons
25What are some of the changes in the brain that may be evident on imaging in a pt w/ schizophrenia?
Enlargement of cerebral ventricles
A reduction of symmetry in the temporal, frontal, and occipital lobes
26What brain pathways are associated with the dopaminergic pathway that led the dopamine hypothesis regarding schizophrenia?
Mesolimbic
Mesocortical
Nigrostriatal
Tuberoinfundibular
27Disruptions in what brain structures might lead to the "odd" movements associated w/ schizophrenia?
Basal Ganglia
Cerebellum
28What seizure disorder is highly associated with schizophrenia?
Complex partial seizures
29What pt education should be provided to families of individuals with schizophrenia in regards to communication or parenting approaches?
Pts w/ schizophrenia have a difficult time with over criticism, hostility, and over involvement
30How many symptoms must be present to diagnose schizophrenia according to the DSM-5?
2+
31How long do delsions, hallucintations, or disorganized speech need to be present to diagnose schizophrenia according to the DSM-5 criteria?
1 month (can be < if there has been successful treatment)
32What are the 3 key symptoms that at least one must be present in order to diagnose schizophrenia?
Delusions
Hallucinations
Disorganized speech
33What other symptoms may also accompany at least one of the key symptoms that may lead to the diagnosis of schizophrenia?
Grossly disorganized behavior: unusual (child-like,unpredictable anger, odd dress, inappropriate sexual activity, sterotypic motor activity, difficulties w/ ADLs)
Catatonic behavior
Negative Symptoms
34In order to diagnose schizophrenia, what impact on functionality must be assessed?
Since the onset of the disturbance, level of functioning is markedly below the level achieved prior to onset
35What is the timeline for continuous signs of the disturbance when diagnosing schizophrenia?
6 months
36During the 6 month period of the continuous signs of disturbance, what inclusion criteria must be met to diagnose schizophrenia?
1 month of delusions, hallucinations, or disorganized speech
Prodromal periods may include only negative symptoms or 2+ symptoms of the key symptoms in an attenuated (reduced) form
37What four diagnoses should be r/o in order to dianose schizophrenia?
Schizoaffective
Depressive disorder w/ psychotic features
Bipolar disorder w/ psychotic features
Medical or substance induced disturbance
38What are the types of schizophrenia that were historically used to differenitate different forms of schizophrenia?
Paranoid (delusions or frequent auditory hallucinations)
Disorganized (regression, disinhibited, primitive behaviors)
Catatonic (cessation of movement and engagement)
Undifferentiated (don't fit into one category or subtype)
Residual (emotional blunting, social withdrawal, eccentric behavior, illogical thoughts, loosening of associations)
39What is one potential "side effect" associated with treatment of schizophrenia that can > risk of suicide?
Post-psychotic depression (occurs in about 25% of pts)
40What is the prognosis associated w/ early onset of schizophrenia in childhood?
Poor
41What gender is more likely to develop paranoid schizophrenia after the age of 45?
Women
42What are the premorbid s/s of schizophrenia?
Prior dx of schizoid or schizotypical personality
Quiet, passive, or introverted personality
Few childhood friends
Somatic complaints
Interest in abstract ideas (religion, philosophy)
43What are some mild manifestations associated w/ the potential for schizophrenia development?
Odd or unusual beliefs (not delusional)
Odd speech patterns
Overly concrete or abstract thoughts
Odd behavior (not disorganized)
44What does the "classic course" of schizophrenia look like?
One of exacerbations and remissions
45What is one prognostic variable that is associated with relapses in schizoprenic disturbances?
Inability to achieve prior function baseline
46What is one thing to stress with patients being treated for schizophrenia when considering sharing information about medication compliance?
Each psychotic episode worsens the probability of returning to prior level of function and stopping or missing medications has the potential to cause further decline in cognition and functionality
47What is one primary difference noted after an episode of psychosis when comparing mood disorder vs schizophrenia?
Schizophrenia typically does not return to prior baseline after psychotic episode
48What symptoms associated with schizophrenia tend to appear first?
Negative (become more debilitating over time)
49What are the localizing signs that might be picked up on a physical exam in a person w/ schizophrenia?
Weakness
Decreased reflexes
50What are the nonlocalizing signs that might be picked up on a physical exam in a person w/ schizophrenia?
disdiadochokinesia (rapid alternating movements)
asterenognosis (name an object by touch)
left-right confusion
diminished dexterity
tics
stereotypies (repetitive movements or sounds)
grimacing
impaired fine motor skills
abnormal motor tone
abnormal movements
51What ocular findings may be present on physical exam for a pt w/ schizophrenia?
Smooth ocular pursuit (fixated on moving object)
Elevated blink rate
52What is one alternative treatment that can augment medications to treat schizophrenia?
ECT
53What type of schizoaffective disorder is more common in older adults?
Depressive
54What details define the diagnosis of schizoaffective disorder according to the DSM-5 criteria?
A major mood episode (major depressive or manic) is concurrent with one of the key symptoms of schizophrenia (delusions, hallucinations, or disorganized speech)
55What is the timeframe that positive symptoms are present in the absence of the major mood episode for those w/ schizoaffective disorder?
2+ weeks
56How is schizoaffective disorder treated?
Mood stablizers (carbamazepine is superior for depressive type)
Antipsychotics
57What is the primary diagnostic feature between schizophrenia and schizophreniform?
Key features (delusion, hallucinations, or disorganized speech) and/or disorganized/catatonic behavior and negative symptoms are present for <6mo
58True or False: Schizophreniform can evolve into schizophrenia if left untreated.
True
59What are the treatments for schizophreniform disorder?
Antipsychotics for 3-6 mo
Mood stabilizers may be a helpful adjunct
60What is the criteria to diagnose a delusional disorder according to the DSM-5?
Presence of 1+ delusions for 1+ mo but criteria for schizophrenia has never been met
Functionality is not impaired
Depressive or manic episodes are brief relative to the duration of the delusional episode
61What type of delusional disorder describes when a pt believes that they are being followed, tracked, or targeted?
Paranoid
62What type of delusional disorder describes when a pt believes that some event is uniquely related to them?
Ideas of Reference
63What type of delusional disorder describes when a pt believes that ones thoughts can be heard by others?
Thought broadcasting
64What type of delusional disorder describes when a pt believes that others are trying to harm them?
Persecutory
65What type of delusional disorder describes when a pt believes that a lover or partner is unfaithful?
Jealous
66What type of delusional disorder describes when a pt believes that another person of higher status is in love with them?
Erotomatic
67What type of delusional disorder describes when a pt believes that they have a physical disorder or the body is somehow diseased?
Somatic
68What type of delusional disorder describes when a pt believes that they have special powers beyond those of a normal person?
Grandiose/Grandeur
69What type of delusional disorder describes when a pt has the false belief that they are guilty or responsible for something?
Guilt
70What is a "shared psychotic disorder"?
When two individuals are experiencing psychosis at the same time
Often linked to "close relationships" like sister-sister, husband-wife, & mother-child
71What is treatment for a shared psychotic disorder?
Separation
72What are the treatment options for delusional disorder?
Often treatment resistant
Needs a good therapeutic relationship between clinician and patient to achieve
73What type of therapy is most effective for delusional disorders?
Individual psychotherapy
74What is one piece of advice regarding delusions involved with a delusional disorder?
Avoid persistent questioning
75What is the goal of treatment for delusional disorders?
Satisfactory social adjustments not necessarily elimination of delusions
76What medication may be effective for treatment of somatic delusions?
pimozide
77What is another likely comorbid disorder for those with a brief psychotic disorder?
Personality disorder
78What is the diagnostic criteria for a brief psychotic disorder according to the DSM-5?
1 day + but < 1 mo and returns to baseline
No negative symptoms present (only positive ones)
79What are the 3 subtypes of brief psychotic disorder?
With marked stressors
Without marked stressors
Postpartum onset
80How is a brief psychotic disorder treated?
Antipsychotic
Benzos
81What term describes a disruption in a patient's beliefs, ideas, and interpretations of their surroundings?
Disordered thought content
82What term describes a disruption in the way that a patient links ideas and words together?
Disordered thought process
83What is the term used for poverty of content?
Alogia
84What term describes very little information conveyed by speech?
Alogia or poverty of content
85What is thought blocking?
When a patient suddenly loses their train of thought and is exhibited by an interruption in speech and difficulty continuing the conversation
86What is loose associations?
Speech content notable for ideas presented in a sequence that are not closely related
87What term describes conversation during the interview where answers to questions diverge increasingly from topic to topic?
Tangential thought process
88What term describes tangential thought process that eventually does return to the original topic?
Circumstance reality
89What is clanging or clang associations?
Using words in a sentence that rhyme or have phonetic similarities
90What is word salad?
Real words are linked together incoherently, yielding nonsensical content
91What is perseveration?
Repeating words or ideas persistently, often even after a topic has changed.
92What are the differential diagnoses associated with psychosis?
General medical condition
Substance induced
Brief psychotic disorder
Schizophrenia
Schizophreniform
Schizoaffective
Schizotypical personality
Mood disorder w/ psychotic features
Schizoid personality disorder
93What types of general medical conditions need to be ruled out before assuming the problem is truly psychiatric in nature?
Delirium: fluid/electrolyte, substance intoxication/withdrawal, hypoglycemia, hypercapnea, hypoxia, infections, or medications
Endocrine: thyroid, parathyroid, adrenal
Liver: hepatic encephalopathy, uremic encephalopathy
Infectious: syphillis, herpes simplex encephalitis, lyme, HIV, prion disease
Inflammatory: Lupus, anti-NMDA encephalitis, leukodystrophies, MS
Metabolic: porphyuria, Wilson's disease
Neurodegenerative: LBD, Huntington's, PD, AD
Neurological: tumor, cyst, seizure, stroke, head trauma, TBI
Vitamin deficiency: esp B12
94What accroynm can help to recall some of the medical conditions that may contribute to psychosis presentation?
VINDICATE: V) vascular I) Inflammatory/Infection N) Neoplastic D) Degenerative/Deficiency/Drugs I) Idiopathic/Intoxication/Iatrogenic C) Congenital A) Autoimmune/Allergic/Anatomic T) Traumatic E) Endocrine/Environmental
95What is schizophrenia?
A psychiatric condition characterized by a constellation of abnormalities in thinking, behavior, and emotion
96What part of the brain is responsible for cognition and executive function?
prefrontal cortex (PFC)
97What part of the brain is responsible for emotions and affect?
ventromedial prefrontal cortex
98What pathway in the brain contains about 80% of the brains dopamine?
Nigrostriatal
99What is the downward drift hypothesis of schizophrenia?
Individuals with schizophrenia tend to follow a downward trajectory
-often less educated
-unable to sustain stable jobs
-drifting downard in terms of socioeconomic status
100Why is glutamate of interest in the research of schizophrenia?
Glutamate is an excitatory neurotransmitter and the NMDA glutamate receptor is blocked by phencycline (PCP/angel dust) and can produce a clinical presentation similar to schizophrenia (w/ + and - symptoms and disorganized thoughts)
101What are the psychiatric indications for neuroimaging studies?
First episode of psychosis
Confusion
Dementia of unknown cause
Prolonged catatonia
Movement disorder of unknown etiology
Personality change after age 50
102What is the most consistent neuroimaging finding in those with schizophrenia?
Hypofrontality
103What is psychosis?
A break from reality involving delusions, perceptual disturbances, and disorganized thinking
104What is the term for fixed, false beliefs that cannot be altered by rational arguements and cannot be accounted for by cultural background of the individual?
Delusions
105What is the term for perceived senses that are not based on reality?
Hallucinations
106What is the term for a misinterpretation of an existing sensory stimulus?
Illusion
107What type of hallucinations are most common in schizophrenia?
Auditory
108What are the different types of auditory hallucinations?
Command
Running Commentary
One/Several Voices Talking at Once
109What is the major concern associated with command hallucinations?
The command may be telling the pt to hurt themselves or others and needs to be fully screened for when assessing hallucinations
110What is the major concern associated with running commentary hallucinations?
Level of distress associated w/ this type of hallucination
111What is the major concern associated with several voices talking at once with this type of auditory hallucinations?
Level of distress associated w/ this type of hallucination and may help predict the level of severity of the psychotic disorder
112What disorders are most commonly associated with visual hallucinations?
LBD
Drug intoxication
113What disorder is most commonly associated with olfactory hallucinations?
Seizure disorder and this can represent an aura
114What disorder is most commonly associated with tactile hallucinations?
Withdrawal from alcohol or drug abuse
115What are the 3 phases of schizophrenia
1) Prodromal
2) Psychotic Symptoms
3) Residual
116What is characteristic about the prodromal phase of schizophrenia?
Decline in functioning that preceeds the first psychotic episode.
Pt may become socially withdrawn and irritable
117What is characteristic about the psychotic phase of schizophrenia?
Perceptual disturbances, delusions, and disorganized thought process/content
118What is characteristic about the residual phase of schizophrenia?
Occurs between episodes of psychosis.
Marked by flat affect, social withdrawal, and odd thinkingehavior
119What is the strongest predictor of treatment outcome of first-episode schizophrenia?
Duration of presenting symptoms before treatment
120What subtype of schizophrenia is associated with better short and long term outcomes?
Paranoid due to best treatment outcomes both short and long term
121What are examples of positive symptoms associated with psychosis?
Disorganized thoughts
Bizarre behavior
Delusions
Hallucinations
122What are examples of negative symptoms associated with psychosis?
Blunted or flat affect
Inattentiveness
Apathy
Anhedonia
123What are the Schnieder first-rank symptoms of psychosis?
Hallucinations
Delusions
Thought Insertion
Thought Withdraw
Thought Broadcasting
Thought Transmission
124What are the 5 As of Schizophrenia?
Anhedonia
Affect (flat)
Alogia (poverty of speech)
Avolition (apathy)
Attention (poor)
125What term was used to define schizophrenia prior to Bleuler naming it?
Dementia precox (Kraeplin)
126What are the risk factors for suicide associated with schizophrenia?
Male gender
<age 30
Paranoid subtype
Comorbid substance use
Depressive symptoms
Unemployment
Frequent exacerbations of disease
Prior suicide attempts
Living alone
Recent hospital discharge
127What symptoms are considered the core symptoms of schizophrenia and the focus of treatment?
Negative symptoms which are the most difficult to treat
128What is the major criteria consideration when diagnosing schizophrenia?
Pt must have associated symptoms (2+) which are present most of the time and last for at least one month in duration
Pt functioning is impacted and has been present for at least 6 months
Schizoaffective disorder and mood disorder w/ psychotic features has been ruled out
Ruled out that presenting symptoms cannot be attributed to a medical condition or substance
If co-concurrent autism disorder, the pt has had hallucinations or delusions for at least one month
129What is the major difference between a brief psychotic episode and schizophrenia dx?
Symptoms are present for <one month with a brief psychotic episode and it does not impact functioning outside of the one month timeframe
130What other disorder is often a precurser to schizophrenia?
Schizophreniform
131What is the major difference between schizophreniform disorder and schizophrenia?
Impact of functioning is < 6mo
132What are the factors that provide a better prognosis for schizoprenia?
Late onset
Good social support
Positive symptoms
Mood symptoms
Female
Few relapses
Premorbid level of function that is high
133What is the purpose of behavioral therapy in the treatment of schizophrenia?
Aimed to help the pt function in society
-social skills
-self-sufficiency
-act appropriately in public
134What cognitive problems are seen w/ schizophrenia?
Deficits processing complex information
Maintaining a steady focus of attention
Working memory
Distinguishing between relevant and irrelavent stimuli
Abstract thinking
135What type of therapy is not recommended for a person w/ schizophrenia?
Group therapy
136What syndrome includes the delusion that imposters have replaced familiar people?
Capgras syndrome
137What syndrome includes the delusion that a persecutor is taking on a variety of faces like an actor?
Fregoli's syndrome
138What syndrome includes the delusion of being a werewolf?
Lycanthropy
139What syndrome includes the delusion that one has a double?
Heutoscopy
140What syndrome includes the delusion that one has lost everything including their internal organs?
Cotard syndrome
141What syndrome includes a shared delusion between two people?
Folie a deux
142What is another name for antipsychotics?
neuroleptics
143What medications are categorized by typical or atypical and work by blocking dopamine receptors?
Antipsychotics
144What type of symptoms associated with schizophrenia are atypical antipsychotics superior at treating when comparing them to typical antipsychotics?
negative
145What other neurotranmitter receptors, aside from D2 receptors, are targeted by atypical antipsychotics?
5HT2A
Alpha
Histamine
146What disorders are treated w/ antipsychotics?
Schizophrenia
Psychosis
Mood Disorders
Tourette's Syndrome
147What are example of low potency typical antipsychotics?
Thorazine (clorpromazine)
Mellaril (thioridazine)
148What is one disadvantage associated with use of a low potency typical antipsychotic?
>anticholinergic effects
149What are the advantages associated with use of a low potency typical antipsychotic?
Less EPS
<risk of neuroleptic malignant syndrome
150What are examples of high potency typical antipsychotics?
Haldol (haloperidol)
Prolixin (fluphenazine)
Stelazine (trifluperazine)
Trilafon (perphenazine)
151What EPS has the fastest onset?
Acute dystonia (<3 hours)
152What is the typical onset of parkinsonism from antipsychotic treatment?
3 days to 3 weeks
153What is the typical onset of akathisia from antipsychotic treatment?
3 months
154What is the typical onset of TD from antipsychotic treatment?
Years
155What patient population is at highest risk of developing TD?
Elderly, white women
156What are the traditional side effects associated with antipsychotics?
Antidopaminergic
Anti-HAM
TD
Acute Dystonia (EPS)
Bradykinesthia (Pseudo-parkinsonism)
Akathisia
Neuroleptic Malignant Syndrome
157What does choreoathtoid mean?
Writhing movements of the mouth
158What is the criteria for a brief psychotic disorder?
Sudden onset of psychotic features lasting at least 1 day but <1mo
Remission is full w/ pt returning to baseline functioning
159What gender is more likely to experience a brief psychotic disorder?
Women
160What age group is more likely to experience a brief psychotic disorder?
Young adults
161What are the risk factors associated with experiencing a brief psychotic disorder?
Low socioeconomic status
Major life stressors: disaster, major cultural change, or other major life stressful situations
162
What other psychitatric disorder is a brief psychotic disorder often comorbid with?
Personality Disorder (>histrionic, narcisstic, paranoid, schiotypal, & borderline)
163What are the clincial features associated w/ a brief psychotic disorder?
At least one symptom of psychosis (hallucination, delusion, or disorganized thoughts) w/ abrupt onset
Labile mood, confusion, and impaired attention
Characteristic: emotional volatility, strangeizarre behavior, screaming/muteness, & impaired memory of recent events
164What are the potential differential diagnoses associated with brief psychotic disorder?
Other schizophrenia spectrum disorders
Delirium
Medical or other substance use causes
165What is the treatment for a brief psychotic disorder?
Hospitalization: evaluation & safety
Rx: high potency antipsychotics, benzos
Psychotherapy: address the experience of the episode & treat precipitating trauma
166What is the characteristic symptoms associated with autoscopic psychosis?
Visual hallucinations of all or part of a person's own body
"Phantom" is usually colorless and transparent
Pts will describe this as if looking in a mirror
Phantom appears suddenly w/o warning
167What part of the brain is most associated with autoscopic psychosis?
Temporoparietal lobes (sense of self) and the visual cortex
168What are the two types of motility psychosis?
Akinetic
Hyperkinetic
**Pts may switch from one from to the other
169What does the akinetic form of motility psychosis look like?
Catatonic stupor
170What does the hyperkinetic form of motility psychosis look like?
Manic or catatonic excitement (may pose a danger to others during this phase)
171What is the prognosis for a pt that displays characteristics of a motility psychosis disorder?
Often rapid resolution
Favorable course that does not lead to deterioration
172What is the mood of pts experiencing motility psychosis?
Extremely labile
173What is post partum psychosis?
Occurs after the birth of a baby
Characterized by depression, delusions, and thoughts of harming either herself or the infant
174What are other causes that may contribute to onset of psychosis not related to a mental health origin?
Brain tumor
Medications: cortisol
Substance Use: PCP
Alcohol
175What is the treatment for a psychotic disorder that is due to a general medical conditioin or substance/medication induced presentation?
Indentify condition or substance
Treat underlying cause
Control immediate behavior
Hospitalization for evaluation and safety
176What are the clinical characteristics of catatonic disorder?
Behavioral abnormalities: motor immobility or excitement, profound negativism, echolaia (speech) or echopraxia (movement) **think mimic
177What medical conditions may cause catatonia?
neurological disorders
infections
metabolic
178What medications may cause catatonia?
corticosteroids
immunosuppressants
antipsychotics (NMS, parkinsonism)
179What are the differential diagnoses to consider when considering a diagnosis of a catatonic disorder?
hypoactive delirium
end stage dementia
akinetic mutism
r/t a primary psychiatric disorder
180How severe are the effects of a schizophrenia disorder?
Significantly impact functioning and long-lasting
181What is the most essential part of the interview when diagnosing a pt w/ schizophrenia?
History (not MSE because symptoms change over time)
182What factors should the clinician take into account when considering the diagnosis of schizophrenia?
Education level
intellectual ability
cultural and subcultural membership
183What may a pt w/ a less severe form of catatonia present like during an initial interview?
marked social withdrawal
egocentricity
lack of spontaneous speech or movement
absence of goal-directed behavior
184What are some nonlocalizing neurological signs that may be present with schizophrenia?
dysdiadochokinesia
astereognosis
primitive reflexes
diminished dexterity
185What does the presence of neurological s/s correlate with in schizophrenia?
Illness severity
Affective blunting
Poor prognosis
186What abnormal involuntary movements may be present with schizophrenia?
tics
stereotypies
grimacing
impaired fine motor skills
abnormal motor tone
187What ocular symptoms may be present in a pt with schizophrenia?
Smooth ocular pursuit
Elevated blink rate
188What is thought to cause the elevated blink rate in a pt with schizophrenia?
Hyperdopaminergic activity
189What characteristic speech patterns may be evident in a pt with schizophrenia?
Inability to perceive the prosody (rhythm/stress/intonation) of speech or to inflect their speech
190What is the term for inability to carry out tasks or movements when asked?
apraxia
191What are the 2 most common affective symptoms associated w/ schizophrenia?
Reduced emotional responsiveness
Overly active & inappropriate emotions-extreme rage, happiness, or anxiety
192What are some common themes that a pt w/ schizophrenia may express extreme emotions about?
Omnipotence (God-like power)
Religion
Fear of disintegration of self (fragmentation of personality)
Destruction of the universe
193How is thought process determined by the clinician?
Observing what & how the pt speaks, writes, or draws
194As thought process worsens, what is obervable?
Loosening of associations
195What is meant by loss of ego boundaries?
The lack of a clear sense of where the pt's own body, mind, and influence end and where those of other animate or inanimate objects begin
196What is an example of demonstrating ideas of reference?
Pt reveals that they believe that the newspaper or TV is reporting specifically about them
197What is an example of thought control?
Pt believes that outside forces are controlling what they think or feel
198What is an example of thought broadcasting?
Pt believes that others can read their thoughts or they can broadcast their own thoughts through TV
199What is an example of loss of ego boundaries?
Pt feels a sense that they have fused w/ an external object like a tree or the universe
200What are cenesthetic hallucinations?
Unfounded sensations of altered states in bodily organs
-burning sensation in the brain
-pushing sensation in blood vessels
-cutting sensation in bone marrow
201When considering the diagnosis of schizophrenia, a pt showing alteration in orientation should prompt the clinician to investigate what differentials?
A medical or neurologic brain disorder (schizophrenia pt is normaly oriented x 3)
202What is the cognitive impact typically noted in a pt w/ schizophrenia?
Decline from baseline fuction in the areas of attention, executive function, working memory, & episodic memory
203What is the most common reason for a pt w/ schizophrenia to be noncompliant w/ treatment?
Lack of insight into the nature & severity of the disorder
204What area of the brain is highly associated w/ lack of insight?
Parietal lobes
205What symptoms are typically linked to safety concerns with a pt w/ schizophrenia?
Agitation
Impulsiveness
Decreased social sensitivity
206What are the risk factors for violent or impulsive behavior in a pt w/ schizophrenia?
Prior violent episodes
Persecutory delusions
Neurologic deficits
207What is the leading cause of premature death among pts with schizophrenia?
Suicide
208What is the most crucial factor associated with dying by suicide in a pt w/ schizophrenia?
A major depressive episode
209What medication can help to control suicidality in a pt w/ schizophrenia?
clozapine
210What often drives a pt w/ schizophrenia to commit homicide?
Hallucinations or delsuions
211What are the positive symptoms of schizophrenia?
Hallucinations
Delusions
Bizarre behavior
Positive formal thought disorder
212What are the negative symptoms of schizophrenia?
Affective flattening or blunting
Alogia
Avolition-apathy
Anhedonia-asociality
Attention
213At what age is schizophrenia considered late onset?
After age 45
214What are examples of hallucinations noted in schizophrenia?
Auditory
Commenting voices
Conversing voices
Visual
215What are examples of bizarre behaviors noted in schizophrenia?
Clothing
Social
Sexual
Aggressive
Repetitive
Stereotyped
216What is the most notable difference between schizoaffective disorder and bipolar disorder with psychotic features?
Psychotic features come & go w/ bipolar disorder w/ psychotic features but mood symptoms persist
Mood features come & go w/ schizoaffective but psychotic features persist
217What is the one feature that distinguishes schizophreniform disorder from other schizophrenia-like disorders?
Timing is short term (at least 1 mo but <6)
Return to baseline is noted
218What assessment tools can be used to assess symptoms associated with schizophrenia?
PANSS-Positive & Negative Syndrome Scale
BPRS-Brief Psychiatric Rating Scale
219What assessment tools can be used to assess for EPS?
SAS-Simpson Angus Scale
AIMS-Abnormal Involuntary Movement Scale
BARS-Barnes Akathisia Rating Scale
220What is the first choice treatment for schizophrenia and other psychotic disorders?
SGA
221What are treatment options for agitation with psychotic disorders?
Benzos
SGA
222What is an advantage of giving an injection of an antipsychotic for acute agitation?
Rapid effects w/o excessive sedation
223What are the disadvantages of low-potency antipsychotics?
>sedation
>postural hypotension
224How are EPS symptoms treated?
<dose of antipsychotic
+ antiparkinson medication
change medication
225What medication may help reduce the symptom of akathisia?
propranolol (therapeutic 30-90mg)
226What SGA may > risk of developing EPS even at low doses?
Risperidone
227What SGAs are most highly linked to parkinsonism and akathisia?
olanzapine
ziprasidone
228What are the severe side effects with clozapine that need to monitored closely?
agranulocytosis
seizures
myocarditis
229What is the monitoring that must be initiated when starting a pt on clozapine?
Weekly labs for 6 months
Bi-weekly labs for the next 6 months
Monthly labs indefinitely
230When is clozapine an appropriate consideration for treatment?
After at least 2 failed antipsychotic trials
231How long should a pt maintain treatment for a pschotic episode?
At least 1 year
232For pts that experience 2+ episodes of psychosis, how long should treatment continue
Indefinite
233What antipsychotics are available in long-acting formulations?
fluphenazine
haloperidol
risperidone
paliperidone
aripiprazole
olanzapine
234When checking lab levels of medications, a low plasma concentration may indicate what potential problems?
Noncompliance
Rapid metabolization
235What are the options if a pt that is responding poorly to an antipsychotic?
Best to change to a different Rx once dose is titrated to max therapeutic recommendations
>dose above the recommendations does not usually improve response
236What are possible adjunct treatments with antipsychotics to help with residual symptoms?
lamotrigine
mirtazapine
donepezil
D-alanine
D-serine
estradiol
memantine
allopurinol