Behavorial Sciences-Schizophrenia

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Author:
malikos87
ID:
64961
Filename:
Behavorial Sciences-Schizophrenia
Updated:
2011-02-08 15:21:08
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psych
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Description:
Schizophrenia
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  1. Axes Description
    • I: Symptoms that cause distress
    • II: Personality disorders and mental retaradation
    • III: Medical conditions that may be relevant
    • IV: Psychosocial and environment
    • V: Global assessement of functioning
  2. Schizophrenia
    • One of the most severe mental disorders
    • Chronic severe debilitating brain disease
    • Affects 1% of population
    • 2 million diagnosed yearly in the US
  3. Epidemiology of Schiz
    • Prevalence is equal in men and women
    • Onset of men: 15-25 years of age
    • Onset of woment: 25-35 years of age
    • High population density is correlated with increased rates
    • Occurs in all countries and cultures
    • Over 50% of schizo's do not live with their families
    • Many are not institutionalized
  4. Downward Drift of Schiz
    • Schizo is diagnosed more in a lower socioeconomic statuses
    • Increased incidence is due to "downward drift" as schizo move into poorer areas
  5. Etiology of Schizo
    • Unknown; however the following factors has been shown to be associated with schizo
    • Genetic
    • Prenatal
    • Social
    • Substance abuse
  6. Biologic Etiology
    • Dopaaminergic system is hyperactive in the mesolimbic pathway--> + symptoms
    • Decreased GABA can lead to increased dopaminergic activity
    • Increased serotonin -->(-) symptoms
    • May be gross abnormalities in the frontal lobes, limbic system and basal ganglia
  7. Dopamine overview
    • Catecholamine
    • Excitatory/inhibitory
    • Nigrostriatal pathway
    • Meso-limbic cortico pathway
    • Tuberoinfundibular system
  8. Nigrostriatal Pathway
    • Substantia nigra: part of the basal ganglia
    • Important for: Reward, addiction, movement
    • Some parts are dark due to high levels of melanin in dopaminergic neurons
  9. Tuberoinfundibular Tract
    • Inhibits the secretion of prolactin from the anterior pitituary.
    • DOPAMINE INHIBITS PROLACTIN!!!
    • Prolactin level may indicate overall dopamine activity
    • Blockage of dopaminergic receptors by antipsychotic drugs prevents the inhibition of prolactin release therefore increasing prolactin level.
  10. Meso-Limbic Cortico Pathway
    • Expression of mood and emotion
    • Increased can cause psychosis
    • Neuroleptic meds have antidopamergic effects and reduces the positive symptoms of schizo(delusions/hallucinations)
    • Dopamine levels tend to be low in depression and higher in mania
    • Tourette syndrome
  11. Neurotransmitters/metabolites
    HVA and VMA, 5-HIAA, MHPG are all increased in the urine with mood + psychotic disorders
  12. Premorbid Personality
    • Childhood: quiet, obedient, passive
    • Adulthood: avoids social activities, introverted
  13. Characteristics
    • Delusion
    • illusion
    • hallucinations
    • bizarre behavior
    • flat affect
    • disorganized speech
    • social isolation
    • A&O x 3
  14. Illusion
    • misperception of real external stimuli
    • ex: Interpreting the appearance of a coat in a dark closet as a man
  15. Hallucination
    • False sensory perception
    • ex: Hearing voices when alone in a room
  16. Delusion
    • False belief not shared by others
    • ex: The feeling of being followed by the FBI
  17. Disorders of form of thought
    • Word salad: incoherent
    • loose associations
    • mutism
    • neologisms: making up new word
    • echolalia: repeating a word
  18. Disorder of thought process
    • flight of ideas
    • illogical ideas
    • thought blocking
    • short attn. span
    • def. in thought and content of speech
    • impaired memory and abstraction abilities
  19. Negative symptoms
    • Flattening of affect
    • though blocking
    • def. in speech content
    • poor grooming
    • anhedonia
    • lack of motivation
    • social withdrawal
  20. Positive symptoms
    • Psychosis
    • loose associations
    • strange behavior
    • hallucinations
    • talkativeness
  21. Suicide
    • rate in the US is about 12/100,000 with the suicide attempts being nine times more then successful attempts
    • suicide in schizo: over 50% attempt, 10% die in the attempt
    • Risk factors that predict suicide in schizo: male sex, college education, youth, many relapses, depressed mood, high ambitions, and living alone.
  22. Duration
    • Schizo: symptoms lasting longer than 6 months
    • schizophreniform: symptoms in b/w 1 and 6 months
    • Brief psychotic disorder: symptoms lasting less than 1 month
  23. Brief Psychotic disorder
    • delusions, hallucinations, or disoragnized speech/behavior
    • 1-30 days
    • return to full former functioning
    • not due to substance abuse or organic use
  24. Schizoaffective disorder
    • symptoms of schizophrenia
    • symptoms of a mood disorder: depression, mania
  25. Subtypes of Schizo
    • paranoid
    • catatonic
    • disorganized
    • undifferentiated=mixture of above
    • Residual=+symptoms at low intensity
  26. Paranoid Schizo
    • delusional
    • auditory hallucinations
    • older onset compared with others
  27. Catatonic
    • complete stupor
    • mute
    • rigid posture
    • "statue"
    • outbursts of violence
  28. Disorganized
    • incoherent
    • unorganized behaviors/speech
    • poor personal appearance
    • little contact with reality
    • flat affect
  29. Antipsychotics
    • aka neuroleptics
    • used primarily as the treatment in schizophrenia
    • takes several days to a couple of weeks to show improvement
    • typical antipsychotcis: older
    • atypical antipsychotics: newer
  30. Typical antipschotics
    • aka first generation antipsychotics
    • older
    • associated with more adverse rxn's
    • Phenothiazines:
    • chlorpromazine- pigmented cornea
    • thioridazine- retinitis pigmentosa
    • fluphanzine
    • Butyrophenones: Haloperidol (high potency)
    • haloperidol- you can give this drug actuely; to calm patients down and reduce aggression
    • MOA: Blocks central D-2 receptors, most affective against positive symptoms
    • Treatment: for at least 4-6 weeks, relapse is common due to bad compliance, lots of adverse effects
  31. ADR
    • Neurological ADR with the high potency drugs
    • EPS
    • Tardive Dyskinsia- involutary repetitive body movments
    • NMS- neuroleptic malignant syndrome
  32. Low Potency drug ADR
    • Histamine blockage: sedation
    • Alpha blockage: orthostatic hyptotension
    • Muscarinic blockage/anticholinergic effects: dry mouth, blurry vision, constipation
  33. ADR
    • weight gain
    • impotence
    • extrapyramidal neurological signs: tremor, akinesia, rigidity, akthisia, acute dystonias
  34. ADR cont'd
    • 4 hours: acute dystonia
    • 4 days: akinisia- no movement
    • 4 weeks: akathisia- restlessness
    • 4 months: tardive dyskinesia- irreversible
  35. Tardive dyskinesia
    • greater than 3 months
    • serious ADR form neuroletpic meds
    • uncontrolled writhing
    • jerking movements often with tongue/mouth
    • potentially irreversible
    • women/older patients
  36. NMS
    • commonly in men
    • RARE but potentially fatal
    • mortality rate of 20%
    • FEVER
    • AUTONOMIC DYSFUNCTION-SWEATING, INCREASE HR
    • MUSCULAR RIGIDITY
    • ALTERED MENTAL STATUS
    • dystonia, akinesia
  37. Pnemonic
    • F-Fever
    • E-Encephalopathy-altered mental status
    • V-Vitals unstable
    • E-Elevated enzymes (cpk)
    • R-Rigidity

    Give pt. DANTROLENE to calm them down
  38. Atypical Antipsychotics
    • aka second generation antipsychotics
    • may also be used for acute mania, bipolar
    • block dopamine and serotonin receptors
    • less likely to cause extrapyramidal symptoms
    • higher compliance
    • lower suicide rate
    • improved quality of life
  39. Atypical antipsychotics
    • Clozapine
    • Olazapine
    • Quetiapine
    • Risperiodone

    sexual dysfunction, breast enlargement, and discharge, infertility in female
  40. Clozapine
    • resistance or patients suffering from ADR from other anti-psychotics should be considered for treatment with clozapine
    • blocks serotonin and dopamine receptors
    • useful in treating negative symptoms
    • NOT ASSOCIATED WITH TARDIVE DYSKINISIA, NMS, or EXTRAPYRAMIDAL EFFECTS
    • agranulocytosis
    • lowers seizure threshold

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