Schizophrenia + Treatments

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Questions and Answers

What is a characteristic symptom of psychotic disorders?

Acute mood swings unrelated to events

Fixed beliefs not influenced by evidence (correct)

Compulsive behaviors without delusions

Persistent emotional blunting

Which of the following would likely be classified as a delusion?

Believing one has special powers (correct)

Feeling detached from reality only in crowds

Experiencing fleeting sadness

Hearing voices during a relaxed state

Which symptom is indicative of disorganized thinking?

Rigid adherence to routines

Overly cheerful demeanor in severe illness

Inability to follow conversational topics (correct)

Excessive energy leading to impulsive actions

What is the primary side effect associated with antipsychotic medications?

Motor disturbances and tardive dyskinesia Signup and view all the answers

Which statement best represents a challenge for compliance with antipsychotic treatment?

Patients find the medications lacking in efficacy Signup and view all the answers

What alternative disorder might be treated with antipsychotics aside from schizophrenia?

Acute Psychotic Episodes Signup and view all the answers

Which approach may enhance support programs for individuals with psychotic disorders?

Integrating family education and involvement Signup and view all the answers

What type of medication is typically used to manage symptoms of schizophrenia?

Antipsychotics Signup and view all the answers

What type of hallucination is most commonly reported by individuals with psychotic disorders?

Hearing voices that others cannot hear Signup and view all the answers

Which of these best describes disorganized motor behavior?

Erratic movements without reason or purpose Signup and view all the answers

What distinguishes Clozaril from other antipsychotics in terms of effectiveness?

It is the most effective current medication for treatment-resistant Schizophrenia. Signup and view all the answers

What is a common side effect of both classical and second-generation antipsychotics?

Drowsiness or sedation. Signup and view all the answers

Why is medication compliance particularly low in patients with Schizophrenia?

The complexity of medication regimens and side effects. Signup and view all the answers

What is the main purpose of Assisted Outpatient Treatment for individuals with Schizophrenia?

To provide a structured environment with support for adherence to treatment. Signup and view all the answers

Which of the following is true regarding the treatment of positive and negative symptoms in Schizophrenia?

Second-generation antipsychotics are developed to treat both positive and negative symptoms. Signup and view all the answers

What is an example of a positive symptom of schizophrenia?

Hallucinations such as hearing voices Signup and view all the answers

What aspect of antipsychotic medication can lead to treatment complications for patients?

Risk of serious side effects, such as neutropenia. Signup and view all the answers

Which medication is characterized as the most effective current treatment for treatment-resistant Schizophrenia?

Clozaril (2nd gen) Signup and view all the answers

What is one major characteristic of metabolic syndrome associated with antipsychotic medications?

Elevated triglycerides Signup and view all the answers

Which side effect is commonly associated with first-generation antipsychotics?

Pseudoparkinsonism Signup and view all the answers

Which disorder is least likely to be treated with antipsychotic medications?

Chronic Fatigue Syndrome Signup and view all the answers

Which condition is commonly misrepresented in the media regarding violent behavior?

Schizophrenia Signup and view all the answers

What are the common indicators of violence associated with disorders such as Schizophrenia?

History of violent behavior Signup and view all the answers

What is characterized by exaggerated movements, particularly of the face and limbs?

Tardive dyskinesia Signup and view all the answers

Which personality disorder may involve the use of antipsychotic medications for managing psychotic episodes?

Paranoid Personality Disorder Signup and view all the answers

What common side effect involving restlessness is seen in patients taking first-generation antipsychotics?

Akathisia Signup and view all the answers

Which factor contributes to a higher likelihood of violence in individuals with Schizophrenia?

Failure to take medication Signup and view all the answers

Which side effect is commonly associated with (1-st gen) antipsychotic medications used to treat Schizophrenia?

Tardive dyskinesia Signup and view all the answers

Which of the following is NOT a characteristic of command hallucinations in Schizophrenia?

Seeing visual hallucinations of distinct characters Signup and view all the answers

What is a characteristic of Negative Symptom-Predominant Schizophrenia?

Worse prognosis Signup and view all the answers

Which medication is primarily used to target positive symptoms in schizophrenia?

Classical antipsychotic medications Signup and view all the answers

Which symptom is more common in males diagnosed with Negative Symptom-Predominant Schizophrenia?

Social withdrawal Signup and view all the answers

What complication can arise from medications used to treat Parkinson's disease?

Psychotic disorders resembling Positive Symptom Schizophrenia Signup and view all the answers

What factor contributes to a good response to classical antipsychotic meds in Positive Symptom-Predominant Schizophrenia?

Frequent abnormal Dopamine-turnover findings Signup and view all the answers

Which neurotransmitter system is more closely involved with the negative symptoms of schizophrenia?

Serotonin system Signup and view all the answers

What is a common side effect of classical antipsychotic medications that resembles a neurological disorder?

Motor signs/symptoms mimicking Parkinson's disease Signup and view all the answers

Which demographic typically receives a later diagnosis of Positive Symptom-Predominant Schizophrenia?

Females between ages 20-25 Signup and view all the answers

What indicates a worse prognosis for individuals with Negative Symptom-Predominant Schizophrenia?

Greater chance of observable brain damage Signup and view all the answers

Which class of antipsychotics is known to affect both dopamine and serotonin systems?

Second-generation antipsychotics Signup and view all the answers

Since Bipolar Disorder is now more frequently diagnosed, the prognosis of Schizophrenia:

worsens Signup and view all the answers

What would be LEAST likely to cause a person with Schizophrenia to become violent?

Hearing Voices Signup and view all the answers

Which persistent movement side effect would cause restlessness such as the "Thorazine Shuffle?"

Akathisia Signup and view all the answers

What would be the best treatment for a person diagnosed with Schizophrenia?

Medication accompanied by regular Individual and Family therapy sessions Signup and view all the answers

What would be a n example of a treatment for an acute psychotic episode?

Sedation or chemical restraint in the ER Signup and view all the answers

What is NOT a feature of Individual or Family Psychotherapy in treating Schizophrenia?

Talking to other schizophrenic individuals to create a sense of community Signup and view all the answers

Current supervised living for patients with schizophrenia includes:

Halfway houses or Day Hospital Programs Signup and view all the answers

2nd (atypical) generation Antipsychotics differ from 1-st gen (classic) antipsychotics in what way?

Atypical Antipsychotics affects both dopamine and serotonin activity in the brain Signup and view all the answers

Study Notes

Introduction to Psychopathology

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DSM-5-TR "Schizophrenia Spectrum and Other Psychotic Disorders"

This is a section on classification systems concerning mental illnesses and disorders concerning psychosis.

What Defines a "Psychotic Disorder"?

Delusions: Fixed beliefs not altered by conflicting evidence (grandiose, persecutory, somatic, religious, nihilistic, etc).
Hallucinations: Vivid perceptual experiences without external stimulus (hearing voices, seeing things, intense smells or tastes).
Disorganized thinking: Derailment, loose associations, neologisms, tangentiality, incoherence ("word salad").
Disorganized motor behavior: Chaotic or bizarre movements, postures, stereotyped repetitive movements.

Major Disorders within DSM-5-TR "Schizophrenia Spectrum and Other Disorders"

Schizotypal Personality Disorder: A personality disorder that can sometimes include delusional thinking.
Delusional Disorder: One or more delusions lasting for at least a month, without other psychotic symptoms.
Brief Psychotic Disorder: Presence of delusions, hallucinations, or disorganized speech or behavior, lasting less than one month. Half of people recover, but a significant portion relapse.
Schizoaffective Disorder: History of either major depression or mania/hypomania in individuals with a diagnosis of schizophrenia.
Substance/Medication-Induced Psychotic Disorder: Psychotic symptoms caused by substance use or medication side effects. (e.g., cannabis, amphetamines, cocaine, hallucinogens, opioids, etc.)

What is Schizophrenia?

A disorder where psychotic symptoms are predominant.
Affects approximately 1-2% of the population across cultures.
Accounts for a significant portion of psychiatric inpatients and first admissions to mental hospitals.
Historically a leading cause of homelessness (often surpassed by substance abuse epidemics).
Causes significant impairment, as high as 30% attempting suicide, with an even greater percentage among unemployed males with depression.
Diagnosed mid-19th Century.
Morel (1860): "Dementia praecox" (premature dementia)
Kraepelin (1898) : "Dementia praecox"
Bleuler (1911): Schizophrenia ("shattered mind")

Risk Factors: Who Becomes Schizophrenic?

Genetic relatedness: Increased risk with consanguinity.
Twin concordance: Significantly higher in identical twins compared to fraternal twins (MZ > DZ).
Environmental factors: Prenatal/perinatal complications like prolonged labor, forceps delivery, and maternal malnutrition
Maternal Influenza: Higher risk with exposure during the 6th month of gestation.
Seasonality: Higher likelihood of developing schizophrenia depending on the time of year of birth, often in the winter.
Cannabis: Increased risk with adolescent marijuana use.
Other infectious agents: Factors like rubella (German measles) and toxoplasmosis may influence.

Early views of Schizophrenia

Metabolic disorder
Double-binding mother

Typical Features of Schizophrenia

Loss of previous functioning: Gradual or acute onset, which may indicate a better prognosis (acute)
Disturbed language: Tangential, incoherent, rambling speech, often with private meanings
Thought disorders: Formal thought disorder, altered thought boundaries (thought broadcasting/insertion/removal)
Emotionality: Flat, inappropriate, or bizarre affect
Social withdrawal: purposeless wandering
Motor abnormalities: Reduced spontaneity, bizarre/stereotyped gestures, catatonia
Other features (positive): Hallucinations/delusions (negative): Social withdrawal/flat affect

What Is the Damage in Schizophrenia?

Early views (discredited): metabolic disorder, double binding. Modern studies indicate structural brain damage.
Cellular derangement: Loss of gray matter, enlarged ventricles (loss is significantly faster with heavy and early cannabis use) . Loss of prefrontal white matter.
Disordered brain activity: Abnormal function evident in PET and fMRI neuroimaging studies, impacting frontal/temporal language areas, basal ganglia, and cerebellum.
Neurotransmitter dysfunction: Dopamine hypothesis (overactive dopamine pathways in schizophrenia compared to healthy individuals) , interactions between dopamine and serotonin.

Positive vs. Negative Symptom -Predominant Schizophrenia

Positive symptoms: often characterized by excesses or distortions of normal functions. (e.g., delusions, hallucinations, disorganized speech) tend to increase in the later stages of life
Negative symptoms: often involve deficits or reductions of normal functions. (e.g., flat affect, avolition, alogia, anhedonia, asociality) tend to decrease in the later stages

Positive-Symptom Schizophrenia and Parkinson’s Disease: The Dopamine (DA) Seesaw

Drugs increasing brain DA turnover can resemble positive symptoms in schizophrenia
Classical antipsychotics lower DA turnover ("blocking"), inducing Parkinson's-like motor symptoms.
Individuals with Parkinson's taking medications to increase DA levels may experience psychotic symptoms.
Serotonin (5-HT) is involved, with modern antipsychotics affecting both DA and 5-HT systems

Treatments for Schizophrenia

Medication: Acute treatment (sedution/chemical restraint), long-term normalization. Compliance is often below 30%.
Individual and Family Psychotherapy: Addressing patient adjustment and symptoms. Specific approaches include families/friends.
Symptom Self-monitoring: Building patient compliance.
Supervised living/rehab: Assisted outpatient programs, halfway houses, day hospitals.

Medication for Schizophrenia

Classical antipsychotics (Haldol, Prolixin, Mellaril and Thorazine): Historically used primarily. These are generally not first-line treatments now.
Second-generation antipsychotics (Atypical) (Abilify, Clozaril, Geodon, Invega, Latuda, Risperdal, Seroquel, Vraylar, and Zyprexa): Used more frequently due to fewer side effects and improved efficacy for negative symptoms.
Cobenfy: A new medication targeting muscarinic receptors that has promising results for treating both positive and negative symptoms, but treatment cost and further efficacy and side effects still require further research

Side Effects of Antipsychotic Medications

Drowsiness/sedation (often beneficial in agitated patients)
Increased risk of metabolic syndrome (weight gain, dysregulated blood lipids, and glucose)
Movement side effects (akathisia, pseudoparkinsonism, tardive dyskinesia): more common with older antipsychotics.

Other Disorders in Which Antipsychotic Medications Are Sometimes Used

Major depression with psychotic features
Severe generalized anxiety disorder that doesn't respond to anti-anxiety medication
Bipolar disorder
Personality disorders (paranoid, schizoid, schizotypal).
Borderline personality disorder (temporary psychotic episodes)
Acute and Post-traumatic stress disorders (paranoid episodes)

Is Schizophrenia a Violent Disorder?

It's a misconception that schizophrenia is inherently violent.
Prior history of violence and drug/alcohol abuse are better predictors of violent behavior.
In individuals with schizophrenia, violence more often leads to non-compliance with medication and experiences with "command hallucinations" that order violent action

Prognosis in Schizophrenia

Historically, a rule of thirds (1/3 improve, 1/3 stay the same, 1/3 deteriorate)
Prognosis may be worse with accurate diagnoses of Bipolar disorder misdiagnosed as schizophrenia.
Medication has been increasingly effective
Incidence is declining likely due to better prenatal/infant nutrition, and public health initiatives

Hallucinations in Schizophrenia

Primarily auditory (malevolent/taunting voices, command hallucinations)
Also visual, tactile, or olfactory, often indicative of other medical issues (seizures, drug abuse, toxic encephalopathy).

Seasonality of Births of Individuals Later Diagnosed with Schizophrenia

Increased likelihood of birth during certain periods of the year.

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Description

This quiz covers material from the DSM-5-TR on schizophrenia spectrum and other psychotic disorders, highlighting symptoms like delusions and hallucinations.