Topic 7 Schizophrenia Spectrum Disorders Part 1

• Schizophrenia is best characterized as presenting which personality trait?

  Deteriorating
• The most common course of schizophrenia is an initial episode followed by what course of events?

  Recurrent acute exacerbations and deterioration
• A client diagnosed with paranoid schizophrenia tells the nurse, “I have to get away. The volmers are coming to execute me.” The term “volmers” can be assessed as what?

  Neologism
• Schizophrenia spectrum disorders are disorders that share features with schizophrenia with the main commonality being psychosis.
• What is psychosis?

  Psychosis is a mental health condition characterized by a loss of contact with reality, including hallucinations and delusions.
• Delusional disorder is characterized by delusions that have lasted 1 month or longer.
• In delusional disorder patients their themes can be grandiose, persecutory, somatic, and referential.
• Delusional disorder patients do not tend to behave strangely or bizarrely.
• Brief psychotic disorder is a sudden onset of one of these:


  Delusions, hallucinations, disorganized speech, disorganized or catatonic behavior.
• Brief psychotic disorders must last longer than 1 day but no longer than 1 month with the expectation to return to normal functioning.
• Schizophreniform disorder behaves exactly like schizophrenia except the symptoms have lasted less than 6 months.
• Impaired social or occupational functioning may not be apparent with schizophreniform patients.
• Schizophreniform patients can return to their previous level of functioning but others develop persistent or recurring psychosis.
• Schizoaffective disorder involves a major depressive, manic, or mixed episode concurrent with schizophrenia symptoms and must not be caused by substances or general medical conditions.
• Substance induced psychotic disorder is a condition where the person experiences hallucinations or delusions due to drugs, alcohol, medications, or general medical conditions such as kidney or liver disease.
• Substance use and medical conditions have to be ruled out before a primary diagnosis of schizophrenia spectrum disorders are made.
• Schizophrenia develops gradually and starts between 15 to 25 years old but there are child onsets (before 15) and late onsets (after 40).
• Schizophrenia is preceded by a prodromal phase where milder symptoms of the disorder occur with some experiencing diminished school performance, cognitive abilities, social functioning.
• Schizophrenia affects individuals of all races and cultures equally but is diagnosed more frequently in males and individuals growing up in urban areas.
• Schizophrenia onset tends to be later in women around ages 25 to 35.
• Women who get diagnosed with schizophrenia later in life tend to have a better prognosis and experience less structural changes in the brain compared to men.
• Substance use disorders occur in nearly half the individuals with schizophrenia and substance may be a form of self treatment.
• Anxiety, depression, and suicide co-occur frequently in schizophrenia.
• Polydipsia is an occurrence with schizophrenia patients that can cause hyponatremia as a result of dry mouth from antipsychotic medications.
• Hyponatremia symptoms can be confusion, delirium, hallucination, worsening of psychotic symptoms, polyuria, and ultimately coma.
• The greatest risk for getting schizophrenia is genetics, which counts for 80% of the risk.
• Epigenetic factors can cause changes that increase vulnerability of passing down schizophrenia to descendants.
• The first antipsychotic drugs were dopamine receptor blockers to reduce symptoms like hallucinations or delusions.
• Newer antipsychotics block serotonin and dopamine which suggest that serotonin can also play a role in schizophrenia.
• Serotonin, dopamine, GABA, glutamate, and acetylcholine are neurotransmitters that can play a role in psychosis.
• Reduced connectivity, pruning errors, Reduced volume and blood flow in the brain at hippocampus and prefrontal cortex are related to schizophrenia.
• Widespread white matter abnormalities can contribute to schizophrenia development.
• Postmortem studies of schizophrenic patients showed reduced gray matter in the temporal and frontal lobes with more tissue loss leading to worse symptoms.
• Infection during pregnancy can increase the risk of mental illness along with conception with a father above 35, being born during late winter or early spring.
• Stress and higher cortisol levels can contribute to schizophrenia development along with toxins, childhood abuse, social adversity, migration to or growing in a foreign culture, and exposure to trauma.
• In many cases, schizophrenia does not respond fully to treatment with mild to severe residual symptoms and variable degrees of functionality.
• What are the phases of schizophrenia?

  Prodromal, acute, stabilization, and maintenance or residual.
• What happens in the prodromal phase of schizophrenia?

  Subtle changes in behavior and functioning. Patient may not "feel right". Symptoms typically appear 1 - 12 months before the first full episode of schizophrenia.
• What happens in the acute phase of schizophrenia?

  Psychotic symptoms emerge and can last several months even with treatment. Hospitalization may be required.
• What happens in the stabilization phase of schizophrenia?

  Symptoms are diminished, can last for several months, and the focus is towards the previous level of functioning. Care can be given at a supervised group home or residential crisis center.