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This Concept Map, created with IHMC CmapTools, has information related to: Psychotic Disorders, Schizophrenia, Psychotic Disorders SCHIZOPHRENIA -1% pop'n - late teens-20s onset -late-onset peak after 45yo -torn or divided mind -more cases in larger cities 10% suicide rate (Tx-Clozaril) Avg life span- 10years less Violence risk only when (+)Sx and substance abuse, Schizophrenia, Psychotic Disorders SCHIZOPHRENIA -1% pop'n - late teens-20s onset -late-onset peak after 45yo -torn or divided mind -more cases in larger cities Feelings as they lose grip on reality: Perplexity Isolation Anxiety/Terror, Schizophrenia, Psychotic Disorders SCHIZOPHRENIA -1% pop'n - late teens-20s onset -late-onset peak after 45yo -torn or divided mind -more cases in larger cities Course: Prolonged Exacerbations, Remissions Negative Sx WORSEN Positive Sx LESSEN Premorbid fcning not regained Up to 50% ATTEMPT suicide 10% COMMIT suicide, Schizophrenia, Psychotic Disorders SCHIZOPHRENIA -1% pop'n - late teens-20s onset -late-onset peak after 45yo -torn or divided mind -more cases in larger cities Etiology-all hypotheses -small anterior hippocampi -enlarged lateral ventricles -failed pruning->expression of dz -TOO MUCH DOPAMINE->psychosis -REDUCE 5-HT->REDUCE negative Sx -Atypical Antipsychotics -reduce 5-HT AND dopamine Genetics:highest w/ twin, both parents Family: "double bind"-OLD VIEW, Schizophrenia, Psychotic Disorders SCHIZOPHRENIA -1% pop'n - late teens-20s onset -late-onset peak after 45yo -torn or divided mind -more cases in larger cities Types: Disorganized (hebephrenia) -no systematic delusions, disorganized -blunted, inappropriate affect -chronic, no remissions -slow, insidious onset-extreme impairment Catatonic -prominent excitement, stupor, mutism, negativism, rigidity, posturing -if present w/out other Sx, could be mood d/o Paranoid -preoccupation w/ fixed delusions -doesn't require regressive Sx -BETTER PROGNOSIS Residual -no active criterion A Sx (delusions, hall., etc.) -BUT Hx of at least one schiz episode + negative Sx -"burned out" schizophrenics Undifferentiated -criteria for illness, but not specific type, Schizophrenia, Psychotic Disorders SCHIZOPHRENIA -1% pop'n - late teens-20s onset -late-onset peak after 45yo -torn or divided mind -more cases in larger cities Cormorbidities Obesity-Rx, poor diet, less mvmt Type II DM-Rx, wt gain CV dz-DM, smoking, obesity HIV-high-risk behaviors COPD-smoking Rheumatoid Arthritis-unknown cause Substance abuse, Schizophrenia, Psychotic Disorders SCHIZOAFFECTIVE D/O Mood, thought disturbances present Thought disturbances remain 2wks after mood Sx abate, Schizophrenia, Psychotic Disorders D/Dx MDD, BPD w/ psychotic features 2ndary to general medical condition 2ndary to substance abuse, Schizophrenia, Psychotic Disorders DELUSIONAL D/O NONBIZARRE delusions predominate No disintegration of behavior Mental status NL except delusions No thought d/o->antipsychotics don't work Check veracity of beliefs Often seen in Borderline PD, schizoid, schizotypal PDs, Schizophrenia, Psychotic Disorders SCHIZOPHRENIFORM PSYCHOSIS Sx last b/w 1-6 mos Provisional or Resolved, Schizophrenia, Psychotic Disorders SHARED PSYCHOTIC D/O Uncritical acceptance by one person of another's delusional beliefs Usually 2 ppl, can be more -dominance, submission patterns Dominant partner w/ schizophrenia or delusional d/o - more ill ᢒ% involve family members Tx: separation, treat ill pt, Schizophrenia, Psychotic Disorders SCHIZOPHRENIA -1% pop'n - late teens-20s onset -late-onset peak after 45yo -torn or divided mind -more cases in larger cities Criteria: a. 2(+) for 1 mo -delusions, hallucinations, disorganized speech (derailment), grossly disorganized, catatonic behavior -Negative Sx- flat affect, alogia, avolition (or only one if bizarre delusions, or commentary or conversatoin) b. social/occupational dysfcn c. duration-Sx for at least 6 mo, Schizophrenia, Psychotic Disorders Common Problems Common Disturbances Formal Thought d/o, Language: -loose ass'ns, thought derailment, circumstantiality, tangentiality, poverty of speech content, neologisms, word salad Thought Content: -delusions, auditory hall, illusions, ideas of reference, thought broadcasting, thought insertion, thought w/drawal (Schneiderian Sx) Affective disturbances: flat, inappropriate (not the ADR of old antipsychotic Rx) Disturbance in sense of self, volition Autistic behavior, thinking (idiosyncratic) Motor Disturbances, Schizophrenia, Psychotic Disorders SCHIZOPHRENIA -1% pop'n - late teens-20s onset -late-onset peak after 45yo -torn or divided mind -more cases in larger cities Bleuler's 4 As: Autism, Ambivalence, Disturbances in affect, associations, Schizophrenia, Psychotic Disorders SCHIZOPHRENIA -1% pop'n - late teens-20s onset -late-onset peak after 45yo -torn or divided mind -more cases in larger cities Tx: Antipsychotic Rx -more effective for (+) than (-) Sx Neuroleptics -conventional-Haloperidol, thiothixene, fluphenazine ADRs-anticholinergic->tardive dyskinesia, EPS, dystonia -atypical-risperidone, olanzapine, clozapine, aripiprazole ADRs-metabolic Neuroleptic Malignant Syndrome-fever, lead-pipe rigidity, delirium, autonomic dysfcn -worse w/ high-potency drugs TD-risk w/ older age, more cumulative Rx -IRREVERSIBLE-DA receptor hypersensitivity Supportive psychoTx Group Tx Family Tx ECT-mostly in schizoaffective d/o, not schizophrenia Institutionalization, Schizophrenia, Psychotic Disorders BRIEF PSYCHOTIC D/O Any (+) Sx present 1 day - 1 mo -May be personality d/o under high stress, Schizophrenia, Psychotic Disorders SCHIZOPHRENIA -1% pop'n - late teens-20s onset -late-onset peak after 45yo -torn or divided mind -more cases in larger cities Good Prognosis: Late, Acute onset (+) Symptoms Obvious precipitants Good premorbid fcn Married Female