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reason for hope
dr. daniel weinberger and other leading National institute of mental health schizo researchers. learned the gray matter loss may be reversible. MIMH is currently researching a drug that seems to have potential for reversing the cognitive decline that is caused by schizo and there are many drug companies also now researching in this area
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spectrum of psychotic disorders
- least to severe
- brief psychotic disorder
- - psychotic symptoms 1-30 days duration, return to prior level of functioning
- substance/med induced psychotic disorder
- psychotic disorder due to another medical condition
- schizo disorder
- - symptoms of schizo 1 month but < 6 months duration
- schizoaffective disorder- symptoms of depression and mania
- delusion disorder
- schizo
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definition of psychosis
- severe mental condition in which there is disorganization of personality, deterioration in social functioning and loss of contact with or distortion of reality
- maybe evidence of hallucination and delusional thinking
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the catatonic features specifer
- catatonic features may be associated with other psychotic disorders such as brief psychotic disorder schizophreniform disorder, schizophrenia, schizoaffective disorder and substance-induced psychotic disorder
- stupor and muscle rigidity or excessive purposeless motor activity
- waxy flexibility negativism echolia (repeat words), echopraxia (way of talking weird), mutism, negativims
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symptoms 8 areas of functioning
- content of thought= what are they talking about
- form of thought
- perception- seeing hearing
- affect
- sense of self- don't know who they are
- volition
- interpersonal functioning
- psychomotor behaviors
all classifed as positive or negative symptoms
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positive, negative, cognitive symptoms
- positive symptoms are manifestation of things that are not normally present (relatively good response to meds)
- Like:
- negative symptoms the absence of things that are normally present- difficult to treat most destructive
- like:
- cognitive symptoms problem that impact living and independence
- like
- -
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positive symptoms (action symptoms)- content of thought
- delusion: false fixed belief
- persecution/paranoia harmed by other CIA poisoing
- grandeur (all powerful, god like, kingly)
- reference- everything is r/t them tv shows etc
- control (forces outside of body controlling behavior)
- somatic body growing third arm changing in weird way)
- nihilistic (body self or other world in non existing the world is gone, i have no heart)
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positive symptoms- delusions content of thought
- religiousity (varies greatly in religious beliefs, level of commitment, voices of hod incessantly searching bible)
- thought broadcasting (thought heard by others)
- thought insertion (others inserted into mind)
- thought withdrawal (thought removed by outside agency)
- magical thinking (thought have control over certain people or situation)
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positive symptom-perceptions
- hallucination - false sensory sensation not associated with real external stimuli. caution with command hallunication
- auditory, gustatory (taste, eating), visual, olfactory, tactile,
- illusions- misinterpretation of real external stimuli- snakes coming out of light
- be careful with these pts
responds to meds
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positive symptoms chx in format of thoughts (demonstrated though speech)
- loose association- topics are unrelated and incoherence
- shift with no relationship and happens so fast cant' understqand
- concrete thinking- literal interpretation of the environment- what brought you to the hospital- a car
- circumstantiality- unable to get to the point of the communication bc of unnecessary layers of details
- tangentiality- never get to the point; unrelated topics are introduced, the original point is lost
- neologisms- invents new word that have symbolic meaning to the person, not to anyone else, calls table an ergot
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chx in format in thought conts
- clang association- choice of words govern by sound, often rhyming. it is very cold, i am cold and bold, the has been sold
- word salad- words put together randomly without connection, most forward action grows life double plays circle uniform
- mutism- inability or refusal to speak
- perservation- persistenly repeats the same word or idea in response to different question
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positive symptoms sense of self
- echopraxia- purposely imititates movements made by others
- echolia- repeating heard words
- indentification and imitation- behavior often takes on form of what they see in another person
- depersonalization- feelings of unreality (one's extremities have changed in size, or sense of seeing self form a distance)
- due to weak ego boundaries schizophrenic lacks feeling of being unique, has identity confusion
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Negative symptoms- lack of action symptoms
- affective flattening- associated with feeling state or emotions, unchanging, facial expression, poor eye contact, reduce body language, inapproriate affect (incongruent), diminished emotional expression (or devoid, flat, or bland)
- alogia (poverty of speech) brief empty responses decreased fluency and content of speech
- avolition/apathy- inablity to initiate goal directed activity little interest in work or social activities, impaired grooming hygiene
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negative symptoms cont
- anhedonia- can lead to suicide
- ambivalence- the co existence of opposite emotions to the same object. person or situation, interfering with the ability to make even a very simple decision, also demonstrated in relationships having simultaneously the need for and fear of intimacy
- deteriorated appearance
- all very difficult to tx
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more negative symptoms
- impaired social interation- clings or intrudes on personal space
- social isolation- focus exclusive on self
- anergia- lack of energy to carry our simple task
- waxy flexibility- posturing oddly even though discomfort
- posturing (voluntary assumptions of bizzare position)
- pacing and rocking (swaying back and forth)
- regression (to early stage of life seen as dysfunctional attempt to reduce anxiety)
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changes in affect (objectively observed behaviors associated with feelings
- inapproriate (incongruent)
- over-reactive (out of proportion)
- blunted (weak)
- flat (void in tone)
- labile (changing)
- chx in mood?
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schizoaffective disorders
- presence of hallucinations and/or delusions that occur for at least 2 werrks in absence of a major mood episode
- prominent mood disorder symptoms evident for majority of the time
- - depressed with psychomotor retardation, and SI
- - euphoria, grandiosity and hyperactivity
- prognosis better than schizo disorder
- meds- antipsych and mood stabilizers
- mood disorder is there
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schizo in children
early warning signs
- trouble discerning dreams from reality
- seeing and hearing voices that are not real
- confused thinking
- vivid and bizarre thoughts and ideas
- extreme moodiness
- peculiar behavior
- concept that people are out to get them
- behaving younger than chronological age
- severe anxiety and fearfulness
- confusing tv and movies with reality
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schizo in children
- severe problem in making and keeping friends
- develops gradually in children w/o the sudden pyschotic break that sometimes occurs in adolescents and adults
- talking about strange fears and ideas
- cling to parents or say things that don't make sense. thouse who used to enjoy relationships w/others may become more shy or withdrawn and seem to be in their own world
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