Schizophrenia: Assessment – Psychiatry | Lecturio


[Music] there are three essential phases of schizophrenia so the first phase is called the prodromal this is where a person has a decline in functioning that precedes the first psychotic episode patients may become socially withdrawn and irritable during this phase next they have the psychotic symptoms this is where there are perceptual disturbances delusions disorganized thought process and content and then there is a residual phase this occurs between episodes of psychosis and it’s marked by a flat effect social withdrawal and odd thinking or behaviors another question to consider what is the strongest predictor of treatment outcome in a first episode of a psychotic break or a first diagnosis of schizophrenia the answer is a duration of presenting symptoms before treatment so for example if somebody gets into treatment very early when they’ve only had symptoms for a brief period of time they’re much more likely to have a good treatment response and outcome than somebody who’s languishing with psychotic symptoms for weeks months or even years before ever getting into treatment here’s another question what subtype of schizophrenia is associated with a better short and long term outcome the specific subtype is the paranoid subtype this has the best treatment outcomes short and long term earlier in this lecture I referenced positive and negative symptoms a lot so you may be asking yourself what are these positive and negative symptoms well there are way that we classify the symptoms associated with schizophrenia and there are several different types as you can see here maybe take a moment and try to think to yourself which category each symptoms falls under the positive symptoms usually being the more active expansive type symptoms and negative symptoms being the more quiet withdrawn type of symptoms so see if you can assign the correct symptom to the correct category this is the answer positive symptoms of schizophrenia include things like disorganized thoughts bizarre behavior delusions and hallucinations negative symptoms are things like blunted or flat effect in attentiveness apathy and anhedonia what our snipers first rank symptoms of psychosis well the answer are hallucinations delusions thought insertion thought withdrawal and thought broadcasting well who is shinai der Kurt Schneider was a German psychiatrist known largely for his writing on the diagnosis and understanding of schizophrenia back in the 1970s he coined the first rank symptoms that we just reviewed another important history lesson is the five days of schizophrenia that tend to be associated with negative symptoms these include anhedonia a flat effect a loggia or in other words poverty of thought a volition in other words apathy and attention being very poor well who define the five A’s of schizophrenia the answer is Eugen Bleuler who was the one to coin the term schizophrenia in 1908 but prior to him emil kraepelin coined another term to refer to patients with schizophrenia do you know what that term was it’s dementia praecox so we talked earlier a little bit about head imaging in schizophrenia and how hypofrontality is very important in a prominent sign and so just to reiterate schizophrenia can appear on a head CT scan as ventricular a Lardon enlargement and also cortical atrophy although keeping in mind these are nonspecific findings let’s consider this case of mr. B he’s a 22 year old man who’s having trouble in college rather than graduating on time he has had to repeat a few years due to inability to get to class because he’s low on motivation his parents come out to college to visit him and they find that his dorm room is a mess their son mr. B is malodorous he hasn’t been showering or taking care of his hygiene he’s talking nonsense when his parents ask him what’s wrong the only thing they can decipher from him is that he’s saying my professor wants to kill me based on your knowledge of the different types of thought disorder and delusions what types of symptoms are most prominent in mr. B well he’s having both positive and negative symptoms of psychosis he appears to be having paranoid delusions about his professor and he’s not making much sense his parents say he’s nonsensical which indicates he may have a thought disorder happening he also seems to be withdrawn he’s staying in his room he’s unmotivated he’s not going to class his room is a mess and he’s also neglected his personal hygiene really important to note that someone like mr. B or any patient with schizophrenia must be assessed for suicide risk I can’t over emphasize that enough the suicide risk assessment is important for every patient including the patient with schizophrenia or a psychotic disorder approximately 10% of patients with schizophrenia will actually commit suicide and so what are the risk factors for suicide in the patient with schizophrenia well we consider these to be some of the risk factors male gender being under the age of 30 being paranoid having a comorbid substance abuse problem be it drugs or alcohol having associated depressive symptoms unemployment frequent recurrences or exacerbations of their disease and symptoms any prior suicide attempt living alone and maybe having a recent hospitalization these are all just some of the risk factors that you want to make sure to ask about so what is at the core of schizophrenia while negative symptoms of schizophrenia are considered the core of the disease and unfortunately they’re also the most difficult to treat let’s go through the diagnostic criteria for schizophrenia so a patient needs to have two or more of the following symptoms each have to be present for a significant amount of time over a consecutive one-month period so that’s delusions hallucinations disorganized speech grossly disorganized behavior and negative symptoms furthermore that patient also has to have been affected by the disorder in various domains of their life including social and occupational functioning and the signs of the disturbances have persisted for at least six months so even if the criterion a is only active for a month the impact to one’s social and occupational functioning extends for at least six months or longer also there the other disorders associated with psychotic features such as schizoaffective disorder and mood disorders with psychotic features have to have been ruled out before somebody can be diagnosed with schizophrenia the person has to be ruled out for having symptoms that could be attributed to substances or a general medical condition and a final criteria is that if the patient has a history of autistic disorder or other pervasive developmental disorder the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month or less if successfully treated I’d like to make a note here of some other psychotic disorders so another disorder would be brief psychotic disorder which basically includes criterion a of schizophrenia however a difference is that the symptoms only persist for less than a month and the disruption to social and occupational functioning is for less than a month another disorder schizophrenia form disorder is very important and is often a precursor to schizophrenia in schizophrenic form disorder a patient will meet criterion a for schizophrenia however the symptoms and the disruption to social and occupational functioning are actually for under six months so it’s very important when thinking about schizophrenia to know that this is really a very serious disorder that has impacted someone’s life for six months or more thinking back to this case study of mr. B I want you to think about what would your diagnosis be of him so of course you’ve ruled out all substance issues all medical conditions that could be contributing to his presentation and also other psychiatric disorders would need to be ruled out before you can attribute his condition to schizophrenia and again when I say other psychiatric disorders were talking about brief psychotic disorder schizophrenic form disorder schizoaffective disorder or mood disorder with psychotic features also his symptoms would have to be confirmed as present for at least six months before it could be attributed to schizophrenia if schizophrenia is diagnosed mr. B and his family should be engaged actively in the treatment options geared towards helping mr. B experience relief from his symptoms and to help him function within society [Music]

2 thoughts on “Schizophrenia: Assessment – Psychiatry | Lecturio”

  1. 👌🏻👏🏻👍🏻 thank you Mam!!!

    Paranoid schizophrenia. Best prognosis. …
    Hypofrontality.
    Ventricular enlargement

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