I hope you enjoyed your weekend. As always, at the beginning of each week, we will do our "week in review" and highlight important content from last weeks readings as well from prior themes. Today we are going to try something a little different, however, due to the suggestion of one of our readers. She suggested that a better way to do these weekly reviews might be in quiz format in order to make it a bit more fun and test retention. So we are going to try that out today. Feel free to give feedback at firstname.lastname@example.org about which format you like better. Answers and explanations are at the bottom of the page.
1) Reduced emotional responsiveness is a common observation during the mental status exam of patients with schizophrenia. The level of responsiveness exists along a continuum. Rank the level of responsiveness from most to least responsive.
a) Flat > Constricted > Blunted
b) Constricted > Blunted > Flat
c) Blunted > Constricted > Flat
d) Blunted > Flat > Constricted
2) Reduced emotional responsiveness in these patients can actually occur from a number of mechanism, and differentiating the actual cause or combination of causes can be a challenge. Do your best to list three potential causes of reduced emotional responsiveness in patients with schizophrenia?
3) Lack of obvious logical relationship between two thoughts expressed in sequence. This was once described as pathognomonic (super specific) for schizophrenia, however this is also frequently seen in mania. Choose the best fit.
b) Flight of ideas
d) Loose associations
4) Mobile and intensive healthcare team that provides treatment, rehabilitation, and support activities to include home delivery of medications, monitoring of mental and physical health, social skill development, frequent contact with family members. Evidence shows that this intervention effectively decreases hospital admissions.
a) Case management
b) Personal therapy
c) Assertive community treatment
d) Vocational therapy
5) Which statement is NOT accurate in regards to the epidemiology of schizophrenia?
a) Prevalence of schizophrenia is about 1%
b) For every 1 woman with schizophrenia there are 1.4 men with the disorder
c) There is an 10x increased risk of suicide than the general population
d) Average age of onset: late teens to early 20s for men and late 20s to early 30s for women.
DON'T LOOK UNTIL YOU HAVE FINISHED THE ENTIRE QUIZ
From Day 7
Reduced emotional responsiveness can be described along a continuum and this applies to any patient not just those with psychotic features. This responsiveness can be described in terms of its intensity, range, and stability.
-Constricted/Restricted is a mild reduction in the range and intensity of expression.
-Blunted is a significant reduction (greater than constricted).
-Flat is an absence or near absence of affective expression.
From Day 7
1) Symptom of the underlying disease process in the brain
2) Adverse effects of antipsychotic medications (parkinsonism)
From Day 8
•Incoherence: speech or thought is difficult or impossible to understand because words or phrases are not connected in a logical way.
•Flight of ideas: a nearly continuous flow of accelerated speech with abrupt changes from topic to topic that are usually based on understandable associations, distracting stimuli, or plays on words. When the condition is severe, speech may be disorganized and incoherent. Most classically associated with mania.
•Alogia: there is a lack of unprompted speech. Another term for this is paucity of speech. This is considered a negative symptom of schizophrenia.
•Loosening of associations: lack of obvious logical relationship between two thoughts expressed in sequence. This was once described as pathognomonic (super specific) for schizophrenia, however this is also frequently seen in mania.
From Day 10
•Case Management: there are often multiple professionals involved in the treatment of these patients (psychiatrist, social workers, occupational therapists, etc...). It is helpful to have one person that ensures their efforts are coordinated, the family is kept informed, and the patient complies with appointments and treatment plans.
•Personal therapy: developed specifically for patients with schizophrenia to enhance personal and social adjustment. Includes social skills training, relaxation exercises, psychoeducation, and self-awareness/reflection. Shown to produce a lower relapse rate after three years compared to controls.
•Assertive community treatment: patient are assigned to one multidisciplinary team (case manager, psychiatrist, nurse, general physicians, therapists) and delivers all services when and where needed by the patient 24/7. It is a mobile and intensive intervention that provides treatment, rehabilitation, and support activities to include home delivery of medications, monitoring of mental and physical health, social skill development, frequent contact with family members, and increase community involvement.
•Vocational therapy: enabling patients to become employed is sign of recovery but can also be a means towards achieving recovery.Methods include sheltered workshops, job clubs, and part-time or transitional employment programs.
From Day 3
20x (not 10x)
•Prevalence: about 1%, meaning 1% of the population at a given time has schizophrenia
•Incidence: about 1.5 per 10,000
•Gender: For every 1 woman with schizophrenia there is 1.4 men with the disorder
•Higher risk of suicide (20x) than the general population (240 per 100,000 compared to 12 per 100,000 annually)
•Higher rates than general population of depressive and anxiety disorders, alcohol and substance use
•Can occur at any age, but the average age of onset tends to be in the late teens to the early 20s for men, and the late 20s to early 30s for women. It is uncommon for schizophrenia to be diagnosed in a person younger than 12 or older than 40.
I hope you like this new format of the "week in review". I want to incorporate reader feedback, so this is my first major attempt at doing so. I want this to be a useful resource, so please keep it coming. Also, if you like the old way better let me know that as well and I can continue to tweak things. Join us tomorrow as we dive right into antipsychotic medications.