Summary: Episode 83: This is the second in our series of Gold Standard USMLE Audio Reviews covering the antipsychotic medications. Let me know if your medical school uses a systems-based curriculum; if so we’ll organize the DVD-ROMs according to your block schedule if you’re interested.<br> History of Schizophrenia<br> [ad#300×250]<br> I. Brief History<br> <br> * Kahlbaum ———Catatonia<br> <br> <br> * Hecker ————-Hebephrenia<br> <br> <br> * Sanders————-Paranoia (“absent mind”)<br> <br> <br> * Morel ————–Demence Precoce<br> <br> <br> * Kraepelin ———Dementia Praecox or Precox (Catatonia + Hebephrenia + Paranoia)<br> <br> <br> * Bleuler ————Schizophrenias (” splitting of the mind”)<br> <br> <br> * Langfeldt———-Schizophreniform Disorder<br> <br> II. Essential features of Schizophrenia<br> Characteristic signs and Sx (+ and -) that have been present during a one-month period or shorter period if successfully treated …………(involves active psychosis w/ delusions & hallucinations)<br> ……with some signs of the disorder persistent for at least 6 months<br> These signs and symptoms are associated with marked social or occupational dysfunction<br> The disorder is not obviously related to organic causes (drug-physical illness) or mood d/o (these options must be eliminated)<br> III. Symptoms at Onset<br> <br> * Somatic Manifestations, changes in the ability to work- vague; ie headaches<br> <br> <br> * Anxiety<br> <br> <br> * Perplexity – “what did you say? I did not hear you.” (they are not mentally there)<br> <br> <br> * Abstract ideas (philosophy, occult, religion, etc.)<br> <br> <br> * Peculiar Behavior- not bathing; justify it by saying only dirty people bath and kept rationalizing it<br> <br> <br> * Trema (fright) – realize that something is wrong<br> <br> <br> * Apocalyptic- person falls to pieces<br> <br> <br> * Vegetable-like phase- pt had no pain with a horrid abdominal abscess<br> <br> IV. Diagnostic Criteria (according to the DSM-IV)<br> <br> * Characteristic symptoms- 2 or more of the following, each present for a significant portion of time during a one month period (or less, if successfully treated)<br> <br> – Delusions<br> – Hallucinations<br> – Disorganized speech (frequent derailment or incoherance)<br> – Grossly disorganized or catatonic behavior<br> – Negative symptoms (affective flattening, alogia, or avolition)<br> Only one of the above is required if the delusions are bizarre of hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other<br> <br> * Social/occupational dysfunction- significant declining performance at work or in relationships since the onset of symptoms; or when the onset is in childhood, the child fails to achieve the expected levels of interpersonal, academic, or occupational achievement<br> <br> <br> * Duration- continuous signs of disturbance persist for at least 6 mos<br> <br> – 6 mo pd must include at least 1 month (or less is successfully treated) that meet Criterion A (active phase Sx)<br> – May include pds of prodromal/residual Sx during whichsigns of disturbance are manifested by either<br> Only negative Sx or<br> 2+ symptoms listed in Criterion A present in the attenuated form (odd beliefs, ususual perceprtions)<br> <br> * Schizoaffective and Mood Disorder (w/psychotic features) have been Excluded<br> <br> – Ruled out b/c either:<br> 1. No major depressive, manic, or mixed episodes have occurred concurrently with acute phase symptoms<br> 2.
