1.3 - Schizophrenia Flashcards
In the United States, the lifetime prevalence of schizophrenia is
about 1 percent
Schizophrenia is (EQUALLY/UNEQUALLY) prevalent in men and women
Schizophrenia is equally prevalent in men and women
Schizophrenia onset is earlier in
a. men than in women
b. women than in men
Schizophrenia onset is earlier in men than in women
More than half of all male schizophrenia patients, but only one third of all female schizophrenia patients, are first admitted to a psychiatric hospital before age 25 years.
The peak ages of onset are 10 to 25 years for men and 25 to 35 years for women.
What are the peak ages of onset for
men
women
The peak ages of onset are 10 to 25 years for men
25 to 35 years for women
About 90 percent of patients in treatment for schizophrenia are between (xx to yy) years old
15 and 55
disorder is characterized as late-onset schizophrenia when
when onset occurs after age 45 years
First degree biological relatives ofpersons with schizophrenia have a (greater/lesser) risk for developing the disease than the general population.
ten times greater risk
The simplest formulation of the dopamine hypothesis of schizophrenia posits that schizophrenia results from (NOT ENOUGH/TOO MUCH) dopaminergic activity.
The simplest formulation of the dopamine hypothesis of schizophrenia posits that schizophrenia results from TOO MUCH dopaminergic activity.
Which biochemical factors are important in schizophrenia are:
- Dopamine
- Serotonin
Norepinephrine
GABA
Neuropeptides
Glutamate
Acetylcholine and Nicotine
What are the symptoms of schizophrenia?
Criterion A
- Delusions
- Hallucinations
- Disorganized speech (e.g., frequent derailment or incoherence)
- Grossly disorganized or catatonic behavior
- Negative symptoms (i.e., diminished emotional expression or avolition).
What are the 3 most important symptoms of schizophrenia?
How many are required for diagnoses? (1/2/3)
At least one of these must be (1), (2), or (3)
- Delusions
- Hallucinations
- Disorganized speech (e.g., frequent derailment or incoherence)
Diagnostic criteria A for the symptoms of schizophrenia
Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1 ), (2), or (3):
- Delusions
- Hallucinations
- Disorganized speech (e.g., frequent derailment or incoherence)
Criterion B-F of Schizophrenia
B. Level of functioning in one or more major areas of functioning, such as work, interpersonal relations, or self-care, is markedly below the level achieved before the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of functioning).
C. Continuous signs of the disturbance persist for at least 6 months.
D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out. Either (1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or (2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.
E. The disturbance is not attributable to the physiological effects of a substance or another medical condition.
F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).
Subtypes of schizophrenia
Paranoid Type
Disorganized Type
Catatonic Type
Undifferentiated Type
Residual Type
Subtypes of schizophrenia
Paranoid Type
paranoid type of schizophrenia is characterized mainly by the presence of delusions of persecution or grandeur
Subtypes of schizophrenia
Disorganized Type
characterized by a marked regression to primitive, disinhibited, and unorganized behavior and by the absence of symptoms at meet the criteria for the catatonic type
Subtypes of schizophrenia
Catatonic Type
marked disturbance in motor function; this disturbance may involve stupor, negativism, rigidity, excitement, or posturing
Subtypes of schizophrenia
Undifferentiated Type
patients who clearly have schizophrenia cannot be easily fit into one type or another.
Subtypes of schizophrenia
Residual Type
characterized by continuing evidence ofthe schizophrenic disturbance in the absence of a complete set of active symptoms or of sufficient symptoms to meet the diagnosis of another type of schizophrenia
Differential Diagnosis of Schizophrenia-Like
Symptoms:
Medical and Neurological
- Substance induced
- Epilepsy-
- Neoplasm, cerebrovascular disease, or trauma-especially frontal or limbic
- Acute intermittent porphyria
- AIDS
- Vitamin B12 deficiency
- Carbon monoxide poisoning
- Cerebral lipoidosis
- Creutzfeldt-Jakob disease
- Fabry’s disease
- Fahr’s disease
- Hallervorden-Spatz disease
- Heavy metal poisoning
- Herpes encephalitis
- Homocystinuria
- Huntington’s disease
- Metachromatic leukodystrophy
- Neurosyphilis
- Normal pressure hydrocephalus
- Pellagra
- Systemic lupus erythematosus
- Wernicke-Korsakoff syndrome
- Wilson’s disease
Differential Diagnosis of Schizophrenia-Like
Symptoms:
Psychiatric
- Atypical psychosis
- Autistic disorder
- Brief psychotic disorder
- Delusional disorder
- Factitious disorder with predominantly psychological signs and symptoms
- Malingering
- Mood disorders
- Normal adolescence
- Obsessive-compulsive disorder
- Personality disorders-
- Schizoaffective disorder
- Schizophrenia
- Schizophreniform disorder
Course of Schizophrenia
- The classic course of schizophrenia is one of exacerbations and remissions.
- Patients usually relapse, however, and the pattern of illness during the first 5 years after the diagnosis generally indicates the patient’s course.
- Further deterioration in the patient’s baseline functioning follows each relapse of the psychosis. This failure to return to baseline functioning after each relapse is the major distinction between schizophrenia and the mood disorders.
What is the major distinction between schizophrenia and the mood disorders?
- Further deterioration in the patient’s baseline functioning follows each relapse of the psychosis.
This failure to return to baseline functioning after each relapse is the major distinction between schizophrenia and the mood disorders.
over the 5- to 10-year period after the first psychiatric hospitalization for schizophrenia, what percent is described as having a GOOD outcome?
over the 5- to 10-year period after the first psychiatric hospitalization for schizophrenia, only about 10 to 20 percent of patients can be described as having a good outcome
over the 5- to 10-year period after the first psychiatric hospitalization for schizophrenia, what percent is described as having a POOR outcome?
over the 5- to 10-year period after the first psychiatric hospitalization for schizophrenia, more than 50 percent of patients can be described as having a poor outcome, with repeated hospitalizations, exacerbations of symptoms, episodes of major mood disorders, and suicide attempts
What is a poor outcome of schizophrenia?
repeated hospitalizations, exacerbations of symptoms, episodes of major mood disorders, and suicide attempts
Features Weighting Toward to Good Prognosis in Schizophrenia
- Late onset
- Obvious precipitating factors
- Acute onset
- Good premorbid social, sexual, and work histories
- Mood disorder symptoms
(especially depressive
disorders) - Married
- Family history of mood disorders
- Good support systems
- Positive symptoms
Features Weighting Toward to Poor Prognosis in Schizophrenia
- Young onset
- No precipitating factors
- Insidious onset
- Poor premorbid social, sexual,
and work histories - Withdrawn, autistic behavior
- Single, divorced, or widowed
- Family history of
schizophrenia - Poor support systems
- Negative symptoms
- Neurological signs and symptoms
- History of perinatal trauma
- No remissions in 3 years
- Many relapses
- History of assaultiveness
Treatment of schizophrenia
- antipsychotic drugs
- psychosocial treatment
- hospitalization
- ECT
first generation antipsychotics
aka
dopamine receptor antagonists
clozapine (Thorazine)
second-generation
antipsychotics
aka
serotonin dopamine antagonists (SDAs)
EMIL KRAEPLIN-
dementia precox
Emphasized the distinct cognitive process (dementia)
early onset (precox)
4 A’s EUGEN BLEULER
Associations
Affect
Autism
Ambivalence
Prevalence
Phil and US
Region 6 (Phil) 1996 - 4.3%
US Lifetime prevalence of Schizophrenia - 1 - 1.5%
NIMH-ECA Study - 1.3%
What percentage of patients with schizophrenia attempt suicide at least once?
50% of patients with schizophrenia attempt suicide at least once
What percentage of patients with schizophrenia die by suicide during a 20 year follow up period?
10 -15% of patients with schizophrenia die by suicide during a 20 year follow up period
Premorbid Signs and Symptoms of schizophrenia
SCHIZOID
SCHIZOTYPAL
5 symptoms dimensions of schizophrenia
- positive symptoms
- negative symptoms
- cognitive symptoms
- aggressive symptoms
- anxiety/depression
Positive symptoms of schizophrenia
excess of normal function
- catatonic behavior
- delusions
- hallucinations
- distortions or exaggerations in language and communication
Positive symptoms are associated not just with schizophrenia, but also with
- bipolar disorder
- schizoaffective disorder
- childhood psychotic illnesses
- psychotic depression
- Alzheimer’s
cognitive symptoms of schizophrenia
- thought disorder
- impaired attention
- impaired verbal fluency
- problems with serial learning
- impairment in vigilance for executive functioning
negative symptoms of schizophrenia
- blunted affect
- emotional withdrawal
- poor rapport
aggressive symptoms of schizophrenia
- hostility
- verbal abusiveness
- physical abusiveness
depressive / anxious symptoms of schizophrenia
- depressed mood
- anxious mood
- guilt
NEURODEVELOPMENTAL HYPOTHESIS of schizophrenia
proposes that a proportion of schizophrenia is the result of an early brain insult, either pre or perinatal which affects brain development leading to abnormalities which are expressed in the adult brain
5 symptoms of psychosis
- Hallucinations
- delusions
- disorganized speech
- disorganized behavior
- gross distortions of reality testing
Cognitive deficits found in schizophrenia show ( DETERIORATION / NO DETERIORATION) over the course of the illness
Cognitive deficits found in schizophrenia show NO DETERIORATION over the course of the illness
non-progressive
Risk factors for schizophrenia
- Nutrition
- Seasonality
- Infection or infectious agents
- Obstetric complications
Hyperdopaminergic state in (cortex / subcortical) area may underlie the (negative / positive) symptoms of schizophrenia
Hyperdopaminergic state
in SUBCORTICAL area may underlie
the POSITIVE symptoms of schizophrenia
Hypodopaminergic state in (cortex / subcortical) area may underlie the (negative / positive) symptoms of schizophrenia
Hypodopaminergic state in CORTEX may underlie
the NEGATIVE symptoms of schizophrenia
Nigrostiatal tract function
a. emotional expression
b. inhibit prolactin release
c. initiation and coordination of motor movements
c. initiation and coordination of motor movements
Mesolimbic/Mesocortical Tracts function
a. emotional expression
b. inhibit prolactin release
c. initiation and coordination of motor movements
a. emotional expression
Tuberoinfundibular tract function
a. emotional expression
b. inhibit prolactin release
c. initiation and coordination of motor movements
b. inhibit prolactin release
