8A-9A - schizophrenia Flashcards
define schizophrenia
chronic psychiatric disorder characterised by a constellation of abnormalities in
thinking,
emotion,
and behavior.
is schizophrenia a brain disorder?
disorder is classified as a brain disorder, with structural and functional abnormalities visible in neuroimaging
studies, and a genetic component as seen in twin studies.
etiology of schizophrenia
- no single factor is
considered causative. - The stress diathesis model is most often used, which states that the person in whom
schizophrenia develops has a specific biologic vulnerability (diathesis), that is triggered by stress
stressor which lead to schizophrenia can be
- Genetic component: as seen in twin studies, consanguinity families, first-degree relatives.
- Biologic components:
- Psychosocial and environmental factors
- Infectious theory: as hypothesized by neuropathologic changes consistent with previous infections
what are examples of biologic components leading to schizophrenia
- Dopamine hypothesis
- Norepinephrine hypothesis: increases sensory input
- GABA hypothesis: ↓ GABA activity results in increased dopamine activity
- Serotonin hypothesis
- Glutamate hypothesis
Hypofunction of the glutamate NMDA receptor causes + and - symptoms - Neurodevelopmental theories
Abnormal neuronal migration during the second trimester of fetal development.
what is thought to cause negative and positive symptoms in schizophrenia( which NT)
Schizophrenic symptoms may result from
* ↑ limbic dopamine activity (positive symptoms),
* ↓ frontal dopamine activity, increase in serotonin (negative symptoms).
schizophrenia subtypes
- paranoid
- disorganized
- catatonic
- undifferenciated
- residual
they were deleted from ICD+DSM5 bcz had little clinical relevance
DSM-5 diagnostic criteria of schizophrenia
A. Two or more of the following must be present for at least 1 month (at least one must be 1, 2, or 3):
1. Delusions.
2. Hallucinations .
3. Disorganized speech.
4. Grossly disorganized or catatonic behavior.
5. Negative symptoms.
B. Must cause significant social, occupational, or functional (self-care) deterioration.
C. Duration of illness for at least 6 months (including prodromal or residual periods in which the above full
criteria may not be met).
D. Symptoms not due to effects of a substance or another medical condition.
management of schizophrenia
1st-generation (typical) antipsychotics (chlorpromazine, fluphenazine, haloperidol, perphenazine ( D2-antagonism) - Treat positive symptoms
2nd-generation (atypical) antipsychotics (aripiprazole, clozapine, olanzapine, quetiapine, risperidone (5HT2 & D2)
Electroconvulsive therapy (ECT) can be effective for acute psychosis and catatonic subtype
Behavioral therapy attempts to improve patients’ ability to function in society
BETTER Prognosis is associated with
- Later onset
- Acute onset
- Female gender
- Good social support
- Positive symptoms predominate
- Mood symptoms
- Few relapses
- Good premorbid functioning
Symptoms of schizophrenia often present in the following three phases:
-
Prodromal phase: decline in functioning that precedes the first psychotic episode. Patients may become
socially withdrawn and irritable, may have physical complaints, and/or declining school or work performance. - Psychotic phase: perceptual disturbances, delusions, and disordered thought processes/content.
-
Residual phase: occurs following an episode of active psychosis. Marked by mild hallucinations or delusions,
social withdrawal, and negative symptoms
Positive symptoms:
- hallucinations,
- delusions,
- bizarre/disorganized behavior,
- disorganized speech.
These tend to respond more robustly to antipsychotic medications.
- Negative symptoms
flat or blunted affect,
* anhedonia (decreased pleasure from positive stimuli)
* apathy,
* alogia (diminished speech)
* asociality.
These symptoms are comparatively more often treatment resistant and contribute significantly to the social
isolation and impaired function of schizophrenic patients.
- Cognitive symptoms
- impairments in attention,
- executive function, and
- working memory.
These symptoms may lead to poor work and school performance.
