Behav. Sci. L2. Flashcards
schizophrenia definition
“split mind” irrational divergence between behavior and thought content - chronic, debilitating illness associated with deterioration in mental function and behavior
when does schizophrenia begin?
young adulthood (1/100)
what is the hallmark symptom of schizophrenia
psychosis - hallucinations, delusions, abnormalities in thought process/organization
illusion
misperception of REAL external stimuli (distortion)
hallucination
sensory perceptions not generated by external stimuli
ideas of reference
false conviction that one is subject of attention by other people (crowds, TV, radio, internet) - feeling as though people are referring to you in their conversations - common
delusion
false beliefs not correctable by logic or reason - no based on simple ignorance and not shared by culture
loss of ego boundaries
not knowing where one’s mind and body end and those of others begin
alogia
lack of informative content in speech, lacking/poverty of speech
echolalia
repeating statements of others/associating words by their sounds, not by their meaning (I’m very sure i’ve got the cure and i’m not pure”
though blocking
abrupt hult in the train of thinking, often bc of hallucination
neologisms
inventing new words
circumstantiality
in responding to questions, one presents unnecessary and voluminous details ultimately arriving at an answer to the question posed
tangentiality
beginning a response in a logical fashion but then getting further and further away from the point an fail to answer the questions initially posed
loose associations
loss of logical meaning btw words or thoughts
characteristics of schizophrenia
at least one episode of psychosis with persistent disturbances of thought, behavior, appearance, speech and affect (emotion) as well as impairment in occupational and social functioning
how does schizophrenia contrast with delirium or substance abuse
schizos do not have clouding of consciousness
what are the DSM-5 diagnostic criteria?
- characteristic symptoms (2+); 2. social/occupational dysfunction; 3. duration of AT LEAST 6 MONTHS; 4. cannot be due to another illness 5. cannot be due to substance use
what are the characteristic symptoms of schizophrenia
delusions, hallucinations, grossly disorganized or catatonic behavior, negative symptoms (flat affect, alogia, avolition), disorganized speech
what are the positive symptoms of schizophrenia
symptoms that are additional to expected behavior: delusions, hallucination, agitation, talkativeness, thought disorder - respond well to most tradition and atypical antipsychotic agents
what are the negative symptoms of schizophrenia
symptoms that are missing from expected behavior: lack of motivation, social withdrawal, flattened affect/emotion, cognitive disturbances, poor grooming, poor/impoverished speech
prodromal schizophrenia
prior to first psychotic break: avoidance of social activities, quiet and passive or irritable, sudden interest in religion or philosophy, physical complaints, anxiety and depression common
psychotic/active schizo
loss of touch with reality - positive symptoms
residual schizo
period between psychotic episodes, in touch with reality but doesn’t behave normally - negative symptoms (peculiar thinking, eccentric behavior and withdrawal from social interactions)
men vs women with schizo
occurs equally in men and women but earlier in men (15-25; women 25-35) and women respond better to antipsychotic meds but have a greater risk of tardive dyskinesia
neurological abnormalities in schizo
abnormalities in front lobes (decreased use of glucose); lateral and third ventricle enlargement; abnormal cerebral symmetry; changes in brain density (decreased volume of hippocampus, amygdala, and parahippocampal gyrus); EEG abnormal; abnormal eye movements
which part of the brain is hyperactive while hallucinations occur?
auditory cortex
when shown a scary face, which areas of the brain are hot/cold in schizo?
hot: limbic system esp amygdala. cold: cortex
dopamine hypothesis schizo
excessive dopaminergic activity in mesolimbic tract and hypoactivity of mesocortical tract (negative symptoms)
how do stimulant drugs cause psychotic symptoms?
amplifying mesolimbic tract
homovanillic acid
metabolite of DA in bodily fluids of schizo - suggests more DA activity and use of CNS
which drug has anti-5HT2A receptor activity?
clozpine - serotonin symptoms
glutamate
major excitatory neurotransmitter in CNS
glutamate hypothesis
antagonists of NMDA subtype of GLU receptors aggravate and create psychosis, while agonists of NMDA receptors may relieve symptoms - NMDA (receptor) hypoactivity
normal pathway of glutamate activity
glutamate excites, GABA interneuron inhibitory, 2nd glutamate excites, dopamine release
psychosis (positive symptoms) pathway of glutamate activity
glutamate tries to excite, but no receptor, so no GABA inhibitory signal, so too much excitement of glutamate causing too much dopamine release
negative symptoms pathway of glutamate activity
normal is GLU-GABA-GLU-GABA-DA; abnormal is the same, but problem with NMDA receptors that Glu binds to, causing too much inhibition since the second glutamate is not inhibited
What is the differential diagnosis when it comes to schizo
psychotic disorder caused by a general medical condition (B12/folate deficiency, temporal lobe epilepsy), manic phase of bipolar, substance-induced psychotic disorder, other psychotic disorders
what other psychotic disorders are similar to schizophrenia
brief psychotic disorder, schizophreniform disorder, scizoaffective disorder, delusional disorder, shared psychotic disorder
brief psychotic disorder
1-29 days of schizophrenia symptoms
schizophreniform disorder
1-6mo of symptoms
schizoaffective disorder
schizophrenia + mania and/or depression
delusional disorder
delusions, but no other schizophrenia symptoms
shared psychotic disorder
one person is delusional and a second person develops same delusion
How do effective antipsychotics work?
block D2 receptors in the mesolimbic DA pathway (blocks neurons from excessively firing even in the face of high DA concentrations)
What does 5HT2a blockade by atypical SGAs allow?
allows dopamine to more freely flow in the nigrostriatal pathway (less side effects)
Why is compliance low for antipsychotic drugs?
unpleasant side effects of fatigue, grogginess, sedation and poor patient insight
What is an option for noncompliant patients
long acting injectable forms of drugs (haloperidol decanoate, fluphenzine decanoate, resperidone, paliperidone, aripiprazole)
