Block 4 Lecture 3 -- Psychosis: Schizophrenia Flashcards
What are the types of schizophrenia?
1) catatonic
2) disorganized (hebephrenic)
3) paranoid
4) residual
5) undifferentiated
What are sxs of catatonic schizophrenia?
withdrawn; little to no movement;
– possibly vegetative
What are sxs of disorganized (hebephrenic) schizophrenia?
verbally incoherent; flat effect; inappropriate emotions or behavior
What are sxs of paranoid schizophrenia?
delusion; hallucinations; false beliefs of grandeur
What are sxs of residual schizophrenia?
long-term
- negative symptoms remain
- most other sxs have disappeared
What are sxs of undifferentiated schizophrenia?
multiple symptom types
What is a hallucination?
hearing/seeing/feeling things that aren’t real
What is a delusion?
holding unusual beliefs not shared by others
What are causes of psychosis?
1) schizophrenia
2) bipolar/unipolar
3) HIV or other infection
4) genetics
5) drug-induced
Define psychosis.
abnormal condition of the mind; loss of contact with reality
Define schizophrenia.
chronic brain disorder affecting thinking, feeling, and actions
– not a split/multiple personality
What are positive symptoms of schizophrenia?
1) delusions
2) hallucinations
3) disorganized speech/thinking
4) grossly disorganized behavior
5) catatonic behaviors
6) psychomotor agitation
What are negative symptoms of schizophrenia?
1) affective flattening
2) avolition
3) alogia
4) anhedonia
5) attentional deficits
6) social withdrawal
Define avoliton.
lack of motivation for initiating tasks
Define alogia.
difficulty or inability to speak
Define anhedonia.
lack of interest/enjoyment in life
What are cognitive sxs of schizophrenia?
1) slow/disorganized thinking
2) difficulty understanding
3) poor concentration, memory
4) difficulty expressing and integrating thoughts/feelings/behavior
– impaired attention, memory, and executive function
What are the mood sxs of cognitive schizophrenia?
1) depression
2) dysphoria
3) hopelessness
4) demoralization
5) anxiety
6) guilt
What are the symptom categories of schizophrenia?
1) positive
2) negative
3) cognitive
4) mood
What are the current hypotheses for schizophrenia pathophys?
1) DA hypothesis
2) serotonin hypothesis
3) Glu hypothesis
4) GABA hypothesis
What structural abnormalities are present in schizophrenia?
1) enlargement of lateral ventricles
2) slight reduction in cerebral cx thickness
3) reduced total brain volume
What are the 4 main brain DA pathways?
1) mesolimbic
- - VTA to NA, HP, Amygdala
2) mesocortical
- - VTA to FCx
3) nigrostriatal
- - SN to striatum
4) tuberoinfundibular
- - HT to AP
What is the role of the ML system in schizophrenia?
positive sxs; worsened by DA
What is the role of the MC system in schizophrenia?
negative sxs; mitigated by DA
What is the role of the NS system in schizophrenia?
posture and involuntary movement; worsened by DA
What is the role of the TI system in schizophrenia?
involved with ADRs
– DA decreases PRL release
Describe the DA hypothesis of schizophrenia.
1) ML system overactive
2) MC system underactive
- - disturbed, hyperactive dopaminergic system
- - hyperactivity of D2r
What is DA’s function in the CNS (effects)?
1) reward
2) pleasure
3) motor function (fine tuning)
4) compulsion
5) perserverance
What are the strengths of the DA hypothesis in schizophrenia?
- amphetamines increase DA to produce psychotic symptoms
- - antipsychotic drugs (block DA) reduce positive sxs
What are weaknesses of the DA hypothesis?
1) amphetamines only mimic positive sxs; FGAs only reduce positive sxs
2) D2r blockade is rapid, but clinical effects take weeks
3) studies show no change in DAr density
4) hallucinogens and anesthetics also cause dose-dependent psychotic sxs
What is serotonin’s function in the CNS (effects)?
1) mood
2) memory
3) processing
4) sleep
What are the strengths of the serotonin hypothesis?
5-HT2a agonists (LSD, psilocybin) cause hallucination like schizophrenia
What are the weaknesses of the serotonin hypothesis?
5-HT2a agonists typically ONLY associated with VISUAL hallucinations
What are the strengths of the Glutamate hypothesis?
1) decreased [Glu] in CSF
2) decreased [NMDAr]
3) decreased [presynaptic VGLUT]
4) noncompetitive NMDAr agonists (PCP, ketamine) cause positive/negative/cognitive sxs
- - exacerbation in schizophrenics
What are the strengths of the GABA hypothesis?
1) decreased [GABA] in CSF
2) decreased no. of GABA neurons
3) decreased expression of glutamic acid decarboxylase (necessary for GABA synthesis)
What are the weaknesses of the GABA hypothesis?
1) cause/effect relationship unclear
2) no supportive results from BZD studies
How is schizophrenia diagnosed?
2 or more sxs for 1+ mos during last 6 mos
– markedly decreased level of functioning
What is the prognosis for schizophrenic patients?
of the 45% who receive treatment:
1) 1/3 recover
2) 1/3 improve with relapses and residual disability
3) 1/3 remain incapacitated
What factors correlate with good prognosis?
1) late/sudden onset
2) married, female, no f/h
3) high IQ
4) positive sxs
5) compliance and good support
What factors correlate with poor prognosis?
1) young age of onset
2) unmarried, male, f/h
3) low IQ
4) negative sxs
What “therapies” are used for schizophrenia? (non-drug)
1) support groups, etc.
2) Assertive Community Treatment
3) Social Media and Smartphone apps
- - better socialize outside home
4) skills training
- - social interaction, independence
5) CBT
- - strategies for coping with sxs
What is ACT?
Assertive Community Treatment
- multidisciplinary team of providers for high-risk patients
- psychiatrist (MD), psychologist, psychiatric nurse, social worker, case manager
What are environmental factors that lead to schizophrenia?
prenatal -- prenatal virus exposure -- poor maternal nutrition perinatal -- poor perinatal nutrition -- perinatal hypoxia -- birth trauma -- advanced paternal age -- birth order adolescence -- stress, drug abuse, age, neurotrauma, psychotrauma
Describe the genetic causes of schizophrenia.
lots of small genetic defects scattered across genome
– genes are huge factor
What causes schizophrenia?
– critical genetic load
or,
– healthy patient w/ environmental factors
Describe incidence/relative prevalence of schizophrenia?
top 10 cause of disability in developed countries
- 0.6-2% of world
- highest in males early in life; females later
How much does suicide risk increase in a schizophrenic patient?
50x
What kind of hallucinations do schizophrenic patients experience?
auditory
visual
tactile
olfactory
