L5+6 - Schizophrenia & the Psychoses Flashcards
treatment for catatonia?
ECT
DSM-5 symptoms of schizophrenia?
The presence of two or more characteristic symptoms which must be present for a significant proportion of time during a one month period (or less if successfully treated). At least one of these must be 1,2 or 3 of:
Delusions Hallucinations
Disorganised speech (i.e. frequent derailment or incoherence)
Grossly disorganised or catatonic behaviour
Negative symptoms (i.e. diminished emotional expression or avolition)
What is the pattern of onset for schizophrenia
delusions and hallucinations are usually at first presentation, then moves onto negative symptoms - chronic disease state.
concordance for scz in twins?
50% - pretty high
indicates that psychologycal and enviro factors probably contribute 50%
Marijuana and SCZ?
There is a clear link….
drug nduced psychosis should dissipate as soon as drug is gone.
maybe someone with non-onset scz is more likely to smoke.
does psychosis indicate schizophrenia?
no.
many people report subclinical psychotic experiences but do not go onto get the diagnosis..
however, you need to have psychosis to get schizophrenia diagnosis.
What is the schizophrenia spectrum?
- demonstrates that some people who have subclinical, isolated psychotic symptoms will not go on to develop schizophrenia.
isolated symptoms –> prodromal symptoms –> schizophrenia
- The more sophisticated the person, the more sophisticated the delusion.
What is the hypothetical path from gene to behaviour?
genotype –> subtle molecular abnormality –> abnormal information processing as a biological endophenotype –> abnormal behaviour with complex functional interactions and emergent phenomena (symptom phenotype)
aka someone with the risk gene can have the underlying changed biological system, but ultimately, it is their personalty and coping skills and interactions with the environment that will determine whether psychiatric symptoms develop
What are some scz risk genes
COMT
FKBPS SNPs
AKTI SNPs
How much earlier is onset in men that women
3-5 years
usually related to some type of stressful event
Describe the course of schizophrenia
prodomal phase (subclinical phenomena) associated with a delusion –> psychosis –> remittance –> relapse –> deficits
15-20% make complete recovery
15% never recover
most patients will recover at least partially
Positive symptoms?
- Hallucinations
- Delusions
- Bizarre behaviours
- Thought disorder e.g. neologism, incoherence, loose associations
Negative symptoms?
- different to ‘affective symptoms’
- flattened affect - no stimulus elicits emotional response
- alogia - decrease in speech flow
- avolition
- anhedonia
- attention deficit
Dopamine hypothesis?
- hypothesises the the overactivity of one of three dopamine transmitter systems in the brain.
- Antipsychotics inhibit this system
- POSITIVE SYMPTOMS due to increased activity in mesolimbic DA pathway
- NEGATIVE SYMPTOMS due to decreased activity in the mesocortical pathway (impairment of reward pathway)
glutamate may be involved in both negative and positive symptoms, and cog impairments
- holinergic and GABA changes are important in cog changes
What did atypical antipsychotics do
serotonin
did not produce movement disorder
e.g. haloperidol
