Lec 80 Schizophrenia Flashcards
What are the positive symptoms of schizophrenia?
hallucinations
delusions
disorganized speech
disorganized behavior
What are negative symptoms of schizophrenia?
- alogia [lack of speech or speech content]
- affective blunting [impaired emotional expression + feeling]
- avolition [lack of energy/drive]
- anhedonia
What are cognitive symptoms of schizophrenia?
impairements in:
- memory
- attention, verbal fluency
What is diagnostic criteria for schizophrenia?
- 2 or more of the following:
- – delusions,
- – hallucinations
- – disorganized speech
- – disorganize or catatonic behavior
- – negative symptoms [flat affect, social withdrawal, lack of motivation/speech/through]
- social occupation/dysfunction
- duration > 6 mos
What differentiates brief psychotic disorder vs schisophreniform disorder vs schizophrenia?
brief psychotic disorder = < 1 mo –> usually stress related
schizophreniform disorder = 1-6
schizophrenia = > 6 mo
What is schizoaffective disorder?
schizophrenia + mood disorder
at least 2 wks of stable mood with psychotic symptoms PLUS major depressive, manic, or mixed episode
2 types = bipolar or depressive
How do you differentiate schizophrenia from schizoaffective disorder and depressive or bipolar disorder with psychotic features?
schizophrenia has:
- no major depressive or manic episodes concurrently with active-phase symptoms
- if mood episodes occurred during active symptoms –> present for a minority of total duration of active and residual periods of the illness
What is lifetime prevalence of schizophrenia?
- 5%
- males = females; blacks = whites
- presents earlier in men [late teens - 20s]; later in women [late 20s - 30s]
How does delusional disorder differ from schizophrenia?
non-bizarre delusions in delusional disorder
What is premorbid state of schizophrenia?
- time before prodrome/onset begins
- affected individuals have good functioning but may have subtle cognitive problems [missed development milestone, reduced IQ, etc]
What is prodrome phase of schizophrenia?
- period during which individuals have social withdrawal and decline in function, inappropriate affect, work-school impairment, strange ideation, deterioration in hygiene
- lasts mos - yrs
What is active/progressive phase of schizophrenia?
psychotic symptoms appear
have exacerbations and remissions
have progression/decline in functioning
What is chronic/ residual phase of schizophrenia?
absent/attenuated positive symptoms but continued negative symptoms
cognitive impairment
acute exacerbations
What is risk of suicide in schizophrenia?
20-50% of pts have suicidal ideation or attempt
higher in males and comorbid depression/alc use
What medical co=morbidities with schizophrenia?
- 20% reduction in lifespan
- increase suicide/accidents
- increased alcohol, substance abuse, smoking
- excess CV mortality [sedentary life style, obesity, metabolic syndrome]
What are environmental risk factors of schizophrenia?
- prenatal infection
- Ob complication
- birth in winter, in urban
- head injury
- drug use –> esp frequent cannabis use in teens
What is prognosis of schizophrenia?
40% have remission or with mild residual symptoms
2030% institutionalization, hospitalization
suicide: 1/3 attempt
What happens to DA in schizophrenia
- high DA activity in schizophrenic induces psychosis
- drugs that treat psychosis are D2 receptor blockers
What happens to glutamate in schizophrenia?
- low glutamate in schizophrenia
- NMDA blockers + PCP block glutamate –> cause psychosis
- modulation of glycine modulatory site on NMDA receptor may improve some cognitive symptoms of schizophrenia
What happens to GABA in schizophrenia?
decreases GABA interneurons in PFC and temporal cortex
What changes in NT in schizophrenia?
- increase DA activity
- decreased glutamate
- decreased GABA
What is neuro-developmental hypothesis of schizophrenia?
disruption of early brain development due to genetic predisposition + environmental stress before brain matures
What structural brain abnormalities?
- enlarged lateral ventricles
- atrophy of PFC, MTL, thalamus
- decreased whole brain volume
- decreased grey matter
- decreased superior temporal gyri
- atrophy of hipoocampus = disorganized, disarray of pyramidal cells
- decreased neural density in PFC
What functional brain abnormalities?
hypofrontality = decrease PFC function
What happens to oligodendrocytes in schizophrenia?
reduced OLGs –> irregular myelin structure
less myelination
What is the largest risk factor for development of schizophrenia?
positive family history –> complex genetics
What macroscopic and microscopic changes in brain in schizophrenia?
macro: enlarged ventricles, temporal lobe abnormalities
micro: hippocampal changes, increased cortical cell density
