Lecture 9: Schizophrenia Spectrum Flashcards
Pre-natal exposure to what during the 1st trimester appears to increase the risk of developing schizophrenia by 7-fold?
Influenza virus
What does the “revised dopamine hypothesis” for schizophrenia propose?
- Hyperactive dopamine transmission in mesolimbic areas
- Hypoactive dopamine transmission in prefrontal cortex
Where in the brain is the dopamine system particularly overactive in schizophrenic pt’s?
Hippocampus
What 5 “negative” sx’s define psychotic disorders?
- Diminshed emotional expression
- Avolition: decrease in motivation to initiate and perform activities
- Alogia: lack of speech
- Anhedonia: inability to feel pleasure
- Asociality
Which types of hallucinations are the most common in Schizophrenia?
Auditory
What is catatonic behavior?
Marked decrease in reactivity to the enviornment
Which sx’s account for most of the morbidity assoc. w/ schizophrenia?
Negative sx’s
Which 2 negative sx’s are particularly prominent in Schizophrenia?
- Diminished emotional expression
- Avolition: decrease in motivated self-initiated purposeful activities
What is the diagnostic criteria for Schizophrenia?
- ≥2 of the following for most of 1 month; at least 1 of the first 3 sx’s
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative sx’s
How long must there be contnuous signs of disturbance for dx of Schizophrenia?
≥6 months; must include at least 1 month of sx’s from criterion A
The catatonic type of Schizophrenia has a clinical picture dominated by at least 2 of which 5 sx’s?
- Motoric immobility as evidenced by catalepsy or stupor
- Excessive motor activity (apparently purposeless and not influenced by external stimuli)
- Extreme negatism or mutism
- Peculiarities of voluntary movement such as posturing, stereotyped movements, prominent mannerisms or prominent grimacing
- Echolalia or echopraxia
What is the single leading cause of death in pt’s with Schizophrenia?
- SUICIDE!
- Usually near illness onset
How is a patient with schizophrenia + acute psychosis managed?
- Hospitilization is needed for patient safety and to get pt stabilized
- IM injections: Haloperidol, Fluphenazine, Lorazepam
Which second-gen antipsychotic used for tx of Schizophrenia is more commonly associated with QTc prolongation?
Ziprasidone
Which drug class can be used for catatonic disorder of Schizophrenia?
Benzodiazepines
What is criteria for Delusional Disorder?
- Presence of 1+ delusions with duration of 1 month
- Functioning is NOT impaired and behavior is not obviously bizarre or odd
What is the diagnostic criteria for Brief Psychotic Disorder?
- Presence of 1+ of the following sx’s. At least one being the first 3.
- Delusions, Hallucinations, Disorganized speech, Grossly disorganized or catatonic behavior
- Duration of an episode is at least 1 day but <1 month
What is the diagnostic criteria for Schizophrenifrom Disorder?
- Two (or more) of the following, each presnt for a significant portion of time during a 1-month period. At least one must be the first 3 sx’s:
- Delusions, Hallucinations, Disorganized Speech, Grossly disorganized or catatonic behavior, Negative sx’s
- Episode must last at least 1 month but <6 months
What is the diagnostic criteria for Schizoaffective Disorder?
- An uninterrupted period of illness during which there is a major mood disorder (major depressive or manic) concurrent with criterion A of schizophrenia
- Delusions or hallucinations for ≥2 weeks in absence of major mood episode (depressive or manic)
There must be the presence of one or both of which 2 sx’s for diagnosis of substance/medication-induced psychotic disorder?
- Delusions
- Hallucinations
What is the timeline for Schizophrenia vs. Schizophreniform vs. Brief Psychotic Disorder?
- Schizophrenia: >6 months
- Schizophreniform: 1-6 months
- Brief psychotic disorder: <1 month
