Lecture 9: Schizophrenia Spectrum

Question 1

Pre-natal exposure to what during the 1st trimester appears to increase the risk of developing schizophrenia by 7-fold?

Answer 1

Influenza virus

Question 2

What does the “revised dopamine hypothesis” for schizophrenia propose?

Answer 2

• Hyperactive dopamine transmission in mesolimbic areas
• Hypoactive dopamine transmission in prefrontal cortex

Question 3

Where in the brain is the dopamine system particularly overactive in schizophrenic pt’s?

Answer 3

Hippocampus

Question 4

What 5 “negative” sx’s define psychotic disorders?

Answer 4

• Diminshed emotional expression
• Avolition: decrease in motivation to initiate and perform activities
• Alogia: lack of speech
• Anhedonia: inability to feel pleasure
• Asociality

Question 5

Which types of hallucinations are the most common in Schizophrenia?

Answer 5

Auditory

Question 6

What is catatonic behavior?

Answer 6

Marked decrease in reactivity to the enviornment

Question 7

Which sx’s account for most of the morbidity assoc. w/ schizophrenia?

Answer 7

Negative sx’s

Question 8

Which 2 negative sx’s are particularly prominent in Schizophrenia?

Answer 8

• Diminished emotional expression
• Avolition: decrease in motivated self-initiated purposeful activities

Question 9

What is the diagnostic criteria for Schizophrenia?

Answer 9

• ≥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

Question 10

How long must there be contnuous signs of disturbance for dx of Schizophrenia?

Answer 10

≥6 months; must include at least 1 month of sx’s from criterion A

Question 11

The catatonic type of Schizophrenia has a clinical picture dominated by at least 2 of which 5 sx’s?

Answer 11

• 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

Question 12

What is the single leading cause of death in pt’s with Schizophrenia?

Answer 12

• SUICIDE!
• Usually near illness onset

Question 13

How is a patient with schizophrenia + acute psychosis managed?

Answer 13

• Hospitilization is needed for patient safety and to get pt stabilized
• IM injections: Haloperidol, Fluphenazine, Lorazepam

Question 14

Which second-gen antipsychotic used for tx of Schizophrenia is more commonly associated with QTc prolongation?

Answer 14

Ziprasidone

Question 15

Which drug class can be used for catatonic disorder of Schizophrenia?

Answer 15

Benzodiazepines

Question 16

What is criteria for Delusional Disorder?

Answer 16

• Presence of 1+ delusions with duration of 1 month
• Functioning is NOT impaired and behavior is not obviously bizarre or odd

Question 17

What is the diagnostic criteria for Brief Psychotic Disorder?

Answer 17

• 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

Question 18

What is the diagnostic criteria for Schizophrenifrom Disorder?

Answer 18

• 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

Question 19

What is the diagnostic criteria for Schizoaffective Disorder?

Answer 19

• 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)

Question 20

There must be the presence of one or both of which 2 sx’s for diagnosis of substance/medication-induced psychotic disorder?

Answer 20

• Delusions
• Hallucinations

Question 21

What is the timeline for Schizophrenia vs. Schizophreniform vs. Brief Psychotic Disorder?

Answer 21

• Schizophrenia: >6 months
• Schizophreniform: 1-6 months
• Brief psychotic disorder: <1 month