Lectures 2 & 3-Schizophrenia Flashcards
What is schitzophrenia? Are there genetic, social, or stress components? Does it get better?
Schizo-phrenia =“Split mind-” irrational divergence between behavior and thought content
Chronic, debilitating illness associated with deterioration in mental function and behavior
Clearly involves a gene by environment interaction
Not caused by any known social or environmental factor
Exacerbated by social stress
Schizophrenia does not get better, the term “Downward drift” represents the social loses that occur with progression of disease.
Describe and define the main symptom of Schizophrenia?
Psychosis
Psychosis consists of hallucinations, delusions, and abnormalities in thought process/organization
Define the term Illusion (symptom of psychosis)
Misperception of real external stimuli
Define the term Hallucination (symptom of psychosis)
Sensory perceptions not generated by external stimuli
Define the term Idea of reference (symptom of psychosis)
False conviction that one is subject of attention by other people (Crowds, TV, Radio, Internet). Feeling as though people are referring to you in their conversations…
Define the term Delusion (symptom of psychosis)
False beliefs not correctable by logic or reason, not based on simple ignorance, and not shared by culture; delusions of persecution most common
Define the term Loss of ego boundaries (symptom of psychosis)
Not knowing where one’s mind and body end and those of others begin
Define the term Alogia (symptom of psychosis)
Lack of informative content in speech, lacking/poverty of speech
ex. “Patient is mute or speaks few words.”
Define the term Echolalia (Clanging) (symptom of psychosis)
Repeating Statements of Others/Associating words by their sounds, not by their meaning
ex. “I’m very sure I’ve got the cure and I’m not pure.”
Define the term thought blocking (symptom of psychosis)
Abrupt halt in the train of thinking, often because of hallucinations
Ex. I have to take my……….
Define the term Neologisms (symptom of psychosis)
Inventing new words
Ex. Patient states he is ‘fatigloo’ which means he is tired
Define the term Circumstantiality (symptom of psychosis)
In responding to questions, one presents unnecessary and voluminous details ultimately arriving at an answer to the question posed
Define the term Tangentiality (symptom of psychosis)
Beginning a response in a logical fashion but then getting further and further away from the point and fail to answer the question initially posed (can understand topic transition)
Define the term Loose associations (symptom of psychosis)
Loss of logical meaning between words or thoughts; when asked a question, illogically jumps from one subject to another
In contrast to delirium or substance abuse, patients with schizophrenia do not have clouding of ______.
Attention and memory capacity typically ______, when not psychotic.
Schizophrenics are alert and oriented, do _____ fluctuate in/out of consciousness/stupor
consciousness; intact; not
In schizophrenia, you have ____ or more of the following symptoms for a significant portion of time during a 1-month period (or less if successfully treated):
Delusions
Hallucinations
Grossly disorganized or catatonic behavior
Negative symptoms (flat affect, alogia, or avolition)
Disorganized speech (frequent derailment or incoherence)
2
For diagnosing schizophrenia, ____ or more major areas of functioning (ie. work, interpersonal relations, or self care) are markedly below level achieved prior to onset.
one
For diagnosing schizophrenia, continuous signs of the disturbance persist for at least ___ months. This ___-month period must include at least ___ month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active phase symptoms) and may include periods of prodromal (symptomatic of the onset) or residual symptoms.
6; 6; 1
In schyzophrenia positive symptoms are ____ to us and negative symptoms are ______ from us.
added; subtracted
List some positive symptoms. Do positive symptoms respond better to typical or atypical antipsychotics?
Delusions
Hallucinations
Agitation
Talkativeness
Thought Disorder
Positive symptoms Respond well to most traditional and atypical antipsychotic agents
List some negative symptoms. Do negative symptoms respond better to typical or atypical antipsychotics?
Lack of motivation
Social withdrawal
Flattened affect/emotion
Cognitive disturbances
Poor grooming
Poor/impoverished speech
Negative symptoms Respond better to atypical than to traditional antipsychotic agents
What are the 3 phases of schizophrenia?
- Prodromal: prior to first psychotic break
- Psychotic/Active: loss of touch with reality-positive symptoms
- Residual: period between psychotic episodes, in touch with reality, but doesn’t behave normally-
Negative symptoms
Schizophrenia occurs ____ in men and women, but age of onset is lower in ____
equally; mens
The greater the number of days on D2 receptor antagonists, the greater the risk of what disease?
TD-Tardive Dyskinesia
______ infection and exposure to _____ during development have been implicated in the etiology of schizophrenia
Viral; drugs
What are the 3 main neurological abnormalities in Schyzophrenia?
Abnormalities of the frontal lobes: Decreased use of glucose in prefrontal cortex = hypofrontality
Lateral and third ventricle enlargement
Abnormal cerebral symmetry (loss of asymmetry)
Asymmetry is normal
What is the dopamine hypothesis of Schyzophrenia?
excessive dopaminergic (DA) activity in mesolimbic tract.
In Schyzophrenia (& othe diseases) psychosis comes from too much DA in the ______ system (middle), and not enough in the ______ lobes.
In Schyzophrenia there is excess dopaminergic activity via excessive # of DA _____, excessive _____ of dopamine or ______ of receptors to DA.
mesolimbic; frontal; receptors; concentration; hypersensitivity
Positive symptoms in schizophrenia come from _____ DA & negative symptoms come from _____ DA.
high; low
What is the Glutamate hypothesis of Schizophrenia?
The NMDA (excitatory) Glutamate receptors (NMDARs) are hypoactive and fire to little in Schizophrenia. NMDARs may sit on GABA (inhibitory) interneurons that spit our inhibitory GABA at high quantities, if NMDA receptor is defective this leads to decreased GABA and elevated DA.
If someone gets a virus and makes antibodies vs the ______ receptor that sit on GABA, and destroy ______ receptors, they get Schizophrenia.
NMDA; NMDA
Describe how you get positive symptoms in Schyzophrenia.
GLUGABAGLUDA:
is the normal circuit and DA output is low. When the GLU NMDA receptor on the GABA interneuron is damaged, there is increased GLU & thus increased DA.
where GLU = +, GABA = -, & DA gives positive symtoms of schyzophrenia
Describe how you get negative symptoms in Schyzophrenia.
GLUGABAGLU-GABA-DA:
The first GABA interneuron is inactive so mad GLU hits the GABA receptor in the midbrain. The hyperactive GABA receptor then acts on the ventral tegmental area and releases a LOW amount of DA to the forebrain. Usually, a HIGH amount of DA hits the forebrain. Negative symtoms = loss of affect.
where GLU = +, GABA = -, & DA gives positive symtoms of schyzophrenia
______ pathway = negative symptoms
Positive symtoms = _____ pathway
Mesocortical; mesolymbic
Psychotic disorder caused by a general _____ condition: B12/Folate deficiency, temporal lobe epilepsy, cortico-steroid induced, can give symtoms simmilar to Schyzophrenia.
medical
Manic phase of _____ disorder can give symtoms simmilar to Schyzophrenia.
bipolar
_______-induced psychotic disorder: Cocaine, crystal meth, ritalin/adderall(stimulants, ketamine, PCP, LSD, bath salts can give symtoms simmilar to Schyzophrenia.
Substance
_____ psychotic disorder (1-29 days of schizophrenia symptoms) can give symtoms simmilar to Schyzophrenia.
Brief
Schizophreniform disorder __-___ months of symptoms) can give symtoms simmilar to Schyzophrenia.
1 - 6
______ disorder (schizophrenia + mania and/or depression) can give symtoms simmilar to Schyzophrenia.
Schizoaffective
It has psychotic + mood symptoms
_____ disorder (delusions, but no other schizophrenia symptoms) can give symtoms simmilar to Schyzophrenia.
Delusional
______ psychotic disorder (one person is delusional and a second person develops same delusion) can give symtoms simmilar to Schyzophrenia (Charles Manson’s family).
Shared
_____ generation antipsychotics side effects = weight gain (used first to avoid neuromuscular issues)
_____ generation antipsychotics side effects = neuromuscular issues (give to fat people)
Second; First
Since compliance rate of Schyzophrenia drugs are low due to side effects, long acting injectable _____ forms of antipsychotic meds are used for noncompliant patients who do not take their pills. Name the ____ drugs.
depot; depot
Haloperidol decanoate, fluphenazine decanoate, (typical)
Risperidone, Paliperidone, and aripiprazole (atypical)
All effective antipsychotics block _____ receptors in the mesolimbic DA path & is often a ____ long treatment
D2; life
Traditional high- and low-potency (D2 receptor affinity) typical first generation antipsychotics (Prior to 1995) ____ (high potency), _____ (low potency), respectively
High potency/affinity drugs are _____ at binding and sticking to D2 receptors and may cause _____ side effects in the nigrostriatal and tuberoinfundibular pathway (see above)
haloperidol; chlorpromazine; better; more
Atypical ____ generation antipsychotics also block _____ receptors (after 1995): Clozapine, risperidone, paliperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, asenapine, iloperidone, lurasidone
They are first line agents due to fewer negative neurological effects such as parkinsonism or tardive dyskinesia because the _____ blockade allows dopamine to more freely flow in the nigrostriatal path
second; 5HT2a; 5HT2a
There is a lot of post-psychotic ______ and suicides in Schyzophrenia (there are “______” hallucinations that tell you to kill yourself).
depression; command
A 24-year-old male presents with auditory hallucinations. He says he hears 3 distinct voices. He perceives voices coming from the television when it is turned off. He states this started 7 months ago. He feels that his family is plotting against him and he is being spied on. What is the most likely diagnosis ?
A. Brief psychotic disorder
B. Schizophreniform disorder
C. Schizophrenia
C. Schizophrenia
Since greater than 6 months
A 57 year old male has had schizophrenia with continuous symptoms for 30 years despite treatment. Which brain morphometric finding is most likely increased in size?
A. Ventricles
B. Hippocampus
C. Cortical Gray Matter
A. Ventricles
