March 30 - Schizophrenia Flashcards
What is neurosis?
An odd or unusual characteristic
What is psychosis?
A mental state or symptom where someone doesn’t need a psychiatry degree to know something’s wrong
What is schizophrenia?
A diagnosis of a complex and usually chronic illness
Describe the initial treatment of schizophrenia
The number one goal is to ensure safety (of the patient, and also the surrounding people if necessary).
Secondary goals include: reducing agitation, hostility, anxiety, tension and aggression, normalizing sleeping and eating patterns. Also convey empathy, caring
What are the major goals of therapy of schizophrenia?
Prevent harm
Bring thoughts and behavior under patient’s control
Restore contact with reality
Maximize functional recovery
Prevent relapse
Eliminating hallucinations and delusions may not be realistic or possible
Describe the pathophysiology of schizophrenia
A chronic, heterogenous, spectrum disorder, often severe and/or disabling
Characterized by imbalances in structure, neural transmission, neurotransmitters leading to disordered thoughts and behavior.
It is very challenging to treat (and diagnose)
Focus is upon functional status, short-term and long-term
It is not the same as “split or multiple personality” (note the difference between an odd characteristic, a disordered state, and a chronic condition)
What is characteristic of a patient with schizophrenia?
Persons with schizophrenia are often fearful, withdrawn, isolated and have gross impairment of capacity for relationships
Describe the etiology of schizophrenia
Genetic (approx 45% if both parents are positive, 5-10% if one parent is positive)
Biologic (relative dopamine imbalance)
Developmental (viral illness during second trimester)
Psychosocial (stress, socioeconomic status, etc.)
Pathophysiology (brain asymmetry, abnormal neuronal pruning)
Describe the clinical course of schizophrenia
Suicide risk is highest in the first 5 years, may be 15% lifelong
Chronic disorder with multiple (from 1 to 30) exacerbations and “recovery”
Wide range of functional status
Symptoms may change over time
What is required for diagnosis?
A deterioration of function
6 month duration of symptoms
Typically onset before 45 years old
Rule out: affective disorders, M.R., organic disorders, substances
Describe the functional impairment with schizophrenia?
It is the cornerstone of diagnosis and assessment of schizophrenia
It is often related primarily to prolonged impact of negative and cognitive symptoms
Degree of impairment correlates with time and severity of poorly-controlled symptoms
The first five years after diagnosis is critical
Can we cure schizophrenia?
No, not right now. We can take steps to try and improve the imbalance and what they are coping with
How do we confirm the diagnosis?
Part of it is time (if someone presents in a really psychotic state, then 2 days later they are fine, it’s more likely substance abuse). We can also do scans to rule out an organic cause (tumor, something hormonal, etc.)
How does blocking dopamine receptors affect the brain?
In the nigrostriatal area, it causes movement disorders
In the mesolimbic area, it causes psychosis relief
In the mesocortical area, it causes psychosis relief and restlessness
In the tuberoinfundibular area, it causes an increase in prolactin
In the frontotemporal area, it causes cognitive impairment
Why is dopamine important?
It is the first target of antipsychotic drugs (first generation antipsychotics)
What type of neurotransmitter is dopamine?
Dopamine is mostly an excitatory neurotransmitter. In someone having a psychotic outbreak of schizophrenia, the patient has too much dopamine
What other neurotransmitter systems does dopamine “interface”?
Serotonin, GABA and norepinephrine
Why are we sure that dopamine is not the complete answer?
Because some people don’t respond well to dopamine blockers. And for many we can take the edge off with acute exacerbation with dopamine blockers, but it doesn’t help long term
What are the two symptom clusters of schizophrenia?
Positive symptoms: elements of personality or character that are there that shouldn’t be
Negative symptoms: something’s missing that should be there
What are many common positive symptoms schizophrenia?
Hallucinations, delusions, ideas of reference, illusions, agitation, anxiety, hostility, restlessness, bizarre actions/statements, distractible/tangential, paranoia, loose associations, suicidal
Describe hallucinations
A common symptom of schizophrenia
Patient may experience in one or more senses - auditory, visual, tactile, olfactory
“Voices” - most common, may be multiple and varied in nature
May be present only in exacerbations or may persist in some form chronically
Describe delusions
False, often fixed beliefs which persist despite “proof” of falseness or illogic
May be paranoid, bizarre, grandoise
Response to even favourable treatment may be minimal or poor
Describe thought disorders
Disorganized, illogical
Garbled speech (trying to get words out faster than the mouth can physically handle)
Thought blocking or “removal”
Made up words (neologisms)
What are many common negative symptoms of schizophrenia
Immobile facial expression, monotonous voice, lack of pleasure in everyday life, diminished ability to initiate and sustain planned activity, speaking infrequently, and with minimal and simplistic content, anhedonia, poor insight and judgement, poor hygiene, apathetic, amotivated, withdrawn, socially isolated, concrete (take things very literally), impaired concentration, suicidal
