NP: Lecture 7 Neuropsychiatry & Schizophrenia Flashcards
schizophrenia dsm 5 criteria
A. Two (or more) during 1-month, en at least one of the first 3:
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behaviour
5. Negative symptoms (e.g. reduced emotional expression / avolition)
B. Reduced functioning in one or more major areas
C. Continuous signs of disturbance for at least 6 months
D. Other diagnoses ruled out (e.g. depressive disorder)
E. Not due to effects of substance or other medical condition
F. If history of autism, then delusions/hallucinations must be present
schizophrenia spectrum and other psychotic disorders soorten
- Schizophrenia
- Delusional Disorder
- Brief Psychotic Disorder
- Schizophreniform Disorder
- Schizoaffective Disorder
- Substance/Medication-Induced Psychotic Disorder
- Psychotic Disorder Due to Another Medical Condition
Depression/bipolar disorder with psychotic features
hoeveel % maakt full recovery
25
hoeveel % recovers partially
50
hoeveel % requires long term care
25
hoeveel jaar eerder dood bij schizophrenia
10-15 jaar… sneu want mostly due to preventable physical conditions
wat is de psychosis spectrum
experience -> symptoms -> disorder
van links naar rechts steeds meer:
* increased conviction of experiences/ideas;
* increased frequency;
* increased distress.
wat is uhr
ultra high risk
uhr factoren voor schizophrenia development
childhood trauma
emotional abuse
physical neglect
high stress
traumatic brain injury?
family history of mental disease?
discrimination?
even goed kijken naar het staging model doc
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welke factoren kunnen leiden van uhr tot actual episode
childhood or adolescence low functioning
tabbacco use
male gender
single status
unemployment
affective comorbidities
physical inactivity
social deficits?
ethnic minority?
personality traits?
hoeveel mensen at uhr develop schizophrenia later
20%
3x purpose of biomarkers
- diagnosis
- prognosis
- treatment response: indication personalized medicine (stijn??)
research domain criteria =…
een attempt to remap clinical conditions from the bottom up: starting with genes -> molecules -> cells -> behaviour -> experience
Neuropsychiatry is concerned with the study of psychiatric illnesses or symptoms associated with brain abnormalities.
Psychosis is one condition in which such an interaction between psychology and biology is well-studied.
The DSM-5 is a useful diagnostic tool with clinical utility, but it does not fully describe a condition/disorder. Heterogeneity and overlap are the rule rather than exception. Initiatives such as RDoC might be better suited to capture the complex nature of psychopathology.
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dopamine hypothesis
wss too much dopamine kan leiden tot symptoms of schizophrenia, vooral de positive symptoms.
gebaseerd op de werking van antipsychotica: want antagonisten werken.
wat doet dopamine?
dopamine causes things in the environment to become more salient. -> they stand out more. therefore lets you focus on a restrictive range of things. therefore these things may stand out more:
- abberant sense of novelty
- abnormal assignment of salience to stimuli and internal representatives
model van dopamine hypothesis ongeveer
predispositions -> dysregulated firing and/or release of dopamine -> aberrant sense of novelty and abnormal assignment of salience to stimuli and internal representations -> delusions are a cognitive scheme that the patient develops to explain aberrant salience experience -> when this aberrant salience captures behaviour or causes distress -> leads to attention.
antipsychotics block dopamine, and dampen the salience of these symptoms (+ may also dampen the motivational salience of normal events) -> the decrease in salience leads to less symptoms via extinction and unlearning
limitations of the dopamine hypothesis
- Mainly related to positive symptoms (hallucinations, delusions, …)
- Not in all patients (treatment non-responders)
- Does not explain the efficacy of some medications (clozapine)
- Simplistic view of reality
what is the most abundant exitatory neurotransmitter
glutamate
N-methyl-D-aspartate (NMDA) receptor (glutamate receptor) antagonism can…
induce psychotic symptoms, including cognitive and negative symptoms (e.g., ketamine)
other lines of evidence for glutamate
- Glutamate genes involved in schizophrenia
- Neuroimaging studies
- Excessive glutamate might account for synaptic loss in schizophrenia (SIRS)
kijken naar glutamate hypothesis in docs
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waar leidt lowered glutamic transmission to?
negative symptoms (autism, inactivity)
promoting serotonin transmission
lowered GABA transmission
waar leidt lowered GABA transmission toe
promoting DA transmission
waar leidt promoting DA transmission toe
positive symptoms (delusion, hallucination)
The dopamine hypothesis of schizophrenia states that dopaminergic abnormalities (in particular, excessive striatal dopamine) underlie schizophrenia and other psychoses
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Dopamine alone cannot explain why individuals experience psychotic symptoms. We need to understand its relationship to other neurotransmitters (e.g., glutamate), and to other explanatory mechanisms (e.g., salience processing)
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wat gebeurt er met cognition in schizophrenia
Generalised cognitive impairment (not 1 specific domain and not specific to schizophrenia!)
- Speed of information processing
- Attention and vigilance
- Working memory
- Learning and memory
- Executive functions
- Social cognition
wat is er voor evidence for cognition in schizophrenia
Mixed evidence about relationship with positive symptoms + effects of medication
Associated with reduced social functioning (e.g., difficulties at work, social relationships)
wat is belangrijk bij cognition in schizophrenia
- Diagnosis
- Communication with patient/family
- Intervention
speed of information processing test
Symbol digit substitution test
attention and vigilance test
Continuous performance test (“press X, but only when preceded by A”)
working memory test
digit span (onthouden cijfers)
learning and memory test
rey complex figure test (natekenen van figuur)
executive functioning test
wisconsin card sorting test
voor hoeveel mensen werkt de treatment met antipsychotics
voor 70% (dus lang niet allemaal)
2 processes of social cognition
- lower order processes (= basic emotion perception)
- higher order processes (theory of mind, via false beliefs task, hinting task)
wat zijn verschillende soorten cognitive styles in schizophrenia
jumping to conclusions
source monitoring bias (niet goed bedenken wat de source van info was)
bias against disconfirmatory evidence
self-serving bias
cognition over a lifespan bij schizophrenia model details
cognitive, motor and social impairment -> anxiety and depression symptoms -> social withdrawal & subjective cognitive changes -> prodromal symptoms -> psychosis
kijken naar model cognition over the lifespan
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A range of cognitive impairments and maladaptive cognitive styles have been found in patients with schizophrenia
However, group findings do not always translate to the individual
A neuropsychologist can help map cognitive difficulties in patient
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early alarm for psychosis
when children are usually very social, but then suddenly are very socially withdrawn
autism spectrum disorder dsm 5
A. Persistent deficits in social communication and interaction
B. Restricted, repetitive behaviours, interests, or activities
C. Present in early developmental period
D. Significant impairment in functioning
E. Not better explained by other things
kijken naar model the diversity of autism
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autism history….
Initially used to refer to symptom of schizophrenia (withdrawal into own fantasy life)
Separated as clinical condition by Leo Kanner and Hans Asperger in 1940s
Still referred to as “childhood psychosis” until 1960s
In 1960s and 1970s: differences in age at onset and symptoms
Since then, “can occur, but be very careful!!”
symptoms overlapping tussen schizophrenia en autism
- Difficulties with language or speech
- Social withdrawal
- Flattened affect
- Rigid interests
schizophrenia dsm criteria
2 or more, at least one month:
delusions
hallucinations
disorganized speech
groslly disorganized or catatonic behaviour
negative symptoms
what is another difficulty for diagnosis
poorly validated measurement instruments
wat is nodig als er history of autism spectrum disorder is
the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations are also present for one month
Children with autistic traits / ASD are at an increased risk of psychotic experiences / psychotic disorder
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Prevalence psychosis in autististic adults is 9.4% (N=63.657)
Prevalence of bipolar disorder is 7.5% (N=31.739)
Individuals diagnosed with psychotic disorder display high levels of autistic traits
Similar symptoms/cognitive difficulties, different neurobiology (Martínez et al., 2019)
ASD+P poor response to antipsychotics (Downs et al., 2017)
No increase in dopamine (Schalbroeck et al., 2021
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Autism is a neurodevelopmental condition which is and has been defined in many ways. Core features appear to include social difficulties, repetitive/restricted behaviours, and sensory sensitivities.
Psychotic symptoms are common among autistic individuals, but the diagnosis and treatment of these symptoms can be complicated.
A transdiagnostic, multi-dimensional approach can help identify how autistic individuals with psychotic symptoms might best be helped.
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