Psych - Schizophrenia Flashcards
Schizophrenia facts
1% of population is affected
Ranks 9th in global disease burden
30% of patients will attempt suicide at some point in their lives and 8-10% WILL DIE FROM SUICIDE
Peak diagnosis in late adolescence and early 20s, continues for a lifetime
Difference between BPD and Schizophrenia?
In BPD, there can be psychosis but only in episodes of severe mania. The main symptoms are MOOD.
In Schizophrenia, the PSYCHOSIS IS CONSTANT; there is also a continuous downward and worsening trend.
Positive and Negative Symptoms
Positive Symptoms –> DELUSIONS, HALLUCINATIONS, DISORGANIZED SPEECH, GROSSLY DISORGANIZED or CATATONIC BEHAVIOR
Negative Symptoms –> BLUNTED AFFECT, ALOGIA (reduced speech), AVOLITION (lack of motivation), ANHEDONIA (lack of pleasure), ATTENTION DEFICIT
the negative symptoms are non-specific and thus may be hard to differentiate from other illnesses
Delusions
Major disturbance in the content of a person’s thoughts or just plain false beliefs; range from plausible but unlikely to completely messed up
Severity is graded on:
CONVICTION (how much patient believes it)
INFLUENCE on BEHAVIOR
PRODUCTIVITY (delusions getting more elaborate?)
Most frequently paranoid/persecutory, grandiose (only I can change the world! Only I can fix this!), or religious
THOUGHT BROADCASTING – idea that everybody can hear your thoughts
THOUGHT WITHDRAWAL – idea that people can come into your head and steal your thoughts
Hallucinations
False perceptions
Can be of sensory modality, but are most commonly AUDITORY
To the patent, they feel exactly as any other perception they have. Even the right parts of the brain light up as they normally should if somebody was indeed speaking to them
COMMAND HALLUCINATIONS – severe and dangerous potentially; patient hears a voice telling them they have to do something, such as hurting themselves or somebody else
Disorganized Speech
Exactly how it sounds – disordered thoughts coming out through their words; can be RAPID and TANGENTIAL; patient may jump from topic to topic; talking a lot, but there is little content in their speech! May, in extreme cases, make up new words!!!
Net effect is that they struggle to communicate with others, leading to social isolation and dysfunction
Disorganized or Catatonic Behavior
Another highly debilitating symptom
Severe form = WAXY FLEXIBILITY, where the patient literally stays in one position until somebody moves them; this is RARE
Milder forms include excessive or purposeless immobility, mannerisms, or posturing; inability to complete simple tasks
Blunted Affect
Negative symptom – don’t get emotionally excited about anything
Alogia
Negative symptom - reduced speech; typically respond with only “yes” or “no” without elaborating on the topic at all; these patients are hard to interview (no open ended questions)
Avolition and Anhedonia
Negative symptoms - Lack of motivation (avolition) and lack of pleasure (anhedonia)
These are common symptoms of MDD too, so be careful
Schizophrenics seem to have a more permanent state of unhappiness – haven’t had fun or experienced pleasure in several years, before diagnosis
Concordance Rates of Schizophrenia
General Pop = 1% One parent = 5-6% One sibling = 10% One parent and one sibling = 17% Two parents = 48%
DZ Twins = 15%
MZ Twins = 30-89% –> means there must be some environmental factors at play!
Susceptibility gene may be the COMT Enzyme!
Endophenotypes
Used in determining genetic associations
A group of behavioral symptoms that occur together in a disease, and have a clear genetic connection. An appropriate endophenotype is associated with the illness, is heritable, is stable in the disease, and is found in NON-AFFECTED FAMILY MEMBERS AT A HIGHER RATE THAN THE POPULATION!
Eye tracking has been implicated
Environmental Factors
Social classes are ALL EQUALLY LIKELY TO DEVELOP SCHIZOPHRENIA, but those with the disease do tend to drift into poverty
Obstetrical complications
Seasons (winter and spring!!!!)
Maternal infections, maternal starvation
MARIJUANA – In certain people it can be a factor; COMT genes predispose –> there are polymorphisms (Val or Met) for this gene. IF THE PERSON HAS 2 COPIES OF VALINE and has EXPOSURE TO MARIJUANA, there is an INCREASED RISK OF SCHIZOPHRENIA
Heterozygous or 2 Met copies have NO INCREASED RISK
Outcome/Course of Schizophrenia
Lifelong illness that usually begins in the late teenage years
Only 13% of patients are considered recovered after 5 ears of treatment
Dx can be DEVASTATING because we have to be treated for life
The disease is episodic and waxes/wanes throughout life (positive symptoms)
Once a patient recovers from a psychotic episode, they may feel like they no longer need treatment or meds, but meds are essential for PREVENTING more episodes!
Compliances is a huge issue
Dopaminergic Theory
States that schizophrenia is caused by an imbalance in dopamine pathways and signaling in the brain
The limbic system has OVERACTIVE DA PATHWAYS, which generates the positive symptoms, while the cortex has HYPOACTIVE DA NEURONS causing the NEGATIVE symptoms
