psychosis I and II Flashcards
where is the dysregulation in schizophrenia?
mesocorticolimbic circuit
what are the 5 symptom clusters in SCZ?
1) positive
2) negative
3) cognitive
4) organizational
5) mood
severity of individual clusters is largely independent
two types of perceptual distortions
- hallucinations
- illusions
types of hallucinations
- visual
- gustatory
- olfactory
- tactile
- auditory
what is an illusion?
something mistaken for something else, like a curtain as a ghost
two types of delusional symptoms
- delusions
- ideas of reference (stimuli refer to me)
types of delusions
Erotomanic: celebrity is my lover
Grandiose: I am messiah, prince
Jealous: partner having others in all night
Persecutory: men following me, plan to kill
Somatic: feet mechanical, device implanted
Nihilistic: world coming to an end
Bizarre: electronic circuit in brain controlled by president to manipulate political events
diagnostic criteria for SCZ
- 2 of 5 active symptoms for one month and one must be from 1-3:
1. Delusions- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative sxs
- significant dysfunction at home or work
- longer than 6 months since onset
what is the exclusion criteria for schizoaffective and mood disorders?
brief or no mood episodes
examples of negative symptoms of SCZ
Social indifference
Lack of motivation
Emotional constriction
Self-neglect
cognitive symptoms of SCZ
Impaired memory, concentration Difficulty filtering Motor planning Executive function Sorting tasks Problem solving Impaired insight Disorientation
what is schizophreniform disorder? what are the criteria?
- criteria A, D, E of SCZ are met
A) two are more symptoms out of five
D) no schizoaffective or mood disorder
E) no substance abuse disorder
big difference from SCZ is that there is no evidence of significant social dysfunction
diagnostic criteria for brief psychotic disorder
1) one of the following:
Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior
2) 1 day to 1 month duration
3) not better explained by other disorder
schizoaffective disorder criteria
1) MDD, manic, or mixed episodes
2) criterion A of SCZ met
3) delusions or hallucinations for 2+ weeks without mood symptoms
4) mood symptoms are present the majority of the time
delusional disorder criteria
1) delusions lasting at least a month
2) SCZ A not met
3) no mood disorder or substance abuse disorder
schizotypal disorder
1) 5/9: Ideas of reference Odd beliefs that influence behavior Unusual perceptual experience Odd thinking and speech Suspiciousness or paranoia Inappropriate or constricted affect Behavior or appearance odd or peculiar Lack of close friends Excessive social anxiety 2) not entirely during psychosis/autism
attenuated psychosis syndrome
1) one of 1-3 in SCZ A met
2) at least once a week for a month
3) criteria for psychotic disorder never met
percent population with SCZ
about 1%
onset of schizophrenia
teens to 20s, rare after 45
gender differences in SCZ
women have:
1) later onset
2) better response to treatment
3) estrogen has neuroprotective effects
course of SCZ
- prodrome - could be many years
- first epidose - highly treatable
- active phase - 3-4 decades
- residual phase - third remit, third attenuate
suicide rates in SCZ
- 20-40% attempt
- 10% succeed
- typically in first decade
violence in SCZ most associated with
- command hallucinations
- persecutory delusions
what med reduces violence and suicide risk the best in SCZ?
clozapine
amount of decreased life expectancy in SCZ
10-30 years
percent of SCZ with substance disorder
- lifetime 50%
- current diagnosis 25%
complications of substance abuse in SCZ
Earlier onset of Schizophrenia Higher relapse, hospitalization rates Treatment non-compliance Poorer medication response Increased risk for violence Increased risk for HIV, hepatitis Greater brain volume loss over 5 yrs
smoking in SCZ
70-90%
anatomical signs of SCZ
- enlarged ventricles
- reduced dendritic spines
functional brain abnormalities in SCZ
- Diffuse cerebral dysfunction, particularly prefrontal + medial temporal
- fMRI deficits in PFC and hippocampus during specific tasks
neurochemical brain abnormalities in SCZ
- DA hyperactivity in mesolimbic tract
- DA hypoactivity in mesocortical
- Glutamate NMDA
- Serotonin, GABA, norepinephrine, ACh
dopamine hypothesis of SCZ
leading hypothesis
dopamine deficiency in mesocorticolimbic pathways
- mesolimbic pathway from VTA to ventral striatum, limbic system, olfactory tubercle
- mesocortical pathway from VTA to frontal cortex
explain neurodegeneration in SCZ
- related to NMDA/glutamate which serve to regulate neuronal apoptosis
- dysregulation can lead to increased apoptosis
- NMDA antagonists can replicate schizophrenic symptoms
five types of treatment for SCZ
- Antipsychotic medications
- Psychotherapy
CBT, metacognitive - Clinical case management
Assertive Community Tx - Psychosocial rehabilitation
Cognitive remediation, supported employment - Peer support
antipsychotic meds
- first generation (FGA): D2 antagonists
chlorpromazine, haloperidol - second generation (SGA): D2 and 5-HT antagonists
clozapine, aripiprazole
