Psychotic Disorders

Question 1

What is schizophrenia?

Answer 1

Bio and psych based disorder of heterogenous presentation (varies b/n patients) that is usually chronic, relapsing/remitting

Question 2

Pos Schizo Symptoms (4)

Answer 2

• Disturbances in perception - hallucinations (no external stimuli) and illusions (misinterpret external stimuli)
  
  • Auditory hallucinations most common
  • “Efferent copy hypothesis” - cannot tell difference b/n internal and external speech
• Delusions - false, fixed beliefs not consistent w/ cultural norms
  
  • Misplaced salience hypo
• Disorganized Thought - word salad or loose associations; no logic
  
  • Likely lose track of ideas while generating speech; cognitive dysfunction
• Behavior - catatonia, echolalia, echopraxia, mutism, etc

Question 3

Negative Schizo Symptoms (4)

Answer 3

• Amotivation - loose drive
• Alogia - poverty of speech
• Affective Blunting - no or inappropriate emotional expression
• Asociality - withdraw from others

Question 4

Cognitive Schizo Symptoms

Answer 4

• Problems w/ executive functions (planning, sequencing, selective attention, formation, working memory)
• **Most linked to prognosis

Question 5

Schizophrenia Dx

Answer 5

• At least 2 of the following for 1+ mo ea… (1 must be positive symptom - first 3)
  
  • Delusions
  • Hallucinations
  • Disorganized speech
  • Disorganized or catatonic behavior
  • Negative symptoms
• Must cause social or occupational dysfunction
• Overall must last > 6 mo
• R/o schizoaffective disorder and mood disorder w/ psychotic features
• R/o other medical or substance abuse issues

Question 6

Schizophrenia Etiology/Pathology

Answer 6

• Genetics
  
  • 45% in MZ twins
  • Mult genes
• Environment = in utero infection, urban environment, migration (moving multiple times too)
  
  • Can be precipitated by stress or adolescent weed use
• Pathology
  
  • Dec brain volume but same # neurons so more tightly packed, smaller neuron size and lower spine density
    
    • Esp gray matter in frontal and temporal regions
  • Enlarged ventricles
• Overall… dec in excitatory synapses and spines or pyramidal cells —> early cognitive impairment and then onset of psychosis
  
  • Can be due to deficit in spinogenesis early on (in utero and early in development) OR excessive spine pruning later in life (adolescence)

Question 7

What characteristics generally lead to better schizophrenia prognosis?

Answer 7

acute onset and short duration, female, no brain abnormalities, low negative or cognitive symptoms, no substance use, good pre-morbid functioning

Question 8

Schizo Epidemiology

Answer 8

• .5-1% population

- Males > females and males tend to present at earlier age of onset (15-25 rather than 20-35)