Schizophrenia Flashcards
How is schizophrenia defined?
“split mind”- divergence between behavior and thought; chronic and debilitating, no clouding of conciousness
What is schizophrenia caused by?
gene/environment interaction
What is schizophrenia exacerbated by?
stress
What is meant by “downward drift” schizophrenia?
patient gradually loses social stature, income, relationships and support
How does the psychosis of schizophrenia present?
hallucinations, delusions, abnormalities in thought/organization
What is an illusion?
misperception of real external stimuli
What is a hallucination?
sensory perception not generated by external stimuli
What is an idea of reference?
false conviction that one is subject to attention by others
What is a delusion?
false beliefs not correctable by logic
What is a loss of ego boundaries?
not knowing where ones mind and body end and wheres others begins
What is Alogia?
lack of informative content in speech
What is echolalia?
repeating statements of others/associating words by their sounds
What is thought blocking?
halt in the train of thinking (usually because of hallucination)
What are neologisms?
inventing new words
What is circumstantiality?
unnecessary and voluminous details while answering a question but eventually arriving at an answer
What is tangentiality?
beginning response in a logical fashion but getting further away from the topic and never answering the question
What are loose associations?
illogically jumping from one subject to another
What are the diagnostic criteria for schizophrenia?
- 2 or more of: delusions, hallucinations, disorganized or catatonic behavior, negative symptoms or disorganized speech
- social/occupational dysfxn (lower than before onset)
- duration of atleast 6 months w/ 1 month of sx
- schizoaffective and mood disorder exclusion
What are the following symptoms described as, positive or negative? delusions, hallucinations, agitation, talkativeness, thought disorder
positive
What are the following symptoms described as, positive or negative? lack of motivation, social withdrawal, flattened affect, cognitive disturbances, poor grooming and speech
negative
Which type of symptoms respond well to both traditional and atypical antipsychotics?
positive
Which symptoms only sometimes respond to atypical antipsychotics?
negative
Who responds better to antipsychotic medication?
women
How is the prodromal period of disease characterized?
- avoidance of social activity
- quiet and passive
- interest in religion of philosophy
- physical complaints
- anxiety and depression
How is the psychotic period of disease characterized?
- loss of touch with reality
- positive symptoms
How is the residual period of disease characterized?
- between psychotic episodes
- in touch with reality but doesn’t behave normally
- negative symptoms
What are patients on antipsychotics at risk of producing and why?
tardive dyskinesia; because of cumulative days of D2 drug blockade
What types of changes occur structurally in the brain with schizophrenia?
- hypofrontality
- lateral and 3rd ventricle enlargement
- asymmetry
- decreased volume
- decreased alpha waves
Which 2 pathways are hypothesized to be associated with schizophrenia in the Dopamine Hypothesis?
- positive-excess dopamine in mesolimbic pathway
- negative- low dopamine in mesocortical pathway
Which neurotransmitter do the newer atypical antipsychotics target?
serotonin (decrease levels)
Which subtype of schizophrenia may have increased NE levels?
paranoid subtype
What is a leading hypothesis in the etiology of schizophrenia?
NMDA receptor hypoactivity
Explain the pathway behind the positive symptoms according to the glutamate hypothesis.
1) bad NMDA receptors
2) loss of inhibition from GABA interneurons
3) increased firing from VTA sending extra dopamine to the limbic system
4) psychosis
* *Mesolimbic pathway**
Explain the pathway behind the negative symptoms according to the glutamate hypothesis.
GLU-GABA-GLU-GABA-DA
faulty NMDA receptors ends with a loss of dopamine to the frontal lobe via the mesocortical pathway
What is the differential diagnosis for Schizophrenia?
- general medical conditions
- manic phase of bipolar
- substance induced
What is the time period of brief psychotic disorder?
1-29 days
What is the time period of schizophreniform disorder?
1-6 months
What is schizoaffective disorder?
schizophrenia+mania/depression
What is shared psychotic disorder?
one person is delusion and a 2nd person develops the same delusion
What do all of the effective antipsychotics target?
block D2 receptors in the mesolimbic dopamine path
Why is the compliance rate with antipsychotics low and what can be done about this?
- unpleasant side effects and poor patient insight
- Use long acting injectable depot
What types of psychotherapy can be helpful with schizophrenia patients?
CBT, family therapy, peer/mentor support
Which of the following are good prognostic indicators: female, younger onset, married, no social relationships, good employment hx, no presence of mood symptoms or positive symptoms, or few relapses
good-female, married, good employment hx and few relapses
bad-younger onset, no social relationships, no mood symptoms or positive symptoms
What are command hallucinations?
the patients hallucination tells them to do something (suicide, murder etc)
