Schizophrenia Flashcards
Positive symptoms
Behaviours and thoughts that are not normally present
Such as: delusions, hallucinations and disorganized speech
Characterized by abnormal salience processing
Negative symptoms
Behaviours and thoughts that normally should be present, but aren’t
Such as: affective flattening, social withdrawal, anhedonia, and diminis
Related to abnormalities in reward processing and social cognition
Prodromal phase
The onset of the illness, before the manifestation of the first psychotic episode
Consists of a decline in cognitive and social functioning, which generally begins in the early adolescent years and precedes the onset of psychotic symptoms by >10 years
Life expectancy of those with schizophrenia
Reduced by 20 years compared with the general population
Mortality studies
Explain the ratio and contributors
Mortality ratio = 2.6
Suicide was the main contributor for early in the course of the illness and cardiovascular disease the main contributor in later years
Risk factors
Prenatal and perinatal events, and parent characteristics
- Complications of pregnancy
- Abnormal fetal growth
- Complications of delivery
- Being born in late winter and spring (which might be due to a greater likelihood of the fetal brain being exposed to maternal respiratory infections or maternal malnutrition)
- Paternal age: possibly because of an association between late fatherhood and schizotypal personality as a predominant driver of this effect, rather than a reduced sperm quality
Risk factors
Environment and drug use
- Urban environment: disadvantaged areas of inner cities and being born and raised exclusively in large cities
- Migration status
- Lack of social support (based on ethnicity)
- Increased exposure of discrimination
- Drug abuse: cocaine, meth, amphetamine, cannabis*
- Childhood adversities, intrusive life events
*1 The risk is greater in those who start cannabis use in early adolescence than in those whos tart use later in life and in those using high-potency varieties of cannabis
Alterations in neurotransmitters
GABA (inhibitory), glutamate (excitatory), and dopamine
Abnormal GABAergic function has been the most consistent observation
Brain volumes in schizophrenia patients
- Reductions in total grey and white matter
- Reductions in whole-brain volume*
- Ventricular volume is increased
- Changes in cortical thickness, gyrifcation and subcortical shapes
- Progression of volume decreases
*1 The reductions in brain volume are more pronounced in patients with a poorer outcome
Examples of altered cognitive processes
Impaired executive function: working memory, task switching, flexibility, planning
Episodic memory
All antipsychotics act by
blocking receptors of the dopamine pathway
Parkinsonism is worse for which generation antipsychotics?
First
Weight gain and diabetes is worse for which generation antipsychotics?
Second
Which statement is true:
I. Antipsychotics have the biggest effect on negative symptoms
II. The target age for detecting clinically high-risk cases is between 12 and 35 years
Only statement II is true.
For statement I: antipsychotics have almost no effect on the negative or cognitive symptoms of schizophrenia
Remission
Only mild positive nad negative symptoms for at least 6 months
Negative outcome predictors
- Male sex
- Younger age at psychotic onset
- Poor response to medication
- Comorbidity
- Poor adherence to meds
- Longer duration of non-first psychotic illness
- Multi-episode patients
Augmentation strategies
These strategies involve the adiditon of other agents to antipsychotics.
Limited evidence
Negative factors for lower Qol
- Stigma
- Poor physical health
- Adverse side effects of medication
- A predominantly acute care model of treatment
- Persistent lower mood
- Treatment resistance
Stages of schizophrenia
- Risk
- Prodrome
- Acute psychosis
- Chronic psychosis
Which statement is true:
I. Medication is used in patients in the prodromal stage
II. Symptoms of schizophrenia should last 3 months or longer before a diagnosis is made, according to the DSM-5
Both statements are false. Medication is NOT used in patients in the prodromal stage, and symptoms of schizophrenia have to last 6 months or longer before a diagnosis can be made of schizophrenia.
