schizophrenia Flashcards
lifetime prevalence, age of onset, and gender ratio for schizophrenia
- lifetime: 0.5-1% worldwide
- equal gender ratio
- age onset: early 20s (20-29)
3 categories of schizophrenia symptoms general
- positive
- negative
- cognitive
positive symptoms of schizophrenia
- hallucination: perception with no stimulus
- delusions: fixed false beliefs that aren’t common in person’s culture and aren’t amenable to change even with conflicting info
- disorganized thinking: loose associations, tangentiality, words salad, circumstantiality
- disorganized behaviour: odd inappropriate behaviour, catatonia
negative symptoms of schizophrenia
- blunted affect: reduced emotional experience and expression
- anhedonia: lack of interest pleasure
- alogia: poor speech
- avolition: lack of motivation or ability to do tasks that have an end goal
- asociality: social withdrawl
cognitive symptoms of schizophrenia
- social processing (theory of mind)
- attention (ignoring distractor, sustaining attention)
- working memory (mental math)
- processing speed
if you are at clinical high risk, you have a ___% chance of developing schizophrenia with in 2 years
30-40%
features at the baseline test of a study that contributed to prediction of psychosis
- history of substance abuse
- recent deterioration in functioning
- higher levels of suspicion/paranoia
- higher levels of unusual thought content
- genetic risk of schizophrenia
- greater social impairment
cannabis and psychosis
- statistically significant
- ppl at greater risk of schizophrenia are more likely to be heavy cannabis users especially under 18y/o
- if you have the determining factors (genetic vulnerability, early initiation, disrupted neurodevelopment process, symptoms), with ongoing use it can lead to a poor outcome but if you stop use it can lead to good outcome
too much glutamates are linked to
- anxiety,
- depression
- diabetes
- leaky gut
- neuro damage
- headaches
- atrial fibrillation
endocannabinoids
- cannabinoid receptors on the GABA and glutamate cells (CB1/2 receptors)
- system plays role in regulating inhibitory GABA and exhibitory glutamate activity underlying neurogenesis
- high concentration of CB1 receptors in hippocampus helps to regulate memory acquisition, consolidation and retrieval
exogenous cannabinoids
- THC
- binds to cannabinoid receptors and inhibits release of GABA and glutamate within the hippocampus
- long term use (especially w adolescents) can cause: down regulation of cannabinoid receptors and inhibition of synaptic changes that are needed for forming and consolidating memories
environmental risks of developing schizophrenia
- prenatal: glucocorticoid release interfering with fetal neuro dev, prenatal paternal stress, fetal hypoxia, mother cannabis/nic use, viral infection, preeclampsia
- proximal: stressors (triggers symptoms in vulnerable people), chronic stress (family, financial), acute stress, childhood trauma, high expressed emotion hostility, criticism, over involvement)
____% of ppl with schizophrenia had severe life stressors 3 months prior to onset
~50%
ethnic disparities in schizophrenia
- higher rates and poorer long term outcomes
- prescription drugs use, specially 2nd gen anti psychotics, are lower in Black/Hispanic patients
- Black/hispanic patients less likely to get treatment than white patients
- due to social biases and institutional and interpersonal racism (clinician bias, unequal access to healthcare, lack of healthcare professionals in underserved areas, language barriers)
treatment phases for schizophrenia
- acute: reduces symptoms severity
- stabilization: consolidates treatment gains
- maintenance: reduce residual symptoms, prevent relapse, and improve functioning
Modern Anti psychotic meds
- atypical antipsychotics (ex aripiprazole, clozapine, olanzapine, paliperidone, quetiapine, resperidone, ziprasidone)
- blocks: weak dopamine (D2) and potent serotonin (5-HT2) receptors
- not helpful in preventing onset
- produce fewer nerve side effects so its preferred
- adherence has lower relapse than non adherence
what is more effective for treatment of positive and negative symptoms of schizophrenia: atypical or typical antipsychotic drugs
they both perform the same for positive and negative symptoms
side effects of atypical anti psychotic meds for schizophrenia
- anticholinergic effects: blurred vision, dry mouth, confusion, constipation, urinary retention
- adrenergic effects: orthostatic hypotension, light headed
- metabolic symptoms: substantial weight gain, onset/worsened diabetes, lipid abnormalities
cannabis use and medication adherence for schizophrenia
- weed increases risk of being more likely to not take meds which increases the risk of relapse
adjunctive psychopathy options
- family psychoeducation therapy (reduces relapse/rehospitalization by 50%)
- assertive community training (multidisciplinary team helps reintegration onto community)
- social skills training (group setting)
- CBT (coping strategies for dealing w/ delusions
- Cognitive remediation (practice tasks that need attention, short term memory, and executive function)
CBTp
- CBT but for psychosis
- reduces emotional stress through altering cognition and behaviours
- develops cognitive model around psychosis
- focus on reducing stress (not reducing symptoms)
- normalizes the psychotic experience
- eliminates biases and misconceptions
- collaborates to form the ‘explanatory model’
explanatory model for CBTp
- identifies triggers of psychotic symptoms, beliefs abt symptoms and associated behaviours and consequences of beliefs
- attempts to understand how this can worsen symptoms
Cognitive model of schizophrenia
trigger (ex fight with mom)>
psychotic symptom (hear voices saying water is poison)>
belief about symptom (mom doesn’t care that i drink poison)
>behaviour (isolate self)> or >consequence (fear)
