Schizophrenia Flashcards
Schizophrenia and psychotic disorders have been largely studied since…
the middle of the 19th century
schizophrenia used to be called?
Early dementia
what are the types of schizophrenia
- Paranoid Type
- Disorganized Type
- Catatonic Type
- Undifferentiated Type
- Residual Type
2 other disorders related to schizophrenia are?
1) Schizophreniform Disorder
2) Schizoaffective Disorder
• Delusional Disorder
• Brief Psychotic Disorder
• Shared Psychotic Disorder
DSM-5 Criteria for Schizophrenia?
→ At least 2 of the following during a 1 month period (one must be 1,2,or 3)
1) Delusions
2) Hallucinations
3) Disorganized Speech
4) Disorganized/catatonic behaviour
5) Negative symptoms
6) avolition –difficulty of making decisions
7) Anhedonia – loss of interest
what symptom makes schizophrenia different from most mental disorders?
→ No personal distress
Signs of disturbance persist for at least __ months including __ month of symptoms from the list
6, 1
is suicide a symptom of schizophrenia?
NO it’s a side effect
Disorder in _____/_____ of thought
form/content
Describe the disorders in the form of thought
o Loosening of associations (word salad)
o Poverty of speech content (say very little)
oVagueness, abstraction of speech (vague ideas)
o Neologisms (made up words), clanging (playing with sounds),perseveration (repeating words or phrases)
Describe the disorders in the content of thought
implausible Delusions
o Of persecution (something is out to get you), reference (general things directed at you personally)
o Thought Manipulation
o External control – individual believes his behaviour is being controlled by someone else
What are the 3 types of thought manipulation
1) Thought insertion (implanted by some other force)
2) Thought withdrawal (Your thoughts are being stolen)
3) Thought Broadcast (Your thoughts can be heard by others around you)
what types of hallucinations are present in schizophrenia
all senses including:
- Auditory( Criticizing voices of people around you, repeating one’s thoughts, or comanding them to act), visual, tactile (less frequent), Somatic (snakes in abdomen, stabbed by knife)
what are some motor symptoms of schizophrenia?
- Psychomotor behavior (catatonia - subcategory):
- Disturbances of psychomotor behavior
- Stupor ‘cerea flexibilitas’ – waxy flexibility
- Catatonic Excitement – can’t stop moving
what are some symptoms of schizophrenia associated with personality and identity?
• Flat or inappropriate affect
• Disturbance to sense of self:
• Unclear sense of identity, outside control
-Avolition: Loss of interest, will, ambivalence
-Impaired interpersonal functioning:
• Social withdrawal, emotional detachment
What are is the frequency of some symptoms associated with schizophrenia?
• Lack of insight – 94% • Blunted affect – 82% • Asociality – 79% • Delusion – 73% • Autism – 72% (self absorption) • Apathy – 60% (lack of caring) • Thought derailment-58% - suspiciousness - 51
List some positive symptoms of schizophrenia
(Not good – they are additions): o Disturbance, excess of normal function -Hallucinations -Delusions → Drugs are better at solving these problems
List some negative symptoms of schizophrenia
(Subtractions, reductions): o Diminution, loss of normal function -Alogia: Poverty of speech -Flat affect -Anhedonia – asociality -Avolition
What are the 5 typical courses of schizophrenia and the % of cases that follow each course?
- One episode, full remission: 25%
- Episodic, partial remission: 25%
- Episodic with full remission: 20%
- Episodic, becoming chronic : 15%
- Chronic deterioration: 15%
what is the point prevalence of schizophrenia?
50-70/10,000 – less than 1%
What is the lifetime prevalence?
1.5 – 2%
What is the age of onset?
o Usually diagnosed 10-35
o Average = 20s
What is the male to female ratio?
1.5 : 1 (same all around the world)
what are some brain structure abnormalities associated with schizophrenia?
1) Enlargement of cerebral Ventricles
2) Reduced brain asymmetry
3) Smaller frontal lobes
4) Cell loss in Hippocampus, limbic system, periventricular areas
What % of patients have ventricle enlargement, and what is it associated with?
6-60% (older patients) • Poor premorbid functioning • Age and/or chronicity • Negative symptoms • Cognitive impairment • Poor response to treatment • History of birth complications • Lack of familial psychiatric history – not passed on
what does reduced brain asymmetry mean?
functions are more spread out
o more ambidexterity and sinistrality
what do smaller frontal lobes suggest?
prenatal, preinatal injury
What are some abnormalities of brain activity associated with schizophrenia?
- Hypofrontality
- Abnormal EEG (specifically in left hemisphere)
- Abnormal ERP
What is hypofrontality in schizophrenia?
lower levels in the front, higher levels in the back (normally reversed)
– visual and auditory regions
Why were the EEGs of schizophrenics abnormal?
o lower activity in frontal, higher activity in posterior
o More variability in left temporal lobes
o More delta waves in frontal lobe
What was abnormal about schizophrenics ERP results?
P300 wave:
o Lower in schizophrenia
o No change with predictions or incentives for speed accuracy
What evidence supports viral agents as the cause for schizophrenia
o 15% more births in winter months
o Higher in cities, where infection risk high
• Maternal Viral infection→ CNS abnormality in children
• Elevated antibodies against common viruses
what is the dopamine hypothesis of schizophrenia
• Hyperactivity of Dopamine
what evidence supports the dopamine hypothesis?
- (phenothiazines) blocks dopamine receptors and is effective in mania
• Dopamine antagonists reduce symptoms
• Dopamine agonists produce symptoms
_______ overdose mimics paranoid schizophrenia
o Amphetamine
what are some problems with the dopamine hypothesis?
o amphetamines weren’t found to worsen symptoms - 46% of patients were unchanged, 28% improved
• MAOIs don’t worsen schizophrenic symptoms
o 71% no change, 26% of patients improved
- failed to find an excess of dopamine metabolites in the cerebrospinal fluid of patients with schizophrenia.
List characteristics of type 1 schizophrenia
caused by excess dopaminergic activity o Positive symptoms predominate o Usually acute, good prognosis o No structural brain damage o Neuroleptics effective in treatment
List characteristics of type 2 schizophrenia
caused by Neuron Loss
o Negative symptoms predominate
o Intellectual impairment
o Poor prognosis
What is the percentage of concordance for monozygotic twins?
Around 50% (no more than 60%)
what is the risk % for people with different relations to schizophrenic patients
2 parent=46% 1 parent,1 sib = 17% 1 parent = 12% 1 sib = 10% 1 child = 6% grandparent= 4% Uncle/nephew = 3%
Recent interest in _______ rather than single nucleotide polymorphisms (SNPs)
Copy Number Variations (CNV)
list 5 types of treatments for schizophrenia
- Antipsychotic medication
- Electroconvulsive Therapy (ECT)
- Individual Psychotherapy
- Group Psychotherapy
- Family Therapy
what is Tardive dyskinesia caused by antipsychotic medication
Repetitive, involuntary movements, shuffling back and forth, rolling hands, lip/mouth movements.
ECT is used primarily in
catatonia, where depression involved, and for those not responding to antipsychotics
individual psychotherapy in effective in
Helping chronic cases (Type II) develop coping strategies
what does Group Psychotherapy provide?
o Provides social support
o Help developing social skills
What does family therapy focus on?
o more emotional families
o Helps prevent relapse
observations suggest a polygenic mode of inheritance for the diathesis of schizophrenia.
- the risk of schizophrenia is higher for individuals with more than one affected relative.
- the symptoms vary along a dimension of severity, suggesting variation in the number of genes possessed.
- schizophrenia persists in the population despite the low reproductive rate of individuals with schizophrenia.
- the concordance rate is higher for probands with severe chronic schizophrenia rather than milder forms.
Have researchers identified candidate genes or chromosomal areas?
BOTH
when and by whom was the term schizophrenia first named
in the early 20th century by Eugen Bleuler.
