Schizophrenia Flashcards
Define illusions
disorder of perception: misperception of real external stimuli
Define hallucinations
disorder of perception: sensory perceptions not generated by external stimuli (auditory hallucinations are most common)
Define Ideas of reference
disorder of thought content: false conviction that one is the subject of attn by other ppl or the media
define delusions
disorder of thought content: false beliefs not correctable by logic or reason, not based on simple ignorance, and not shared by a culture or subculture; delusions of persecution are most common.
Define loss of ego boundaries
disorder of thought processes: not knowing where one’s mind and body and those of others begin (e.g. a pt feels she is “merged” into others)
Define impaired abstraction ability
disorder of thought processes: difficulty in discerning the essential qualities of objects or relationships despite normal intelligence (e.g. when asked what brought him to the hospital, a pt says “bus”)
define magical thinking
disorder of thought processes: the idea that thoughts cause or prevent external events from happening
define alogia
disorder of form of though: lack of informative content typically seen in normal speech/”poverty of speech”
define echolalia
disorder of form of thought: associating words by their sounds, not by their logical meanings
define loose assoications
disorder of form of thought: loss of logical meaning btw words or thoughts (eg. pt talking about parents then about world hunger)
define neologisms
disorder of form of thought: inventing new words
define perserveration
disorder of form of thought: repeating the same word or phrase over and over
define tangentiality
disorder of form of thought: beginning a response in a logical fashion but then getting further and further from the point
define thought blocking
disorder of form of thought: abrupt halt in the train of thinking, often because of hallucinations
define word salad
disorder of form of thought: uttering unrelated combinations of words or phrases
What is psychotic disorder caused by a general medical condition (PDMC)?
medical illnesses that cause psychotic symptoms are referred to as PDMC. Examples of PDMCs are MS, Parkinson’s disease, Huntington’s disease, neoplasms, neurologic infections, temporal lobe epilepsy, cerebrovascular disease. Endocrine disturbances like thyroid disease, Cushing’s, Addison’s, SLE. Metabolic disorders, vitamin deficiencies.
How to differentiate btw schizophrenia and psychotic disorder caused by a general medical condition (PDMC) (e.g Huntington’s, Parkinson’s)?
Schizophrenia itself is characterized by psychotic symptoms occurring concurrently with CLEAR CONSCIOUSNESS, the diagnosis of PDMC can be made only in the absence of delirium or dementia.
Psychosis in schizophrenia vs psychosis brought on by medications -how are they different?
schizophrenia –> flat affect
meds –> preservation of affect
What’s considered firstline therapy for schizophrenia?
atypical anti-psychotics aka second generation anti-psychotics (e.g. clozapine, riseridone, aripiprazole) because they cause fewer negative neurological effects (e.g. parkinsonism, tardive dyskinesia)
Not super high yield: but what are the 5 DSM-IV-TR subtypes of schizophrenia
1) undifferentiated (characteristic of more than 1 subtype)
2) paranoid
3) residual (no current frank psychotic symptoms but h/o of at least one previous psychotic episodes)
4) disorganized (hebephrenic)
5) catatonic
T/F: more than 50% of ppl with schizophrenia attempt suicide.
True
-often due to postpsychotic depression or when experiencing “command” hallucinations ordering them to harm themselves
List 8 factors that lead to better prognosis in schizophrenic patients
- are older at onset of illness
- are married
- have social relationships
- are female
- have good employment histories
- have mood symptoms
- have positive symptoms
- have experienced relatively few relapses
List the 3 characteristics and the prognosis of schizophrenia
- psychotic and residual symptoms lasting at least 6 months
- normal consciousness and memory function
- auditory hallucinations predominate
lifelong social and occupational impairment
List the 3 characteristics of psychotic disorder caused by a general medical condition (PDMC)
- hallucinations that are visual and changeable rather than auditory and recurrent
- occurs in context of an acute medical illness
- symptoms not due to delirium or dementia
psychotic symptoms remit when medical condition improves
List the 2 characteristics of brief psychotic disorder
- psychotic and residual symptoms lasting more than 1 day but less than 1 month
- obvious precipitating psychosocial factors
50-80% recover completely
List the 2 characteristics of schizophreniform disorder
- psychotic and residual symptoms lasting 1-6 months
- obvious precipitating psychosocial factors
33% recover completely
List the 4 characteristics of schizoaffective disorder
- fit criteria for both a mood disorder and schizophrenia
- psychotic symptoms present for at least 2 week without mood symptoms
- mood symptoms during the psychotic and residual phases
- chronic social and occupational impairment
lifelong social and occupational impairment but less severe than in schizophrenia
List the 2 characteristics of delusional disorder
- fixed, nonbizarre delusional system present for at least 1 month
- absence of other thought disorders
50% recover completely, many have relatively normal social and occupational functioning
List a characteristic of shared psychotic disorder (folie a deux)
development of a delusion in a person in a close relationship with someone with delusional disorder
List a characteristic of manic phase of bipolar disorder
- psychotic symptoms, elated mood, rapid onset, hyperactivity, rapid speech, and increased sociability.
- delusions of grandeur
List 2 characteristics of schizoid personality disorder
- voluntary social withdrawal
- no evidence of a thought disorder
lifelong
List 3 characteristics of schizotypal personality disorder
- negative symptoms
- bizarre behavior and odd thought patterns
- no frank hallucinations or delusions
lifelong
List 2 characteristics of borderline personality disorder
- extreme mood swings with uncontrollable anger and episodic suicidal thoughts
- transient episodes of paranoia and/or dissociation
lifelong
When patient presents with psychotic symptoms, what should be examined next before coming up with possible conditions?
if there are mood symptoms and if they are residual or not
yes –> bipolar, depressive disorder, schizoaffective disorder
no –> delusional disorder, brief psychotic disorder, schizophreniform disorder, schizophrenia
List 5 psychotic disorders that have similar symptoms to schizophrenia but do not include all required for diagnosis
- brief psychotic disorder
- schizophreniform disorder
- schizoaffective disorder
- delusional (psychotic) disorder
- shared psychotic disorder
Unlike schizophrenia that affects younger people, delusion disorder commonly starts in middle age and patients are usually socially and occupationally functional. Delusional disorder has 3 subtypes. List them.
1) Erotomanic type: conviction that a famous person is in love with the patient
2) Jealous type: belief that one’s partner is having romantic or sexual relations with someone else
3) Persecutary type: belief that someone is trying to harm the patient.
Explain downward drift of schizophrenia
the average patient loses social stature, income, relationships, support network
define circumstantiality
in responding to questions, one presents unnecessary and voluminous details ultimately arriving at an answer to the question
List some positive symptoms of of schizophrenia
are additional symptoms to expected behavior; gaining symptoms
- delusions
- hallucinations
- agitation
- talkativeness
- thought disorder
List some negative symptoms of schizophrenia
are missing from expected behavior
- lack of motivation
- social withdrawal
- flattened affect/emotion
- cognitive disturbances
- poor grooming
- poor/impoverished speech
DSM-5 requires how many symptoms to be present for diagnosis of schizophrenia
at least 2 of the specified symptoms
What are the three phases of schizophrenia?
-Prodromal: prior to first psychotic break
avoidance of social activities
quiet and passive or irritable
sudden interest in religion or philosophy
may have physical complaints
anxiety and depression
-Psychotic/Active: loss of touch with reality; Positive symptoms
hallucinations
delucions
-Residual: period btw psychotic episodes, in touch with reality, but doesn’t behave normally; Negative symptoms
peculiar thinking
eccentric behavior
withdrawal from social interactions
Schizophrenia affects men and women equally, but onset is different. Explain
age of onset in men: 15-25 years
age of onset in women: 25-35 years
women also respond better to antipsychotic meds
what’s the relationship btw amt of days on anti-psychotics and tardive dyskinesia?
cumulative days of anti-psychotics (D2 receptor blockers) can lead to permanent movement disorder -tardive dyskinesia
In schizophrenia, do you have increase or decrease use of glucose?
decrease use of glucose in the prefrontal cortex –> hypofrontality
In schizophrenia, what happens to the ventricles?
lateral and third ventricles are enlarged
In schizophrenia, what happens to the asymmetry of the cerebrum?
It is abnormally symmetric
In schizophrenia, what happens to the volume/density of hippocampus, amygdala, and parahippocampal gyrus?
decreased volume of hippocampus, amygdala, and parahippocampal gyrus
What are some changes that are seen on EEG with someone in schizophrenia?
- decreased alpha waves
- increased theta and delta waves
- epileptiform activity
Are there abnormalities in eye movements in someone with schizophrenia?
Yes (poor saccadic smooth visual pursuit)
What NT abnormalities account for the positive and negative symptoms found in schizophrenia?
positive symptoms –> due to increase dopamine in mesolimbic tract
negative symptoms –> due to decrease dopamine in mesocortical tract
Elevated levels of which metabolite of DA in bodily fluids of pts with schizophrenia suggests more DA activity and use in CNS.
homovanillic acid
T/F: There is a link btw serotonin hyperactivity and schizophrenia but little is known about it.
True
T/F: NE hyperactivity may be involved in schizophrenia
True
State the dopamine hypothesis
- excessive dopaminergic activity in mesolimbic tract
- hypoactivity of mesocortical dopamine tract/pathway
What’s the glutamate hypothesis? Antagonists and agonists of NMDA subtype of of glutamate receptors have what effects on schizophrenia?
- glutamate is the major excitatory NT in the CNS
- antagonists of NMDA subtype of glutamate receptors aggravate and create psychosis
- agonists of NMDA receptors experimentally relieve symptoms
Part of the glutamate hypothesis is the NMDA receptor (NMDAR) hypoactivity hypothesis.
some NMDAR sit on GABA interneurons positioned between a cortical glutamate pyramidal neuron and its secondary neuron. A loss of inhibition occurs in the secondary glutamate allows excessive firing and an increase in firing in the ventral tegmental area which sends extra DA into the limbic system thus causing psychosis.
so mutation in NMDAR or antagonism of it –> loss of inhibition of dopamine release –> increase dopamine –> psychosis
Explain normal functioning of GLU-GABA-GLU-DA
glutamate works on GABA interneuron, GABA once activated will inhibit glutamate release, which will inhibit dopamine release
**this GLU-GABA-GLU-DA helps maintain balance of dopamine
Explain what is wrong with the GLU-GABA-GLU-DA circuit in explaining positive symptoms in mesolimbic circuit.
1st glutamate doesn’t bind NMDA receptors –> nonfunctional so does not excite GABA interneuron–> loss of inhibition of second glutamate which excites VTA to make excess dopamine –> positive symptoms of schizophrenia
*deficient GABA and hypofunctional NMDA receptors
Explain normal circuitry of GLU-GABA-GLU-GABA-DA
Glutamate is excitatory to GABA–> inhibits 2nd glutamate –> no GABA –> no inhibition of dopamine (a lot of dopamine)
How does the GLU-GABA-GLU-GABA-DA contribute to negative symptoms in mesocortical pathway?
second glutamate receptor is over-active (“hot”)–> increase GABA –> decrease dopamine –> negative symptoms in mesocortical pathway.
atypical antipsychotics block D2 receptors as well as 5-HT2a. What does 5HT2a blockade lead to?
allows dopamine to more freely flow in the nigrostriatal pathway
Someone with schizophrenia often stabilizes in midlife with positive or negative symptoms predominating?
negative symptoms predominating
