Schizophrenia Flashcards

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1
Q

Define the hallmark symptom of schizophrenia and how it may present as.

A

Psychosis: An impairment of reality testing. This may present as alterations in sensory perceptions, thought content, or thought process/organization.

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2
Q

“Misperception of real external stimuli.”

A

Illusion

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3
Q

“Sensory perception not generated by external stimuli.”

A

Hallucination

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4
Q

“False conviction that one is the subject of attention by other people, or feeling as though people are referring to you in their conversations.”

A

Ideas of reference

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5
Q

“False beliefs not correctable by logic or reason, and not based on simple ignorance, not shared by culture.” What’s the most common type of this?

A

Delusion – Delusion of persecution

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6
Q

“Not knowing where one’s mind and body end and those of others begin.”

A

Loss of ego boundaries

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7
Q

“Lack of informative content in speech, lacking/poverty of speech.”

A

Alogia

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8
Q

“Repeating statements of others/Associating words by their sounds, not by their meanings.”

A

Echolalia (“Clanging”)

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9
Q

“In responding to questions, one presents unnecessary and voluminous details in ultimately arriving at an answer to the question posed.”

A

Circumstantiality

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10
Q

“Beginning a response in a logical fashion, but then getting further and further away from the point and fail to answer the question initially posed.”

A

Tangentiality

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11
Q

“Loss of logical meaning between words or thoughts; when asked a question, illogically jumps from one subject to another.”

A

Loose associations

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12
Q

“Abrupt halt in the train of thinking (often because of hallucinations).”

A

Thought blocking

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13
Q

“The idea that thoughts cause or prevent external events from happening.”

A

Magical thinking

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14
Q

“Difficulty in discerning the essential qualities of objects or relationships despite normal intelligence.”

A

Impaired abstraction ability

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15
Q

“Inventing new words.”

A

Neologisms

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16
Q

“Repeating the same word or phrase over and over.”

A

Perseveration

17
Q

“Uttering unrelated combinations of words or phrases.”

A

Word salad

18
Q

What is the diagnostic criteria for schizophrenia?

A

A. Characteristic symptoms of a psychotic episode: 2 or more (delusions, hallucinations, grossly disorganized or catatonic behavior, negative symptoms, disorganized speech) for 1-month (“active phase”). B. Social/occupational dysfunction. C. Continuous signs of disturbance for 6+ months, incl. the 1 month of active symptoms. Prodromal/residual symptoms may occur. D + E. Not due to another illness or substance/general medical condition.

19
Q

What are the key positive symptoms? What are the key negative symptoms?

A

+ delusions, hallucinations, agitation, talkativeness, thought disorder. - lack of motivation, social withdrawal, flattened affect/emotion, cognitive disturbances, poor grooming, poor/impoverished speech.

20
Q

Course of schizophrenia?

A

Prodromal –> Psychotic/Active –> Residual (period between psychotic episodes)

21
Q

Neurobiological abnormalities seen in schizophrenia?

A

Hypofrontality, Lateral & Third ventricle enlargement, Abnormal cerebral symmetry (loss of asymmetry), Decreased volume of hippocampus, amygdala, parahippocampul gyrus

22
Q

Describe the DA hypothesis. What pathways are involved, and what symptoms result?

A

Excessive dopaminergic activity in the mesolimbic pathway results in positive symptoms, while decreased dopaminergic activity in the mesocortical pathway results in negative symptoms.

23
Q

Are 5HT & NE implicated in schizophrenia?

A

Probably hyperactive.

24
Q

What is the glutamate hypothesis? What is normal in the mesolimbic pathway? What is normal in the mesocortical pathway? How are these affected in the hypothesis?

A

The glutamate hypothesis is rooted in the idea of a hypoactive NMDA receptor. If sitting on GABA (inhibitory) interneurons that are stimulated by GLU (stimulatory) via NMDA, an ineffective NMDA impairs GABA transmission. In the mesolimibic pathway: GLU-GABA-GLU-DA…Increased DA due to pathological NMDAR. In the mesocortical pathway: GLU-GABA-GLU-GABA-DA…Decreased DA due to pathological NMDAR.

25
Q

What are other psychotic disorders that look like schizophrenia, but differ in duration or characteristic symptoms?

A

Brief psychotic disorder (1-29 days), Schizophreniform (1-6 mo), Schizoaffective (Schizophrenia + Mania &/or Depression), Delusional disorder (Delusions, but no other schizophrenia symptoms), Shared psychotic disoreder

26
Q

Don’t confuse schizophrenia with…

A

Manic phase of bipolar, substance-induced psychotic disorder (cocaine, crystal meth, ritalin/adderall/other stims, ketamine, PCP, LSD, bath salts), other psychotic disorder caused by general medical conditions

27
Q

All effective antipsychotics do what? How is the treatment classified? Why?

A

Block D2 receptors in the mesolimbic DA pathway. High & low-potency typicals versus atypicals. High-potency typicals bind better to D2Rs, but may cause more side effects (nigrostriatal & tuberoinfundibular paths). Atypicals also block 5HT2A.

28
Q

What is first line treatment of schizophrenia? Why?

A

Atypical antispychotics. Fewer negative neurological effects such as TD or parkinsonism, probably because the 5HT2A blockade allows DA to more freely flow in the nigrostriatal pathway.

29
Q

What is the prognosis of schizophrenia? What are “good” prognostic factors?

A

Lifelong impairment, w/ chronic, downhill course in 90%. Suicide is commonly attempted and achieved. Good prognostic indicators: Female gender, older age at onset, married, social relationships, good employment history, presence of mood symptoms, presence of positive symptoms, few relapses.