Schizophrenia Flashcards
Define the hallmark symptom of schizophrenia and how it may present as.
Psychosis: An impairment of reality testing. This may present as alterations in sensory perceptions, thought content, or thought process/organization.
“Misperception of real external stimuli.”
Illusion
“Sensory perception not generated by external stimuli.”
Hallucination
“False conviction that one is the subject of attention by other people, or feeling as though people are referring to you in their conversations.”
Ideas of reference
“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?
Delusion – Delusion of persecution
“Not knowing where one’s mind and body end and those of others begin.”
Loss of ego boundaries
“Lack of informative content in speech, lacking/poverty of speech.”
Alogia
“Repeating statements of others/Associating words by their sounds, not by their meanings.”
Echolalia (“Clanging”)
“In responding to questions, one presents unnecessary and voluminous details in ultimately arriving at an answer to the question posed.”
Circumstantiality
“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.”
Tangentiality
“Loss of logical meaning between words or thoughts; when asked a question, illogically jumps from one subject to another.”
Loose associations
“Abrupt halt in the train of thinking (often because of hallucinations).”
Thought blocking
“The idea that thoughts cause or prevent external events from happening.”
Magical thinking
“Difficulty in discerning the essential qualities of objects or relationships despite normal intelligence.”
Impaired abstraction ability
“Inventing new words.”
Neologisms
“Repeating the same word or phrase over and over.”
Perseveration
“Uttering unrelated combinations of words or phrases.”
Word salad
What is the diagnostic criteria for schizophrenia?
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.
What are the key positive symptoms? What are the key negative symptoms?
+ delusions, hallucinations, agitation, talkativeness, thought disorder. - lack of motivation, social withdrawal, flattened affect/emotion, cognitive disturbances, poor grooming, poor/impoverished speech.
Course of schizophrenia?
Prodromal –> Psychotic/Active –> Residual (period between psychotic episodes)
Neurobiological abnormalities seen in schizophrenia?
Hypofrontality, Lateral & Third ventricle enlargement, Abnormal cerebral symmetry (loss of asymmetry), Decreased volume of hippocampus, amygdala, parahippocampul gyrus
Describe the DA hypothesis. What pathways are involved, and what symptoms result?
Excessive dopaminergic activity in the mesolimbic pathway results in positive symptoms, while decreased dopaminergic activity in the mesocortical pathway results in negative symptoms.
Are 5HT & NE implicated in schizophrenia?
Probably hyperactive.
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?
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.
What are other psychotic disorders that look like schizophrenia, but differ in duration or characteristic symptoms?
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
Don’t confuse schizophrenia with…
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
All effective antipsychotics do what? How is the treatment classified? Why?
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.
What is first line treatment of schizophrenia? Why?
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.
What is the prognosis of schizophrenia? What are “good” prognostic factors?
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.
