Schizophrenia Flashcards
Schizophrenia
=positive symptoms
=negative symptoms
=disorganized symptoms
Positive Symptoms
=things that are present
=delusions - fixed false beliefs with a bizzare quality
=hallucinations - perception in the absence of stimuli
-auditory most common and then visual
-brain regions for auditory: Broca’s area, Wernicke’s area
Negative Symptoms
=things that are absent =flat affect - emotionally unaffective, no change in facial expression =alogia - poverty of speech and one word answers =asociality -less interest in social contact =avolition -apathy, lack of motivation =anhedonia -lack of ability to experience pleasure
Disorganized Symptoms
=disorganized speech
-circumstantiality, tangentiality, rhyming speech, word salad
-word salad: words strewn together, lost meaning but has good grammar
=bizzare behavior
-inappropriate dress for the weather
-little or no self care
-catatonia: absence of movement or holding or unusual pose
DSM 5
A. symptoms
B. function is impaired
C. continuous signs for at least 6 months
D, E, F. differential diagnosis
Epidemiology
=lifetime risk: .7%
=male: female 1.4:1
=males more severe
=many negative symptoms - worse prognosis
-positive symptoms are more easily treated
=onset typically 18-30 with different patterns by sex
Males vs Females
=men peak once in 20s
=women have a slightly smaller peak a little later
=women have a second small peak in late 40s/early 50s
=women have a third very small peak in 60s
=estrogen is a protective factor
Schizoaffective Disorder
=between a mood disorder and schizophrenia
=a major mood episode with negative symptoms
= psychotic symptoms persist in absence of a mood episode for > 2 weeks
Schizophrenoform Disorder
=identical criterion A - positive, negative, disorganized symptoms
=does not last as long as schizophrenia
=1 month to 6 months
Delusional Disorder
=one or more delusions for > 1 month
=does not have other symptoms to meet criterion A
=behavior is not obviously odd or bizarre
=functioning is not greatly impaired
Delusional Disorder Subtypes
=Erotomanic- a prominent figure loves you
= Grandiose - inflated self worth, power, knowledge, identity
= Jealous - partner is unfaithful
= Persecutory - being targeted or maliciously treated
= Somatic - physical defect or medical condition
= Mixed or Undifferentiated
Brief Psychotic Disorder
=same criterion A
=does not last long: 1 day - 1 month
=often develops as a stressor
=could have one episode and never have it again
Etiology
=don’t know a lot about differences in etiology for the disorders - just know for the spectrum
=Genetics
-highly heritable
-predisposition may remain unexpressed
-adoption studies suggest a significant genetic component
=communication deviance and family adversity may interact with genetic risk
-communication deviance is a vague confusing communication style
Schizophrenia is polygenic
=COMT-DA metabolism
-DA is dopamine
=and a bunch of others I don’t need to know
Prenatal Factors Matter
=mother exposed to infection during second trimester
=Rh incompatibility
=pregnancy and birth complications
-affect oxygen level to infant
=maternal malnutrition during pregnancy
=stressful maternal event late in the first trimester or early in the second
Early Predictors
=delayed speech and motor development
=early motor abnormalities
=suggest brain abnormalities are already present which set stage for schizophrenia
Structural and Functional Brain Abnormalities
=cognitive abnormalities
=loss of brain volume
=problems with frontal lobe functioning
=density of neurons, distribution of neurons
=smaller brain volume before disorder sets in
=increased receptors for dopamine and particularly sensitive to dopamine
-those with with and those predisposed
=low levels of glutamate
Problems with Frontal Lobe Functioning
=some studies show hyperactivity and some show hypoactivity
- Cognitive abnormalities
2. loss of brain volume
- seen in people predisposed but not with schizophrenia as well
- -enlarged ventricles - open fluid filled cavities
- not specific to schizophrenia, also in dementia
- can also be overall loss - about 3%. found in amygdala, hippocampus, thalamus (relay for sensory info)
Family Factors
=communication deviance - vague, unclear communication style
=expressed emotion - higher levels of criticism, hostility, over involvement of family
-may be mediated by stress
-stress –> cortisol –> higher dopamine
Social Factors
=urban living in first 16 years of life
-mediated by stress - complex, faster lifestyle
=immigration
- darker skin –> stress, discrimination
=SES - biodirectional
-schizophrenia makes employment harder –> lower SES –> stress –> schizophrenia
Cannabis
=cannabis use during teens –> 2x risk of schizophrenia
=males who smoked heavily in teens –> 6x elevated risk of schizophrenia
= depends on gene
-met/met low percent of schizophrenia with or without cannabis
-met/val low with no cannabis, and medium with cannabis
-val/val medium with no cannabis and high with cannabis
Antipsychotic medication
=1950s –> contributed immediately to deinstitutionalization of mental hospitals - way less people in them
Outcomes
=with stringent definition of recovery: 14% recover
-for at least 2 years
-remission of symptoms and/or good social functioning
=in US, a lot of relapse, symptoms come back
Schizophrenia reduces life expectancy
=by 15-20 years
=long term neuroleptic use and associated problems
- obesity, metabolic disorders, smoking, drug use, poor diet, sedentary life style
=12% suicide
Outcomes Vary By Culture
=better prognosis in less industrialized nations
- less expressed emotion?
- less industrialized nations have less hostility and involvement in another’s health
- less long term maintenance pharmacotherapy
Harrow 2007
=over long term follow up (15 years) patients who were not taking long term antipsychotics had better outcomes
- dopaminergic: antipsychotic meds slow it down and body tries to compensate by increasing DA
- much worse as soon as withdrawn
- keep increasing dose
Rates of Chronic Severe mental illness in the US have increased dramatically
=overuse of long term psychotic meds
=best use of meds is acute, get someone out of an episode
-1955: 1/617 Americans with schizophrenia
-today: 1/125 Americans
1st Generation Anti-psychotics (neuroleptics)
-Therazines, Haldol =DA antagonists, block DA action =work best for positive symptoms =side effects are common, challenging -weight gain, GI problems, EP, -EP are parkinson's like movements, extra paramital symptoms -monitor very closely
2nd Generation Anti-psychotics
-clozaril, zyprexa, seroquel
=no more effective, but fewer EP
=other side effects: significant weight gain
=contribute to brain tissue loss
Estrogen
=may play a protective role
=research to use as treatment
=gave women with schizophrenia estrogen patch or placebo patch. women with estrogen patch had less symptoms
Psychosocial Treatment
=family therapy
=case management
=social skills training
=cognitive remediation - attention, memory, executive function
=CBT and other individual therapies
-psychoeducation: educate about symptoms and how to handle them
Approaches used abroad
=Finland’s open Dialogue approach
- if they can live with psychotic symptoms, don’t medicate
- see people after first psychotic break –> relieve symptoms through dialogue –> never becomes chronic
greek roots of schizophrenia
=schizo: to split or crack
=phrenia: mind
=split with reality
=psychosis: loss of contact with reality
Do psycotic symptoms increase when a person is stressed?
yes
