Schizophrenia

Question 1

Schizophrenia

Answer 1

=positive symptoms
=negative symptoms
=disorganized symptoms

Question 2

Positive Symptoms

Answer 2

=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

Question 3

Negative Symptoms

Answer 3

=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

Question 4

Disorganized Symptoms

Answer 4

=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

Question 5

DSM 5

Answer 5

A. symptoms
B. function is impaired
C. continuous signs for at least 6 months
D, E, F. differential diagnosis

Question 6

Epidemiology

Answer 6

=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

Question 7

Males vs Females

Answer 7

=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

Question 8

Schizoaffective Disorder

Answer 8

=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

Question 9

Schizophrenoform Disorder

Answer 9

=identical criterion A - positive, negative, disorganized symptoms
=does not last as long as schizophrenia
=1 month to 6 months

Question 10

Delusional Disorder

Answer 10

=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

Question 11

Delusional Disorder Subtypes

Answer 11

=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

Question 12

Brief Psychotic Disorder

Answer 12

=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

Question 13

Etiology

Answer 13

=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

Question 14

Schizophrenia is polygenic

Answer 14

=COMT-DA metabolism
-DA is dopamine
=and a bunch of others I don’t need to know

Question 15

Prenatal Factors Matter

Answer 15

=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

Question 16

Early Predictors

Answer 16

=delayed speech and motor development
=early motor abnormalities
=suggest brain abnormalities are already present which set stage for schizophrenia

Question 17

Structural and Functional Brain Abnormalities

Answer 17

=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

Question 18

Problems with Frontal Lobe Functioning

Answer 18

=some studies show hyperactivity and some show hypoactivity

Question 19

1. Cognitive abnormalities

2. loss of brain volume

Answer 19

1. seen in people predisposed but not with schizophrenia as well
2. -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)

Question 20

Family Factors

Answer 20

=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

Question 21

Social Factors

Answer 21

=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

Question 22

Cannabis

Answer 22

=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

Question 23

Antipsychotic medication

Answer 23

=1950s –> contributed immediately to deinstitutionalization of mental hospitals - way less people in them

Question 24

Outcomes

Answer 24

=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

Question 25

Schizophrenia reduces life expectancy

Answer 25

=by 15-20 years
=long term neuroleptic use and associated problems
- obesity, metabolic disorders, smoking, drug use, poor diet, sedentary life style
=12% suicide

Question 26

Outcomes Vary By Culture

Answer 26

=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

Question 27

Harrow 2007

Answer 27

=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

Question 28

Rates of Chronic Severe mental illness in the US have increased dramatically

Answer 28

=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

Question 29

1st Generation Anti-psychotics (neuroleptics)

Answer 29

-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

Question 30

2nd Generation Anti-psychotics

Answer 30

-clozaril, zyprexa, seroquel
=no more effective, but fewer EP
=other side effects: significant weight gain
=contribute to brain tissue loss

Question 31

Estrogen

Answer 31

=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

Question 32

Psychosocial Treatment

Answer 32

=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

Question 33

Approaches used abroad

Answer 33

=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

Question 34

greek roots of schizophrenia

Answer 34

=schizo: to split or crack
=phrenia: mind
=split with reality
=psychosis: loss of contact with reality

Question 35

Do psycotic symptoms increase when a person is stressed?

Answer 35

yes