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
