Schizophrenia Flashcards
neuro disregulation of schizophrenia
mesocorticolimbic circuit
must have 2 of 5 of these symptoms (and 1 from the first three)
delusions hallucinations disorganized speech grossly disorganized or catatonic behaior negative sxs
must also have
social/occupational dysfunction
duration of 6 months of continuous symptoms
no schizoaffective and mood disorder
no substance abuse or othe rmedical issue
need to exclude autism
relation to autism
autism has disorganized speech and negative symptoms, but does not have prominent hallucinations or delusions
somatic delusion
feet mechanical, device implanted
nihilistic delusion
world coming to an end
Schizophreniform Disorder
sitting on the tipping point to schizophrenia
duration of 1-6 months with a 50% chance of going on to develop schizophrenia
schizoaffective disorder
major depressive, manic, or mixed episodes concurrent with first criteria for schizo
–mood symptoms present for majority of total duration/delusions for 2+ weeks
subtypes of schizoaffective disorder
bipolar
depressive
delusional disorder
one or more delusions more than 1x month
criteria A not met
mood episodes brief compared to delusional periods
attenuated psychosis syndrome
intact reality testing- but either delusions, hallucinations, or disorganized speech
more than once/week for past month
suddenly distressing and disabling
schizo epi
1%
when does schizo begin?
typically teens
which episode is most responsive to treatment
first
how many relapses until chronic schizo?
3
women as compared to men
better premorbid function, estrogen is neuroprotective because inhibits D2 receptors
3 phases of schizo
1) prodromal
2) active
3) residual
prodromal phase
social, cognitive deficits may precede activity phase by many years
active phase
full syndrome, typically 3-4 decades (teens, 20s, 50s)
residual phase
1/3 remission, 1/3 attenuation of symptoms in older years, stages of illness propose
suicide in schizo
20-40% attempt, 10% complete
what med reduces risk of suicide and violence?
clozapine
life expectancy schizo
10-30 years
percentage of schizos that smoke
90%
what neuroanatomy fnding?
dendritic spine density on deep layer 3 pyramidal neurons
–means decrease excitability to DLPFC layer 3 pyramidal cells–> dec cognitive ability
functional brain abnormalities
diffuse cerebral dysfunction (esp prefrontal and medial temporal)
neurochemical brain abnormalities
DA hypersensitivity in MESOLIMBIC
DA hypoactivity in MESOCORTICAL
glutamate NMDA
5ht, GABA, NE, Ach
mesolimbic pathway
midbrain VTA–>Nucleus accumbens, olfactory tubercle, and limbic system
*overactivity due to postive symptoms
mesocortical pathway
midbrain VTA–>frontal cortex
*learning and memory; reduce associated with negative symptoms
nigostriatal pathway
control of movement
tuberoinfundibular pathway
projects from hypothalamus to anterior pituitary gland and controls prolactin secretion
if you treat the movement and prolactin pathway…
causes worsening of positive and negative symptoms
NMDA antagonists
causes apoptosis/neuro degen due to excitotoxicity
PCP and ketamine
neurodegen because they are NMDA antagonists
atypical antipsychotics
treat schizo because inhibit neurodegen assocaited with excitotoxicity and apoptosis
first generation antipsychotics
F2 antagonists (chlorpromazine, haloperidol)
second generational antipsychotics
clozapine
G2, 5HT2 antag
antipsychotics have limited improvement in
negative and cognitive symptoms
antispyschot drugs help
psychotic (positive) symptoms, agitation, disorganizaiton
