schizophrenia

Question 1

when does it usually start?

Answer 1

young adulthood. rare in children. (1% prevalence)

Question 2

what is downward drift of schizophrenic patient

Answer 2

as the disease progresses they decrease in social status and income, etc. they lose relationships, support network

Question 3

what is the hallmark of schizophrenia?

Answer 3

psychosis.

Question 4

what is psychosis

Answer 4

impairment in reality testing. alterations of sensory perceptions (hallucinations), abnormalities in thought content (delusions), abnormalities in thought process/organization.

Question 5

do patients with schizo have clouding of consciousness?

Answer 5

no. this is what distinguishes schizo from delirium. their attention and memory capacity is still in tact. alert and oriented.

Question 6

diagnostic criteria

Answer 6

1 month of active symptoms with two or more of the following: delusions, hallucinations, grossly disorganized or catatonic behavior, negative symptoms, disorganized speech. there must be social and occupational dysfunctions.

Question 7

what is the duration for schizo diagnosis

Answer 7

disturbance has to persist for at least 6 months and that 6 month period must include 1 month of active symptoms. can include periods of prodromal or residual symptoms.

Question 8

positive symptoms

Answer 8

additional to expected behavior. are added to a patients normal functioning. delusions, hallucinations, agitation, talkativeness, thought disorders.

Question 9

what drugs to positive symptoms respond well too?

Answer 9

they respond better to traditional and atypicals

Question 10

negative symptoms

Answer 10

missing from expected behavior. lack of motivation, social withdrawal, flattened affect/emotions, cognitive disturbances, poor grooming, poor impoverished speech.

Question 11

negative symtoms respond to what drugs?

Answer 11

atypicals.

Question 12

undifferentiated schizo

Answer 12

most common, characteristic of more than one subtype.

Question 13

paranoid

Answer 13

delusions of persecution. older age of onset and better functioning than other types.

Question 14

residual

Answer 14

all negative symptoms. at least one psychotic with subsequent negative symptoms.

Question 15

disorganized

Answer 15

onset before age 25. incoherent speech, bizarre behavior, mirror gazing, facial grimace, inappropriate emotional response.

Question 16

catatonic

Answer 16

rare since intro of antipsychotics.

Question 17

prodromal

Answer 17

prior to first psychotic break. avoidance of social activities, quiet and passive or irritable, sudden interest in religion and philosophy. may have physical complaints, anxiety and depression.

Question 18

psychotic/active

Answer 18

loss of touch with reality. associated with positive symptoms.

Question 19

residual

Answer 19

period between psychotic events. in touch with reality but doesn’t act normally. negative symptoms with peculiar thinking, eccentric behavior, and withdrawal from social interactions.

Question 20

serious risk of antipsychotic meds?

Answer 20

tardive dyskinesia. choreiform movements. permanent movement disorder.

Question 21

abnormalities of the brain in schizophrenia

Answer 21

hypofrontality (decreased metabolism), lateral and third ventricle enlargement, loss of asymmetry, decreased volume of hippocampus and amygdala, decreased alpha waves, increased theta and delta waves on EEG. poor saccadic smooth visual pursuit.

Question 22

dopaminergic hypothesis

Answer 22

there is hypodopamanergic function in negative symptoms and hyperdopaminergic function in positive symptoms.
excess in the mesolimbic tract. lack of in the mesocoritcal tract.

Question 23

glutamate hypothesis mesolimbic

Answer 23

NMDA hypoactivity hypothesis. NMDAR become mutated and are inactive, or have less activity. they respond less to signals within the mesolimbic which has glu-GABA-glu-DA set up. this causes more dopamine within the mesolimbic system.

Question 24

glutamate hypothesis for mesocortical

Answer 24

NMDA hypoactivity hypothesis. NMDAR become mutated and are inactive, or have less activity. they respond less to signals within the mesocortical which has glu-GABA-glu-GABA-DA set up. this causes less dopamine within the mesocortical system.

Question 25

brief psychotic disorder

Answer 25

1-29 days of schizophrenia symptoms.

Question 26

schizophreniform

Answer 26

1-6months of symptoms.

Question 27

schizoaffective disorder

Answer 27

schizophrenia with mania/depression.

Question 28

delusional disorder

Answer 28

delusions, but no other schizophrenia symptoms.

Question 29

shared psychotic disorder.

Answer 29

one person with delusion, another person shares same/

Question 30

effective antipsychotics do what?

Answer 30

block D2 receptors within the mesolimbic systems

Question 31

what is the prognosis

Answer 31

chronic, lifelong process. 90% have decline because of it. often stabilizes in mid-life when the negative symptoms predominate.

Question 32

suicide in schizo.

Answer 32

50% attempt. 10% succeed. command hallucinations.

Question 33

better prognosis?

Answer 33

female, older age of onset, married, social relationships, good employment, mood symptoms, positive symptoms, fewer relapses.