schizophrenia Flashcards
when does it usually start?
young adulthood. rare in children. (1% prevalence)
what is downward drift of schizophrenic patient
as the disease progresses they decrease in social status and income, etc. they lose relationships, support network
what is the hallmark of schizophrenia?
psychosis.
what is psychosis
impairment in reality testing. alterations of sensory perceptions (hallucinations), abnormalities in thought content (delusions), abnormalities in thought process/organization.
do patients with schizo have clouding of consciousness?
no. this is what distinguishes schizo from delirium. their attention and memory capacity is still in tact. alert and oriented.
diagnostic criteria
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.
what is the duration for schizo diagnosis
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.
positive symptoms
additional to expected behavior. are added to a patients normal functioning. delusions, hallucinations, agitation, talkativeness, thought disorders.
what drugs to positive symptoms respond well too?
they respond better to traditional and atypicals
negative symptoms
missing from expected behavior. lack of motivation, social withdrawal, flattened affect/emotions, cognitive disturbances, poor grooming, poor impoverished speech.
negative symtoms respond to what drugs?
atypicals.
undifferentiated schizo
most common, characteristic of more than one subtype.
paranoid
delusions of persecution. older age of onset and better functioning than other types.
residual
all negative symptoms. at least one psychotic with subsequent negative symptoms.
disorganized
onset before age 25. incoherent speech, bizarre behavior, mirror gazing, facial grimace, inappropriate emotional response.
catatonic
rare since intro of antipsychotics.
prodromal
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.
psychotic/active
loss of touch with reality. associated with positive symptoms.
residual
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.
serious risk of antipsychotic meds?
tardive dyskinesia. choreiform movements. permanent movement disorder.
abnormalities of the brain in schizophrenia
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.
dopaminergic hypothesis
there is hypodopamanergic function in negative symptoms and hyperdopaminergic function in positive symptoms.
excess in the mesolimbic tract. lack of in the mesocoritcal tract.
glutamate hypothesis mesolimbic
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.
glutamate hypothesis for mesocortical
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.
