Schizophrenia Flashcards
delusions/hallucinations
flat affect, diminution of thought and speech, lack of goal-direction
disorganized speech/behavior, decreased cognition
positive sx
negative sx
cognitive sx
mediating systems of thought/perception
schizophrenia results from these 3
PFC
Temporal lobe (cortex, amygdala, HC)
DA (VTA-MCL)
extensively interconnected w cortical/subcortical regions that process sensory info
“the executive”
PFC
highly processed/complex info
EXECUTIVE FUNCTION
working/ST memory
planning/prioritizing/multitask
behavioral flexibility
affective/emotional states (reigns in amygdala)
decreased activity in which disorder?
dorsolateral PFC
orbitofrontal PFC (mediofrontal)
schizophrenia
delayed response task: test of working memory supports what?
lesion here?
PFC regulates executive fxn
lesion here results in inability to switch strategies or change behavior (monkey keeps reaching for same side)
WI card sort test
perseveration
unable to show behavioral flexibility
pts w/PFC damage or schizo
neocortex+amygdala+HC+paraHC gyri
convergence of info from ALL sensory modalities
regulates info processing, sensory perception, emotion-laden memory
temporal lobe
seizure causing altered mental states including hallucinations, déjà vu, “out of body” experiences, all in absence of motor convulsions
Temporal lobe epilepsy
which lobe is activated during hallucinations? and is abnormal in schizophrenic brains?
temporal
reward+reinforcement
VTA to PFC, accumbens, temporal lobe
(projections to entire brain)
mesocortical limbic pathway
psychosis (3 sx)
hallucinations
paranoia
attention abnormalities
results of DA antagonists
which receptors?
D2 receptors
antipsychotics (reverse sx)
efficacy of antipsychotics is correlated with what?
affinity for D2 receptors
haloperidol has the greatest impact on what type of sx?
positive
not much effect on negative sx
atypical antipsychotics do what?
not only antagonize D2 receptors, but also other receptors and also IMPROVE NEGATIVE SX
there are not good treatments for what type of schizo sx?
cognitive
where’s the lesion?
thought disorder
emotional blunting/lability
psychosis
dlPFC
ofPFC
temporal, DA
what is reduced in schizophrenic brains?
name what changes occur in 1)ventricles 2)temporal lobe 3)cytoarchitecture
grey matter in PFC
ventricular enlargement
temporal lobe reduction
temporal/frontal changes
psychopathologic mechanism for schizo?
hypoactivity of PFC –> disinhibition of VTA –> hyperactivity of dopamine in MCL pathway
DA does what to the PFC?
inhibits
risk factors for suicide in schizos?
male depression hopelessness substance use unemployment social isolation
epidemiology
1%
M=F
15-25 in men
27 in women
schizophrenia is a d/o of?
thought and perception
amygdala, hippo, parahippo gyrus are found in which lobe?
temporal
2 DA pathways:
nigrostriatal
MCL
NS: cell bodies in SN, projects to forebrain
MCL: cell bodies in CTA and projects to limbic and cortical areas (incl PFC and temporal)
3 drugs that are DA agonists and can produce paranoia and hallucinations
L-DOPA, amphetamines, cocaine
antipsychotic MOA?
DA antagonists
PCP MOA?
antagonist at the glutaminergic NMDA receptor
glycine effect?
promotes glu binding to NMDA –> improves negative and cognitive sx
cognitive dysmetria hypothesis: 5 components of the neural network disrupted in schizo that causes sx
PFC AC thalamus temporal cortex cerebellum
in schizo, DA hyperactivity where?
ventral striatum (–> MCL)
risk factors of schizo
risk factor for relapse?
IU injury maternal influenza maternal starvation (2nd tri) cannabis during adolescence low SES "downward drift"
families w/high expressed emotion
schizo ddx
temporal lobe epilepsy wilson's, parkinson's, huntington's Vitamin B12 neurosyphilis lupus heavy metal poisoning deletion in 22q --> DiGeorge
substance-induced psychotic d/o agents?
stimulants hallucinogens antiparkinsonian's anticholinergics alcohol/BZD/barb w/d
if hx of autism/communication d/o, then what additionally is needed for schizo dx?
prominent delusions/hallucinations
majority of morbidity comes from these symptoms:
negative
three chars of alogia
diminution of thought
lack of speech content
reduced speech
name 3 main cognitive sx that show “disorganization of thought processes” (criteria A3 and A4)
loosening of associations
illogical thought processes
incomprehensible speech
soft signs aka: what are they?
EPS
poor coordination
right/left confusion
gait impairment
tell me about schizoaffective d/o
prognosis?
tx?
A) either MDE or manic episode concurrent with schizo Criterion A (MDE must include “depressed mood”)
B) delusions/halluc for 2+ wks in absence of a mood episode
C) Mood sx present for the majority of the illness
Better prognosis than schizo, but worse than MDD or bipolar
tx: antipsychotic w/antidepressant OR mood stabilizer
tell me about delusional d/o
A) delusions w/duration of 1+ month
B) Schizo Crit A never been met (hallucinations, if present, not prominent and assoc w/delusion theme)
C) Functioning not impaired, behavior not odd outside of delusions themselves
D) if mood/MDE occurs, brief
E) r/o body dysmorphic d/o and OCD
women>men; mid-late life
schizophreniform and
brief psychotic d/o
SPh: A, D, E of schizo but btw 1-6 months
BP: < 1mo
prodromal sx of schizo active phase
social w/d
loss of interest
deterioration in hygiene
unusual behavior outbursts of anger
must have meds to bring active phase to end
predictors of poor outcomes
lower IQ male gender age of onset neg/cog sx structural brain abnormalities long prodrome absence of mood sx presence of obessions/compulsions soft signs family hx live in industrialized nation
does early intervention (meds/psychosocial) during the prodrome reduce conversion to schizo?
no
acute psychosis tx
atypicals
watch for wt gain/HTN/dyslipidemia/insulin resistance
monitor weight/circumference/lipid levels/glucose
med for tx-refractory schizo
clozapine
SE: seizures/cardiomyopathy/agranulocytosis
adverse effects of all antipsychotics?
QT prolongation
sudden cardiac death
caution in adolescents/elderly (dementia)
timeframe for NMS?
w/in 30d of new antipsychotic OR increase in dose
sx arise over several days
NMS sx?
SS sx?
mental status changes muscle rigidity (elevated CK) hyperthermia ANS instability (tachy/tachypnea)
CLONUS/hyperreflexia/hyperthermia/tachy/altered mental state
antipsychotics mostly tx these symptoms, but not so much these sx…
what’s the best tx?
positive
negative/cognitive
psychosocial rehab= meds + teaching (e.g. ACT program)
also family psychoeducation (reduces relapse) cognitive therapy (changing delusional thoughts and response to)
which hormone regulates thought and perception?
DOPAMINE
