Schizophrenia Flashcards
Gender differences in incidence for schizo
None
Mean age of onset for males / females
Males = 21 Females = 27
Risk of suicide
Risk factors
High risk of suicide. 20-40% attempt. 10-15% succeed. Risk factors include being male, depression, hopelessness, substance use, unemployment, and social isolation.
What percentage of pxs have auditory / visual hallucinations?
75% auditory, 50% visual
What is the most common type of delusion?
Persecutory
Idea of reference
Belief that remarks, newspapers, radio, TV, internet are intended directly for that patient.
Negative sxs
Flat affect, difficulty initiating / persisting in goal-directed activities, difficulty making decisions.
Alogia
Diminution of thought, evidenced by reduced speech or lack of content in speech
Cognitive sxs
Disorganized speech / behavior
Decreased IQ
Anosognosia - not recognizing that one has an illness.
Cognitive dysmetria hypothesis
Sxs of schizo arise from disruption of neural network whose nodes include PFC, anterior cingulate cortex, thalamus, temporal cortex, and cerebellum.
Soft signs
Subtle abnormalities on neurological exam such as poor coordination, left/right confusion, and gait impairment
DSM Criteria for Schizophrenia
- A) 2 or more of the following for at least 1 month; one must be 1-3
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized / catatonic behavior
- Negative sxs
- B) Disruption of work, relationships, or self-care.
- C) 6 months of total sxs (including prodrome or residual), 1 month of A
- D) Ruled out schizoaffective, depressive, or bipolar disorder w/ psychotic sxs
- E) Not due to substance or other medical conditions
- F) If autism is present, only diagnose schizo if there are delusions or hallucinations
Prodrome
Usually lasts months-years. Includes subtle sxs of psychosis such as social withdrawal, anhedonia, poor hygiene, odd behavior, and anger outbursts.
Schizo prognosis
1/3 do well, 1/3 do OK, 1/3 do poorly
Predictors of poor outcomes for schizo
Low pre-morbid IQ, male gender, early onset, neg / cog sxs, structural brain abnormalities, long prodrome, no mood sxs, presence of obsessions / compulsions, soft signs, family history of schizo, and living in an industrialized nation.
Main areas of brain that show dysfunction in schizo
Dysfunction occurs in PFC, temoral lobe (temporal cortex, amygdala, hippocampus, and parahippocampal gyrus), and DA systems (VTA-mesocorticolimbic system)
dlPFC important for what?
Working memory, planning, prioritizing, multitasking, and behavioral flexibility / shifting responses
Orbitofrontal PFC important for what?
Affective / emotional regulation. Applies the brakes / reason to emotion.
Decreased activity in what area of the brain is implicated in negative sxs?
PFC
Function of temporal lobe
Temporal lobe epilepsy causes what?
Acts in convergence of input from all sensory modalities. Regulates information processing, sensory perception, memory, emotion, and learning of emotionally laden info.
•Temporal lobe epilepsy causes hallucination
Mesocorticolimbic DA pathway
VTA –> PFC, accumbens, and temporal lobe. Important for reward / reinforcement
Role of glutamate in psychosis
Low levels of glutamate may cause psychosis.
Increased glycine, which promotes glutamate binding to NMDA receptors, improves negative and cognitive sxs.
Defect in which part of brain causes thought disorder?
dlPFC
Physical brain problems w/ schizo
Gray matter is slightly reduced in PFC, temporal lobe volume is decreased, and ventricles are enlarged, but these effects are minimal.
The main problem is cytoarchitectural disarray in the temporal and frontal regions. Neurons can’t communicate / process information.
Hypofrontality
Hypoactivity of PFC (hypofrontality) → disinhibition of VTA → hyperactivity of DA in mesocorticolimbic pathway → hypofrontality (vicious circle).
Too much DA released to nucleus accumbens → psychosis.
Psychotic disorder due to medical conditions (8)
Temporal lobe epilepsy, neurodegenerative disorders, neoplasia, Vit B12 deficiency, infection (neurosyphilis), lupus, toxicity, 22q deletion (DiGeorge syndrome)
Substance / Medication induced Psychotic Disorderm (5)
Caused by stimulants (amphetamine, cocaine), hallucinogens, antiparkinsonian meds, and anticholinergics. Also due to withdrawal from alcohol, benzos, or barbiturates.
Side effects of atypical antipsychotics
Atypicals cause metabolic side effects such as weight gain, HTN, high cholesterol, and insulin resistance
DSM Criteria for Schizoaffective Disorder
- A) Depression or mania + criterion A of schizo
- B) Delusions / hallucinations for 2+ weeks without mood episode at some point.
- C) Mood problems are present majority of the time.
- D) Not due to a substance or other medical condition
DSM Criteria for Delusional Disorder
- A) 1+ delusions for at least a month
- B) Criterion A for schizo has never been met. Hallucinations, if present are not prominent and are related to the delusion.
- C) Function is not impaired beyond impact of delusion. Behavior is not bizarre.
- D) Mood disorders are brief if they are present at all
- E) Not due to substance or other medical condition.
Are neg / cog sxs present in delusional disorder?
More common in men or women?
Typical age of onset
No neg / cog sxs
More common in women.
Onset is usually in mid / late life.
Brief psychotic disorder
Delusions, hallucinations, or disorganized speech / behavior lasting less than 1 month
Schizophreniform disorder
Basically main sxs of schizophrenia but lasting b/w 1-6 months. Similar to prodrome of schizophrenia.
