Schizophrenia Flashcards
what is psychosis
syndromes that impair both thought content and thought process, including perceptions not based in reality and disorganized/ illogical thoughts
positive symptoms of SZ
hallucinations, delusions - these can be a/w suicidality or homicidality
disorganized speech/thought, disorg or catatonic behavior
*respond well to tx usually
negative symptoms of SZ
alogia (poverty of speech), diminished emotional expression (esp in face, eye contact, intonation aka prosody), avolition (inability to initiate purposeful activity), anhedonia
“A” criteria for SZ
2 of the following for min 1 month: grossly disorganized behavior, negative symptoms (dec emotions or avolition), delusions, hallucinations, disorganized speech*
*at least 1 required
B and C criteria for SZ
B: social or occupational dysfunction
C: duration - disturbance persists for 6 months, including 1 month of A criteria, that may include prodromal or residual sx
*no better explanation: schizoaffective or mood disorder, substance or general medical condition (may have SZ and autism if delusions or hallucinations)
what is a delusion
false, fixed belief involving misinterpretation or perception or experience
m/c: persecutory delusions
persecutory delusion
belief of being tormented, followed, tricked, spied on, or ridiculed
referential delusion
belief that certain gestures, comments, book passages, newspapers, song lyrics, or other things are specifically directed at patient
“bizarre” delusions
clearly implausible and not understandable beliefs that do not derive from normal life experiences
or loss of control over mind or body
what is a hallucination
perception of sensory experiences w/o external stimulus; any sensory modality but auditory is m/c (voices that aren’t the person’s own thoughts)
3 ways thinking may be disorganized
answers to questions are unrelated or barely related
“derailment” or loose associations between topics
incomprehensible “word salad”; ~receptive aphasia
incoherence vs derailment/ loose associations
incoherence: disturbance in speech within clauses
derailment: disturbance between clauses
grossly disorganized behavior: examples
markedly disheveled, unusual dress, inappropriate sexual behavior, unpredictable or untriggered agitation, bizarre affect
catatonic psychomotor behaviors
stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerism, stereotypy agitation not influenced by external stimuli, grimacing, echolalia, echopraxia
D2 and 5HT2-R antagonists’ effect on positive and negative sx
negative: much less responsive, especially to pure D2-blockers
prevalence of SZ
0.3-0.7% adults
more often diagnosed in African Americans and Asian Americas
onset of SZ
occurs between late teens-mid-30s, prior to adolescence is rare
SZ-like sx common to other childhood disorders
disorganized speech - autism, pervasive development disorders
disorganized behavior - ADHD
*do not contribute to SZ without considering other common childhood d/o
age of onset of SZ for M and F
F - late 20s, M - early-mid 20s
female more likely to have late onset (over 40)
sx of SZ in M and F
+ more common in F, - more common in M
female more likely to have pre-morbid functioning, affective sx, better short and med term prognosis
family hx in M and F with SZ
F: more SZ
M: more schizotypal, schizoid personality traits
neuroanatomical differences in SZ
enlarged lateral ventricles a/w negative sx
dec brain tissue, widened sulci
dec temporal lobe volume a/w + sx; less often frontal lobe
hypofrontality
abnormal smooth pursuit and saccadic eye movements
complement and SZ
immune-system gene C4 a/w increased risk for SZ d/t too much pruning –> impaired mental function
neuropsychological deficits in SZ
short-term memory, psychomotor processing speed, attention
*severity is a strong predictor of social and vocational outcome
stages of SZ
premorbid - around 10 yo, minimal sx
prodromal - 11-18 yo, slow development of negative sx, “going through a phase”, cognitive sx present
onset - 18-30 yo, active sx, + sx present, cognitive sx present
chronic/ relapse - >30 yo, remission uncommon; cognitive sx; negative sx persist b/t episodes of + sx, which diminish w time
outcomes of chronic residual/ relapsing phase of SZ
single episode - less than 10%
stable/intermittent - 35-55%
progressive worsening a/w severe disability - 35-55%
factors a/w better prognosis
acute onset w precipitating event at a later age; female; associated mood disturbance; good inter-episode fxn; compliance with meds; no CNS abnormality; no fam hx of SZ
poor insight in SZ
manifestation of illness, may lead to poor med compliance -> more relapsing, more hospital admissions, poorer psychosocial functioning and course of illness
SZ and suicide
5% commit suicide, but 20% make 1+ attempt; elevated during post-psychotic periods
risk factors: male, under 45, substance use d/o, depressive/ hopeless sx, unemployment, recent hospital discharge
SZ and substance use d/o
57% SZ pts had lifetime diagnosis, EtOH m/c then cannabis
nicotine dependence in 80-90% bc relieves negative sx and cognitive impairment, but smokers may have more + sx and hospitalizations
SZ and polydipsia
prevalent in SZ pts (25%), d/t defect in osmoregulation of thirst and renal sensitivity to AVP
Na
genetics and SZ
80% pts have no fam hx
a/w greater paternal age
developmental and environmental theories of causation
dev: altered interstitial neuron connections, a/w hypoxia during gestation and birth
env: late winter/ early spring birth and 2nd trimester flu exposure -> brain damage
SZ and mesolimbic pathway
increased activity -> delusions, hallucinations, + sx
SZ and mesocortical pathway
decreased activity -> apathy, withdrawal, lack of motivation, - and cognitive sx
SZ and nigrostriatal pathway
inhibition -> extrapyramidal side effects of antipsychotic drugs
SZ and tuberoinfundibular pathway
DA inhibition -> sexual side effects of antipsychotic drugs
MOA of 5HT-2A blockers for SZ
5HT-2A inhibits DA release
5HT-2A blockers disinhibit -> more DA release in midbrain with minimal EPS
NMDA-R and SZ
NMDA hypofunction = dec Glu transmission -> dec GABA tone -> inc DA in mesolimbic pathway = pos sx
dec Glu -> dec DA in mesocortical pathway = neg sx; hypofrontality
schizoaffective disorder criteria
- uninterrupted period of illness with major mood episode (MDE or bipolar) with A criteria of SZ
- delusion/ hallucination for 2+ wk w/o major mood episode
- major mood episode sx present for majority of total duration of active and residual illness
- not attributable to substance or other condition
tx for schizoaffective d/o
paliperidone
depressed: antipsychotic + antidepressant
bipolar type: antipsychotic +/- mood stabilizer
prognosis schizoaffective d/o
better than SZ, worse than mood d/o’s, bipolar > depressed, - sx less severe and pervasive than SZ
delusional disorder criteria
1+ delusions for min 1 month (not if SZ A criteria met)
impairments of psychosocial functioning more circumscribed than other psychotic disorders, and behavior not as bizarre or odd
types of delusions in delusional disorder
erotomanic, grandiose, jealous (M>F), persecutor (m/c), somatic
tx, course, and prognosis of delusional d/o
tx: anti-psychotic
course: sudden onset usually
prognosis: recovery (20-50%), decrease or chronic sx (50-80%)
brief psychotic d/o criteria
1+ of the following for 1d-1m:
delusions, hallucinations, disorganized speech*, disorganized or catatonic behavior
*one of these must be present
eventual return to premorbid level of functioning
prevalence, onset, and risk factors of brief psychotic d/o
prev: 9% of cases of first-onset psychosis
onset: mean age mid-30s, but any age possible
RF: pre-existing personality d/o (m/c schizotypal and borderline)
tx, course, and prognosis of brief psychotic disorder
tx: short-term anti-psychotics
course: emotional turmoil or overwhelming confusion
prognosis: 100% return to normal functioning w/i 1 mo; high relapse rates; 50% will dev SZ or mood d/o
schizophreniform d/o
SZ sx between 1-6 mo
*no necessary decline in functioning
shared psychotic d/o criteria
presence of a delusion in pt influenced by someone else (primary case)
primary case has longer-standing delusion with similar content
DA receptor occupancy and effectiveness of anti-psychotics
65-80% D2 occupancy in striatum = good response
>80% occupancy -> EPS
conventional vs atypical antipsychotics
conv: high affinity for D2-R
atyp: D2-blocker (ML pathway) and 5HT-2A blocker(MC, NS, TI) = fewer EPS
both are effective for diminishing + sx
