Schizophrenia

Question 1

what is psychosis

Answer 1

syndromes that impair both thought content and thought process, including perceptions not based in reality and disorganized/ illogical thoughts

Question 2

positive symptoms of SZ

Answer 2

hallucinations, delusions - these can be a/w suicidality or homicidality
disorganized speech/thought, disorg or catatonic behavior
*respond well to tx usually

Question 3

negative symptoms of SZ

Answer 3

alogia (poverty of speech), diminished emotional expression (esp in face, eye contact, intonation aka prosody), avolition (inability to initiate purposeful activity), anhedonia

Question 4

“A” criteria for SZ

Answer 4

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

Question 5

B and C criteria for SZ

Answer 5

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)

Question 6

what is a delusion

Answer 6

false, fixed belief involving misinterpretation or perception or experience
m/c: persecutory delusions

Question 7

persecutory delusion

Answer 7

belief of being tormented, followed, tricked, spied on, or ridiculed

Question 8

referential delusion

Answer 8

belief that certain gestures, comments, book passages, newspapers, song lyrics, or other things are specifically directed at patient

Question 9

“bizarre” delusions

Answer 9

clearly implausible and not understandable beliefs that do not derive from normal life experiences
or loss of control over mind or body

Question 10

what is a hallucination

Answer 10

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)

Question 11

3 ways thinking may be disorganized

Answer 11

answers to questions are unrelated or barely related
“derailment” or loose associations between topics
incomprehensible “word salad”; ~receptive aphasia

Question 12

incoherence vs derailment/ loose associations

Answer 12

incoherence: disturbance in speech within clauses
derailment: disturbance between clauses

Question 13

grossly disorganized behavior: examples

Answer 13

markedly disheveled, unusual dress, inappropriate sexual behavior, unpredictable or untriggered agitation, bizarre affect

Question 14

catatonic psychomotor behaviors

Answer 14

stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerism, stereotypy agitation not influenced by external stimuli, grimacing, echolalia, echopraxia

Question 15

D2 and 5HT2-R antagonists’ effect on positive and negative sx

Answer 15

negative: much less responsive, especially to pure D2-blockers

Question 16

prevalence of SZ

Answer 16

0.3-0.7% adults

more often diagnosed in African Americans and Asian Americas

Question 17

onset of SZ

Answer 17

occurs between late teens-mid-30s, prior to adolescence is rare

Question 18

SZ-like sx common to other childhood disorders

Answer 18

disorganized speech - autism, pervasive development disorders
disorganized behavior - ADHD
*do not contribute to SZ without considering other common childhood d/o

Question 19

age of onset of SZ for M and F

Answer 19

F - late 20s, M - early-mid 20s

female more likely to have late onset (over 40)

Question 20

sx of SZ in M and F

Answer 20

+ more common in F, - more common in M

female more likely to have pre-morbid functioning, affective sx, better short and med term prognosis

Question 21

family hx in M and F with SZ

Answer 21

F: more SZ
M: more schizotypal, schizoid personality traits

Question 22

neuroanatomical differences in SZ

Answer 22

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

Question 23

complement and SZ

Answer 23

immune-system gene C4 a/w increased risk for SZ d/t too much pruning –> impaired mental function

Question 24

neuropsychological deficits in SZ

Answer 24

short-term memory, psychomotor processing speed, attention

*severity is a strong predictor of social and vocational outcome

Question 25

stages of SZ

Answer 25

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

Question 26

outcomes of chronic residual/ relapsing phase of SZ

Answer 26

single episode - less than 10% stable/intermittent - 35-55% progressive worsening a/w severe disability - 35-55%

Question 27

factors a/w better prognosis

Answer 27

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

Question 28

poor insight in SZ

Answer 28

manifestation of illness, may lead to poor med compliance -> more relapsing, more hospital admissions, poorer psychosocial functioning and course of illness

Question 29

SZ and suicide

Answer 29

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

Question 30

SZ and substance use d/o

Answer 30

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

Question 31

SZ and polydipsia

Answer 31

prevalent in SZ pts (25%), d/t defect in osmoregulation of thirst and renal sensitivity to AVP Na

Question 32

genetics and SZ

Answer 32

80% pts have no fam hx | a/w greater paternal age

Question 33

developmental and environmental theories of causation

Answer 33

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

Question 34

SZ and mesolimbic pathway

Answer 34

increased activity -> delusions, hallucinations, + sx

Question 35

SZ and mesocortical pathway

Answer 35

decreased activity -> apathy, withdrawal, lack of motivation, - and cognitive sx

Question 36

SZ and nigrostriatal pathway

Answer 36

inhibition -> extrapyramidal side effects of antipsychotic drugs

Question 37

SZ and tuberoinfundibular pathway

Answer 37

DA inhibition -> sexual side effects of antipsychotic drugs

Question 38

MOA of 5HT-2A blockers for SZ

Answer 38

5HT-2A inhibits DA release | 5HT-2A blockers disinhibit -> more DA release in midbrain with minimal EPS

Question 39

NMDA-R and SZ

Answer 39

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

Question 40

schizoaffective disorder criteria

Answer 40

- 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

Question 41

tx for schizoaffective d/o

Answer 41

paliperidone depressed: antipsychotic + antidepressant bipolar type: antipsychotic +/- mood stabilizer

Question 42

prognosis schizoaffective d/o

Answer 42

better than SZ, worse than mood d/o's, bipolar > depressed, - sx less severe and pervasive than SZ

Question 43

delusional disorder criteria

Answer 43

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

Question 44

types of delusions in delusional disorder

Answer 44

erotomanic, grandiose, jealous (M>F), persecutor (m/c), somatic

Question 45

tx, course, and prognosis of delusional d/o

Answer 45

tx: anti-psychotic course: sudden onset usually prognosis: recovery (20-50%), decrease or chronic sx (50-80%)

Question 46

brief psychotic d/o criteria

Answer 46

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

Question 47

prevalence, onset, and risk factors of brief psychotic d/o

Answer 47

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)

Question 48

tx, course, and prognosis of brief psychotic disorder

Answer 48

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

Question 49

schizophreniform d/o

Answer 49

SZ sx between 1-6 mo | *no necessary decline in functioning

Question 50

shared psychotic d/o criteria

Answer 50

presence of a delusion in pt influenced by someone else (primary case) primary case has longer-standing delusion with similar content

Question 51

DA receptor occupancy and effectiveness of anti-psychotics

Answer 51

65-80% D2 occupancy in striatum = good response | >80% occupancy -> EPS

Question 52

conventional vs atypical antipsychotics

Answer 52

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