Schizophrenia Flashcards
Schizophrenia (basic definition)
severe, chronic, debilitating disorder that affects 1% of the population
-you develop normally and then you have a drop in your level of functioning
Schizophrenia (clinical presentation)
-presents with positive, negative and cognitive symptoms
Cognitive Symptoms: impaired attention, memory, and executive function (they see deficits in working memory, executive functioning like facial recognition of expressions)
Psychosis: hallucinations, delusions, thought disorder (things that are present that shouldn’t be there)
Negative Symptoms: asociality, alogia, annhedonia (things that are missing that should be present) (melody in your speech, facial expression)
DSM 5 Criteria for Schizophrenia
Criterion A: 2 or more of the following each present for a significant portion of time during a one month period (or less if successfully treated)
- Delusions
- Hallucinations
- Disorganized Speech (is really talking about disorganized thoughts here because you can’t read thoughts. DISORGANIZED THOUGHTS IS NOT A CRITERIA FOR SCHIZOPHRENIA)
- Grossly disorganized or catatonic behavior
- Negative Symptoms (i.e. Diminished emotional expression or avolition)
Criterion B: social occupational dysfunction in one or more areas such as work, interpersonal relations, or self-care
Criterion C: continuous signs of the disturbance for at least 6 months (less than 6 months, called schizophrenoform disorder)
Criterion D: R/O MDD and BAD
Criterion E: not due to substance or general medical condition
Criterion F: can’t be autism unless A 1-2 above are prominent
Schizophrenia Exacerbations
- the higher you are on the impairment axis, the worse you’re doing.
- When someone has an exacerbation, get more symptoms, go to the hospital get medication and return to baseline
-half the people who have schizophrenia feel their ok, they get off their meds and sort of pop back up with exacerbation. Interepisode, your baseline level of symptoms goes up (see that in about a third of people-neuroinflammation, circuits aren’t doing well. We work hard to prevent this from happening)
Syndrome Defintion
-refers to the association of several clinically recognizable features, signs (observed by a physician), Symptoms (reported by the patient), phenomena or characteristics that often occur together
Disease Definition
-may be thought of as recognizable signs and symptoms with a KNOWN cause
Glutamatergic Hypothesis of Schizophrenia
- phencyclidine (PCP) is an NMDA receptor antagonist
- PCP can precipitate schizophreniform psychosis
- PCP can exacerbate the psychotic states in schizophrenic patients
- glycine site Agonists improve some symptoms
- suggests glutamatergic hypofunction as cause of pathophysiology in schizophrenia
Genetic Risk for Schizophrenia (physiology)
-about 50% of the risk alleles contribute to broken synapses. The theme is: people with schizophrenia are growing brains, the synapses aren’t quite working right. When you start maturing the synapses (synaptic printing), between 18-25: if you stress the brain the wrong way and you have this genetic risk, you can get the phenotype. A lot of the genetic risks are associated with excitatory synapses
DDx for Schizophrenia
MDD BAD Schizoaffective Disorder Drugs Medical Conditions Rx
Really old treatments for Schizophrenia
- lobotomy
- insulin coma
- fever therapy
- ECT
- solitary confinement
- we sheets
Dopamine and disease (Nigrostriatal system)
Physiological effect: locomotion
Associated Disorder: Parkinson’s Disease
Therapy: L-DOPA
Dopamine and Disease (mesocortical and mesolimbic systems)
Physiological Effect: affective and compulsive behaviors
Associated Disorder: Schizophrenia, other mental illness
Therapy: Neuroleptics
Dopamine and Disease (Tuberoinfundibular system)
Physiological Effect: prolactin secretion
Associated Disorder: prolactinoma
Therapy: bromocriptine
Dopamine and Schizophrenia (Drug Rx)
- chlorpromazine (Thorazine) first drug
- Blocks D2 dopamine transmission
- significant side effects
1st Generation Antipsychotics
Butyrophenones:
- haloperidol
- droperidol
Thioxanthenes:
- chlorprothixene
- fluphenthixol
- thiothixene
- zuclophenthixol
Phenothiazines:
- chlorpromazine
- fluphenazine
- perphenazine
- prochlorperazine
- thioridazine
