schizophrenia and other psychotic disorders Flashcards
Psychosis
Psychosis DOES NOT EQUAL SCHIZOPHRENIA
an imprecise term denoting a syndrome characterized by a distorted or non existent sense of reality
Manifested by disturbances in the formation and content of thoughts behaviors and affects
Crazy insane violent
heterogenous group of disorders
Can be a Symptoms (secondary to something else aka steroids)
Core feature of a disorder (psychotic disorder)
Where can psychosis occur
Med Neuro conditions
General medical conditions, Dementia (neurocognitive disorder), Delirium (medications, infectious causes), Substance-induce
Mood disorders: Bipolar disorder- manic or depressive episode (NOT hypomanic), MDD
Psychotic disorders- Brief psychotic disorder, schizophreniform disorder, schizophrenia, schizoaffective disorder, delusional disorder
Personality disorder- schizotypal, schizoid, paranoid, borderline
Schizophrenia DSM5 diagnosis
2 or more of the following each present for a significant portion of time during a 1 MONTH PERIOD (or less if successfully treated) with at least one being 1 2 or 3
- delusions (do not have to be bizarre)
- hallucinations (does not have to be 2 + conversing)
- Disorganized speech (frequent derailment or incoherence)
- grossly disorganized or catatonic behavior
- negative symptoms (affective flattening, alogia, or avolition)
Positive symptoms: things that happen in addition to normal behavior (hallucinations)
Negative symptoms: things that are withdrawn from normal behavior (avolition/faceless expressions)
Social dysfunction: one or more major areas of functioning such as work, interpersonal relations, or self care are markedly below the level achieved prior to the onset
Duration: continuous signs of the disturbance for at least 6 months, including prodromal, active phase and residual periods
Schizoaffective and mood disorder exclusion, substance/ gen med condition exclusion
changes in DSM5
the symptom threshold is raised need 2 sx, Delusions dont need to be bizzare, hallucinations dont need to be 2 + conversing
Schizophrenia epi
1% of population, M=F for rate, M 15 -25, F 25-35 peak onset
Wide spectrum of spectrum of presentations reflects a spectrum of heterogenous diseases
current DSM criteria draws from past classifications, Deteriorating course, positive symptoms (Added symptoms), Negative symptoms (removed symptoms)
Schizophrenia natural hisotry
every psychotic episode will lower the baseline affect
Prodomal symptoms start in puberty adolescence and get worse until mid to old age
Prodrome of schizophrenia
subclinical constellation of symptoms, often resembling depression, but more subtle
Often diagnosed in retrospect when you ask where tthere any behavioral changes
Most families will be able to describe a change in behavior, how outgoing or social someone used to be even before they had a florid psychotic break
Can also be a time of attenuated symptoms, odd beliefs, that by themselves are not concerning, but taken with the gestalt, show a picture of illness
Schizophrenia symptom domains, (positive, negative and cognitive)
Positive: delusions, hallucinations, disorganization
Negative: Anhedonia (inability to feel pleasure), Avolition (no movement to goals), Affective flattening
Cognitive: executive function, working memory
symptoms of schizophrenia
Formal thought disorder (disorder in the formation of thoughts: loose associations, tangentially, circumstantially, thought blocking, ideas of reference
Behaviors: bizzare, inappropriate, disorganized, catatonia, amotivational, Violence (SI HI)
Affect- emotional state: blunted, restricted, incongruent with mood
Delusions- disoder of the content of thought: Fixed, false beleif, not socially sanctioned, Jealousy, guilt, grandiosity, religious, somatic, persecution, often based in kernnel of truth, bizarre or non bizarre
Halluinations of schizophrenia
Cortical phenomena, perception of a stimulus in the absence of one, Alone do not mean psychosis (hypnagogic vs hypnopompic (right before sleeping vs right after waking up and these psychosis are normal)
Any sensory modality: auditory in many primary psychotic illnesses, visual in other causes of psychosis (delirium), gustatory, tactile (drugs), olfactory (TLE)
Theres a bottle of water that you think is a snake: ILLUSION
Theres nothing and you think there is something: Hallucination
Schizophrenia Etiology
brain abnormality that interacts with environment and social stressors: biochemical, anatomical, genetic envrionmental, psychosocial
Schizophrenia and neurotransmitters
Dopamine excess: psychosis, amphetamines: medications are D2 antagonists, drugs that increase dopamine cause psychosis (amphetamines)
Serotonin: 5HT2A antagonism is thought to have interaction with DA, second generation antipsychotic have more 5HT2A action
Glutamate: deficiency can result in psychosis (NMDA receptor hypofunction), several pathways are possible via limbic system, PCP and ketamine are NMDA antagonists and can induce psychosis
Dopamine pathways LEARN THESE!!
Mesolimbic pathway–> Positive symptoms
Mesocortical pathway to DLPFC–> Secondary negative sx or worsening of cognitive sx
Mesocortical pathway to VMPFC–> Secondary negative sx or worsening of affective sx
Nigrostriatal pathway –> EPS (parkinsonism) extrapyramidal symptoms
Tuberoinfundibular pathway from the hypothalamus to the pituitary–> Prolactin release (breast milk)
Etiology of schizophrenia
polygenic and epigenetic
Identical twin will have a 50% chance of getting it
sibling 10%,
Environmental- birth in the winter, pregnancy influenza, complications, stressor in pregnancy advanced paternal age, cannabis
Psychococial- biologic, all sx have some meaningf or the patient, patients with high expressed emotions relapse more often, social class downward drift, you cant hold a job if youre hallucinating all the time
treatment pharmacology of schizophrenia
Chlorpromazine , DA receptro antagonists, typical= older, D2»_space;>5HT and NE treat the positive symptoms
The atypicals ore newer drugs– broad receptor spectrum d2 and 5ht treat positive and negative symptoms
