Schizophrenia and Related Disorders Flashcards
____ is a symptom of a mental illness/condition, not a specific medical condition in itself
Psychosis
Symptoms of psychosis include ____
hallucinations, delusions, thought disorganization, and
agitation/aggression, or other odd behaviors
Primary vs. Secondary psychosis
- Primary psychotic disorders: include schizophrenia, schizoaffective disorder, schizophreniform, and delusional disorders
- Secondary psychosis : due to medical conditions, medications, and substance use
Associated risk factors of psychosis
■ Living in an urban area
■ Immigration
■ Family history of schizophrenia
■ Obstetrical complications
■ Late winter/early spring birth (considered to be due to exposure to influenza virus during neural
development)
■ Advanced paternal age at conception (associated with increased risk of de novo mutations)
Schizophrenia genetics
■ Exact mechanism unknown and believed to be largely in connection with environmental factors
as well
■ Higher risk in first degree relatives
■ Rate in monozygotic twins is 40-50%, and rate in dizygotic twins is 10-15%
Obstetrical complications of schizophrenia (increase risk by two fold)
Preterm labor, blood group incompatibilities, fetal hypoxia, maternal infection
T/F there is a Higher prevalence of schizophrenia seen with some autoimmune conditions
T
Structural and functional brain abnormalities in people with schizophrenia
○ Structural brain abnormalities
■ Reduction in gray matter volume in multiple brain regions
■ Enlarged ventricles
○ Functional brain abnormalities
■ PET and MRI scans show abnormal brain activation with schizophrenia
■ Abnormalities typically in storage or retrieval of information
Neurotransmitters involved in schizophrenia
○ Dopamine (most widely accepted): Hypothesized that excess dopamine in the mesolimbic tract causes positive psychotic symptoms
○ Glutamate (excitatory NT): Believed to be due to hypofunction of the NMDA glutamate receptor
○ Gamma amino butyric acid (GABA) (inhibitory NT): Decrease in GABA reuptake transporter mRNA levels
○ Acetylcholine: Increased incidence of tobacco use in people with schizophrenia has led to the hypothesis that nicotine (stimulates a subset of ACh receptors) may provide some therapeutic correction in schizophrenia
Symptoms of schizophrenia
■ Hallucinations
■ Delusions
■ Disorganized speech
■ Grossly disorganized or catatonic behavior
■ Negative symptoms (affective flattening, alogia)
Schizophrenia positive symptoms
● Visual hallucinations
● Auditory hallucinations (most common hallucination)
● Somatic hallucinations
● Delusions
● Paranoia
● Disorganized thinking and speech
Schizophrenia negative symptoms
● Flat affect
● Monotonous / little to no speech (alogia)
● Anhedonia / apathy, poor grooming & hygiene
● Extreme isolation
● Lack of emotional and facial expression
● Catatonia
catatonia symptoms
● Stupor (oblivious inability to move or respond to stimuli)
● catalepsy (hold a position you move them into passively)
● Mutism (little to no verbal communication)
● Waxy flexibility (body remains in whatever position, resistance to being moved)
● Negativism (lack of verbal response, no response to external stimuli)
● Posturing (rigid body posture, holding a posture or position that goes against gravity, active)
● Mannerisms (extreme or odd movements and mannerisms)
First line treatment of schizophrenia
antipsychotic medications (dopamine receptor antagonists
Treatment resistant schizphrenia
General guidelines are if a patient has failed 2 different antipsychotic medications, they are considered to have treatment resistant schizophrenia and should be evaluated for clozapine (also a SGA)
Treat catatonia with _____
benzodiazepines
After recovery from first acute psychotic episode, it is recommended to continue antipsychotic medication for
_____ before considering taper
2-3 years
■ Many will require indefinite treatment, and discontinuation is associated with higher rate of relapse
If there is good response for positive schizophrenia symptoms with an antipsychotic, but negative symptoms persist, could consider adding _____
an antidepressant or mood stabilizer
Non-medication recommended therapies for schizophrenia
■ Psychotherapy / CBT → often best for patients with a degree of insight regarding their psychosis (Lower rates of hospitalization and relapse)
■ Family based interventions
■ Social skills training → improvement in interpersonal and everyday life skills
Schizophrenia prognosis
○ The life expectancy of people with schizophrenia is reduced by more than a decade compared to the
general population, Largely due to heart disease
○ The rate of suicide among people with schizophrenia is over 4 times higher than the general population
Psychotic Disorder presentation
Brief psychotic disorder is characterized by 1 or more symptoms of psychosis lasting from one day and resolve
within 1 month with full return of previous functioning
■ Hallucinations
■ Delusions
■ Disorganized speech
■ Disorganized behavior
Psychotic Disorder Diagnosis
○ Must meet DSM V criteria (previous slide)
○ Need to rule out substance and medical related causes of psychosis, as well as MDD or Bipolar
○ Diagnosis usually made provisionally or retrospectively
○ Lack of negative symptoms
Psychosis subtypes
■ With marked stressor → previously called brief reactive psychosis (more common subtype). Occur shortly after a significant
stressor such as death of a loved one, moving to a new country, natural disaster
■ Without marked stressor → unknown cause (less common)
■ With postpartum onset → within 4 weeks of delivery
Psychotic Disorder treatment
○ Same as general initial management of psychosis regardless of cause
○ Second generation antipsychotic medication
○ Short acting benzodiazepine for severe anxiety and agitation
