Schizophrenia And Spectrum Disorders 1 Flashcards
What are the schizophrenia spectrum and psychotic disorders?
• Schizophrenia • Schizophreniform disorder • Brief psychotic disorder • Delusional disorder • Schizoaffective disorder Psychotic: I mplies a break from reality in thinking and/or perceptions
What are the psychotic symptom disorders?
Schizophrenia Spectrum Disorders
➢ Each diagnosis involves one or more of the following 5 psychotic symptom domains:
Psychotic Symptom Domains
(1) Delusions
(2) Hallucinations
(3) Disorganized speech (thinking)
(4) Disorganized behavior
(5) Negative symptoms
First domains are core domains
What are delusions?
(1) DELUSIONS
➢ A fixed false belief that is not amenable to change, even with conflicting evidence
Examples of Delusional Themes ‒ Delusion of grandeur (grandiose) ‒ Persecutory (paranoid) ‒ Somatic (body/health related) ‒ Capgras delusion (someone replaced by an imposter)
What are the types of delusion?
Examples of Delusional Themes ‒ Delusion of grandeur (grandiose) ‒ Persecutory (paranoid) ‒ Somatic (body/health related) ‒ Capgras delusion (someone replaced by an imposter)
‒ Delusion of control (external force controlling one’s behavior)
‒ Delusion of reference (belief that an external action [e.g., television announcement] refers to or has special meaning to oneself)
‒ Thought broadcasting delusion (thoughts being transmitted to others)
❖ These are just a few themes for delusional content
What are hallucinations?
(2) HALLUCINATIONS
➢ A sensory perception without an external stimulus
➢ Typical features – Auditory – Single voice, voices conversing, running commentaries – Command hallucinations – Derogatory
Explain disorganized speech/thinking
(3) DISORGANIZED SPEECH/THINKING
➢ Speech (thinking) lacks the normal, logical connections between words or thoughts
➢ Patients with this symptom are described as having a formal thought disorder
Examples
– Speechwithunrelated/remotely-relatedconnections between thoughts (derailment, loose association)
– Speech with word association based on rhyming (clang association)
– Speech with no meaningful relationship between words within a sentence (word salad)
What is the differential diagnosis of disorganized speech/thinking?
➢ Differential Diagnosis: Aphasia (an impairment in language caused by brain injury such as stroke)
– In aphasias, phonemic paraphasic errors are common (i.e., speech errors characterized by additions/deletions of syllables, such as saying “lar” for “car”)
– In psychotic disorders, pronunciation is good— the major problem is the logical connection between words (e.g., “Doors magazines has political party”)
– Age of symptom onset tends to be older in stroke patients
What is grossly disorganized behavior?
Disorganized: Non-goal-oriented behavior (e.g., unable to take care of activities of daily living, grossly inappropriate mood/affect)
What is catatonia?
➢ Catatonia: Multiple motor/behavioral abnormalities that reflect diminished reactivity to the environment, such as:
– Posturing, waxy flexibility, stereotypies
– Non-responsiveness, mutism
What are the negative psychotic symptom disorders?
5) NEGATIVE SYMPTOMS
– Diminished emotional expression (verbal and nonverbal)
– Avolition (decreased self-initiated, purposeful activities)
– Alogia/poverty of speech (reduced speech output)
– Anhedonia
– Asociality (disinterest in social interactions
Contrast negative and positive psychotic symptoms
➢ Negative vs. Positive Symptoms
– Negative symptoms (symptom domain 5): Thoughts, behaviors or perceptions that normally exist that are now absent or markedly diminished (e.g., loss of emotional expression)
– Positive symptoms (symptom domains 1-4): Thoughts, behaviors, or perceptions that are distorted or in excess of normal function (e.g., distorted thinking as in a delusion)
What are the diagnostic criteria of Schizophrenia?
Diagnostic Criteria
➢An Active-Phase for ≥1 mo, defined as:
•At least 2 psychotic domain symptoms with at
least one being a core symptom (1-3 listed in
blue):
(1) Delusions
(2) Hallucinations
(3) Disorganized speech
(4) Grossly disorganized behavior
(5) Negative symptoms
➢Continuous signs of the disturbance for ≥ 6 mos (2 symptoms do not have to be present the entire time)
Describe the schizophrenia timeline
Schizophrenia Timeline (Elaborated) ➢ Duration: Signs of the disturbance for >6 mos (including any prodromal and/or residual phases, if present):
• Prodromal Phase • Active Phase (must be >1 month) • Residual Phase The above 3 happen across atleast 6 mos ➢ Prodromal and residual phases often manifest as only 1 symptom domain (e.g., negative symptoms
What are the subtypes of schizophrenia?
➢ Subtypes
– There are no subtypes for schizophrenia except to specify “with catatonia” if present
– Nonetheless, the presentation of schizophrenia can dramatically vary depending on which psychotic symptoms are most prominent
➢ Differential: Substance-induced psychosis
(e.g., consider psychotomimetic drugs such as stimulants and dissociative anaesthetics)
Describe the neuropathology of schizophrenia-dopamine hypothesis
Dopamine (DA) Hypothesis
1. Overactivity of mesolimbic DA relates to positive symptoms
2. Underactivity of mesocortical DA relates to negative symptoms
mesocortical
The DA hypothesis is insufficient. Other neurotransmitters (incl. serotonin and glutamate) are dysregulated
How can imaging show the effects of schizophrenia?
