schizophrenia ch 15

Question 1

DSMIV

Answer 1

Disturbance lasting at least 6 months and not due to medical or SA do, in which 2 or mor both the following symptoms are present for at least 1 month:

1. delusions or hallucintaons
2. disorganized speech
3. disorganized behavior or catatonic behavior
4. or negative symptoms

Subtypes of schizophrenia

1. paranoid
2. Catatonic
3. Disorganized -speech and behavior
4. Residual - absence of prominent positive symptoms but evidence of disturbance through less severe positive or negative symptoms
5. Undifferentiated - non of the above symptoms are predominant

Question 2

Etio

Answer 2

Bio -
Genetics - risk is higher by 40% if present in both parents ,
DISC1, disrupted in schizophrean 1 gene assoc with schizophrean as well s bipolar do, md, autism, aspergers.

Biochemical- due to excess dopaminergic activity usually in mesocoritical and mesolimbic tracts.

Most effective meds for psychotic s/s are dopamine antagonists.
Drugs that increase dopaminergic activity are psychotomimetic.

Serotonin excess causes these symptom clusters.
Gaba neuron loss can lead to hyperactivity of dopamergic neurons.
Reudcitions in glial cell density.
Working memory is mediated by cortical network activated by the DLPFC.

Enviromental - higher risk for males in urban areas, with hx of migraine. With cannabis or SA in urban settings, high social stress, low social connectedness, poverty, enviroanmtnel toxins.

Question 3

Clinical presetnation

Answer 3

Positive symptoms - D, delusions, thought broadcasting, thought insertion, reference delusions or persecution. Auditory hallucinations are most common - voices converse among themselves or comment of individuals behavior. Can also be threatening or accusatory.

Negative - A, flat affect, thought blocking, poverty of speech, abolition, social withdrawal. Primary symptoms are intrinsic to schizophrenia itself.

Cognitive symptoms - memory and attn deficits
language difficulties
problems with executive functioning

Disorganization - thought, derailment or loose of associations, poverty of speech, or behaviors.

Motor symptoms - slowing of psychomotor activity, isolated posturing, catatonia is rare.

Neurologic signs - hard signs impaired reflex, sensory, or motor functioning and are localized to a particular brain region, hypoalgesia, impaired olfactory functioning, and oculomotor abnormalities.
Soft signs do not implicit a specific brain area including grimacing, increased blink rates, problems sequencing motor tasks, or asterognosis, difficulties with smooth alternating movements.

Question 4

Diagnosis and prognosis

Answer 4

Good prognosis - late onset,
acute onset, presence of precipitating factors, high premorbid function, mood symptoms, being married, fx of mood d., good supper system, positive symptoms.

Recovery is fostered through tx at symptom mgmgt and fostering engagement in work and community.

Schizoaffective do- when mood symptoms co-occur with psychotic symptoms , along with at least a 2 week period of psychotic symptoms in the absence of mood symptoms, and when mood symptoms are present for a significant portion of the total illness duration.

Schizophreniform lasts less than 6 months and not associated with functional decline.

Question 5

Tx

Answer 5

To minimize risks, begin with ziprasidone or aripipraxoek in drug naie patients.
Medication switching is associated with significantly increased risk of hospitalization.
Switching techniques:
Immediate, cross-taper,
individiula taper
Abrupts discontinuation of antipsychotic mediation associated with withdrawal dyskineisa and rebound cholinergic effects.

Metformin for wt and glucose.
Topiramate - anticonvulsant off label for obesity mgmt, and eating do, smoking cessation, alcohol abuse. It reduces BCP effectiveness.

Smoking - 70-90% schizophrenics smoke.It reduces plamsa levels of many drugs.
buproprion used for nicotine addiction.

SA do - in30-65% of schizophrenics. Alcohol, cannabis, nicotine most common.

SGA recommended for individual with schizophrenia with comorbid SAdo. clozaine, olanzapine, and quetiapine.
Naltrexone - opioid receptor antagonists used for alcohol dependence.

Low fetal harm with SGA.
Suicide is leading cause of premature death in schizophrenics. Risk: male, cuacasion, sing.e social isolation, fx hx of suicide, unemployment, sSA, depression, young age at ones, high SES, high intelligence, high aspirations, chronic course. ,higher insight.

CBT
FT
SST
Vocational rehab
Assertive community treatment.

Question 6

meds

Answer 6

FGA, SGA
Clozaril - salivation, wt gain, agranulocytosis. 
Riperidone
Paliperidone
Olanzapine
Quetiapine
ziprasidone
Aripiprazole

SE - Akathisia, NMS, TD, medication induced parkinsonism.