Schizophrenia- exam 3 Flashcards
What is psychosis?
Break with reality, specifically hallucinations or delusions
what is schizophrenia?
A heterogeneous disorder that includes positive and negative systems like delusions, hallucinations and inappropriate actions and emotions
Who are Kraeplin and Bleuler and what did they do/think
Emil Kraeplin:
- psychiatrist in Germany
- coined the term Dementia Praecox in 1898, endogenous pyshcosis. Praecox (early onsent), Dementia (profressive worsening)
- he deined 3 categories that were used for until the DSM-5: paranoid, catatonic, disorganized (hebephrenic)
Eugen Bleuler
- swiss psychiatrist
- coined term schizophrenia in 1908. Schizein: to split, phren: the mind, loss of ‘associative threads’, broadened the concept
What is the typical age of onset for schizophrenia?
Symptoms usually begin an adolescent or early adulthood, late teens to early 30s, most common in 20s
What is the DSM 5 criteria for schizophrenia
A. 2+ of the following each present for a significant portion of time furing a 1-month period (or less of successfully treated)
- delusions, hallucinations, disorganized speech, catatonic behavior, negative symptoms
B. Level of function in one or more areas of life is markedly deminished
C. continous signs of the disturbance persist for at least 6 months
D. schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out
E. disturbance not attributable to physiological effects of a substance
F. history of ASD or communication disorder of childhood onset
What are positive and negative symptoms of schizophrenia
Positive symptoms are in excess of normal function. This includes delusions, hallucinations and disorganized speech and behavior.
Negative symptoms are less than normal functioning. This includes affect flattening, alogia, avolition, and asociality
Define delusion and give examples
Delusions are false beliefs
types of delusions include:
religious,
grandiose: false belief that one has great power, knowledge, or talent or that one is a famous and powerful person
persecution: false belief that oneself or one’s loved ones are being persecuted, watched, or conspired against by others
reference: belief that everyday events, objects, or other people have an unusual personal significance
Influence:
thought insertion: belief that another person or object is inserting thoughts into ones mind
Define hallucination, what type of hallucination is most common in schizophrenia
Hallucinations are false perceptions, the most common in schizophrenia are auditory hallucinations
What are disorganized speech and thoughts
Ideas are not logically related and have loose associations. Speech is fragmented and disconnected. There’s trouble sticking to one topic, easily gets off track and derailed. The content of speech is sometimes disturbed, but the patient does not think it’s unusual
What is a word salad
Disorganized thinking and speech
What characterizes catatonia(and waxy flexibility)
catatonia is disorganized behavior that reflects noticeable psychomotor dysfunction that may involve decreased or excessive and peculir motor activity which can range from pronounced unresponsiveness to agitation.
waxy flexibility: a condition in which a patient’s limbs retain any position into which they are manipulated by another person and which occurs especially in catatonic schizophrenia
What is the prevalence of schizophrenia worldwide?
less than 1% of the general population (around 0.03-0.07%)
What is prodromal, active, and residual?
Prodromal or residual: may see just negative symptoms
active:
What is expressed emotion and how is this related to hospitalizations
families that are critical and over-involved with the schizophrenic contribute to rehospitalization
Which neurotransmitter system is involved in 2/3 of cases of schizophrenia
dopamine receptor up regulation
What is meant by “functional excess” in the dopamine system? What are three different ways that the neurotransmitter could be overactive
- Too much dopamine, 2. too many dopamine receptors, 3. receptor supersensitivity of hyperactivity
What is some of the evidence that dopamine is the neurotransmitter involved in schizophrenia
- too much dopamine, 2. too many dopamine receptors, 3. receptor supersensitivity of hyperactivity
What are the first generation/conventional schizophenia meds
Dopamine receptor (D2) antagonist; phenothiazines, butyrophenones
What are the second generation or atypical antipsychotics? And what is different about their mechanism of action?
- affect serotonin and dopamine
- treat positive symptoms equally as well as 1st generation drugs, may be modestly more effective on negative (& cognitive) symptoms
- difference is they also effect serotonin
What is the advantage of second generation, or atypical antipsychotics, over the original antipsychotic? Are they side effect free?
- fewer side effects
- lower wbc’s promoting vulnerability to infection
- weight gain
- promote type 2 diabetes
- cause less extrapyramidal side effects
- increased patient complaince over typical antipsychotic meds
What is Cogentin and what is a used for
- benzotropine
- used to treat extrapyramidal side effects of schizophrenia meds (tardive dyskinesia)
What is diphenydramine
- benadryl (antihistamine)
- used to treat dystonic reaction
- blocks histamine receptor
What are extrapyramidal side effects
- input to motor system that control, smoothes, coordinates movements
- cerebellum & basal ganglia
- basal ganglia pathways use dopamine
- blocking dopamine interferes with smoothness and coordination
- parkinsons like movements: tremor at rest, rigid limbs, a decrease in and slowing of spontaneous movements
- Tardive dyskinesia
- dystonia
What is acute dystonic reaction
- involuntary tension or spasm in muscles of head, tongue, or neck
- grotesque look: head and upper torso twist to side, eyes bulge slightly and deviate to right
- tongue twists and protrudes, feels thick
- 24-72 hours after ingestion of single dose, holdol or compazine
- symptoms worsen with stress or anxiety, and improve with voluntary motor activity
- possible laryngospasm
What is tardive dyskinesia
- prolonged treatment (6 months, to years)
- rhthymic lip puckering, chewing, smaking, and tongue protrusions
- pill roll
- shuffle
What brain area/structures are implicated in the symptoms of extrapyramidal side effects, acute dystonic reaction, and tardive dyskinesia
cerebellum and basal ganglia
basal ganglia pathways use dopamine
blocking dopamine interferes with smoothness and coordination
What is the genetic contribution to schizophrenia? And what concordance rates do twin studies show
combination of genetic predisposition and environmental stressors
concordance rate:
- children: 9.35
- siblings: 7.3
- dizigotic twins: 12.08
- monozygotic twins: 44.3
What is a single gene dominant mutation? Know the malaspina study on father
mutation only has to be present on one gene for it to be the phenotype
Malasphina: child is more likely to have schizophrenia when they are the younger child born to older father, father usually over 50. It is a single gene dominant mutation
What is the role of maternal infections in schizophrenia? What infections and when
higher likelihood of developing schizophrenia if the mother had an infection during the second trimester of pregnancy (toxoplasma gondii, flu virus). It may be organism specific or an immune response
