Schizophrenia - Lauden

Question 1

What are structural changes in the brain in schizophrenia?

Answer 1

Larger ventricles (the larger the more severe, relative to neuronal area)
 Males\>females

Disordered/disorganized pyramidal cells in hippocampus (correlated with severity)

Grey matter gets smaller, especially in adolescence

Shrinkage of cerebellar vermis, thicker corpus callosum

Question 2

What are the functional changes in the brain in schizophrenia?

Answer 2

Cognitive impairments

Low frontal blood flow, multifactorial

Usually begins at age 17-22, later for women but not usually after age 46

After time appears as mild mental retardation

Question 3

What are the clinical features of schizophrenia?

Answer 3

Positive symptoms generally more responsive to treatment:

Hallucinations
Delusions
Bizarre behavior
Positive formal thought disorder
Disordered speech
Catatonia

Negative symptoms often remain after treatment:

Affective flattening
Alogia
Apathy/avolition
Anhedonia/asocialtity
Attention/withdrawal
Social isolation

Cognitive symptoms/Difficulties in concentration and memory:

Disorganized thinking
Slow thinking
Difficulty understanding
Poor concentration
Poor memory
Difficulty expressing thoughts
Difficulty integrating thoughts, feelings, behaviors
Depression, hopelessness, suicidality, anxiety, agitation and hostility

Question 4

What are the characteristic symptoms for the first diagnostic criteria for schizophrenia?

Answer 4

delusions
hallucinations
Disorganized speech (eg, frequent derailment or incoherence)
Grossly disorganized or catatonic behavior
(catatnoia: frozen without communication, urinary retention and constipation, psychosis and depression. need NG tube and catheter)

negative symptoms, i.e, affective flattening, alogia, or avolition

Question 5

What are the diagnostic criteria for schizophrenia?

Answer 5

A. 2 or more characteristic symptoms for a significant part of one month

B. Socia’/occupational dysfunction for a majority of the time

C. Duration for at least 6 months with at least one month of symptoms within 6 months. (If less than 6 months: schizophreniform)

D. Schizoaffective disorder and mood disorder with psychotic features ruled out.

E. Rule out substance or general medical condition (can’t diagnose until effects wear off but indicate an increased tendency for psychosis in general)

F. Rule out pervasive developmental disorder

Question 6

What are signs of good and bad prognosis of schizophrenia?

Answer 6

Good prognosis:
Late onset
Obvious precipitating factors
Acute onset (trauma)
Good premorbid social, sexual and work histories
Mood disorder symptoms (esp depressive disorders)
Married
Family history of mood disorders
Good support systems
Positive symptoms (better than negative)

Poor prognosis:
Withdrawn, autistic behavior (don’t connect or communicate)
Family history of schizophrenia
Negative symptoms
Neurological signs and symptoms (minor findings like learning disorders)
History of perinatal trauma
No remissions in three years
Many relapses
History of assautliveness (violence and schizophrenia are contentiously correlated, not usually)