Schizophrenia- Lett Flashcards
who introduced the term schizophrenia?
a. Emil Kraeplin (1887)
b. Eugen Bleuler (1908)
c. Kurt Schneider (1920)
b
what are the diagnostic criteria for schizophrenia according to the DSM-5?
- At least 2 of the following symptoms for at least 1 month:
a. Positive symptoms: - Delusions
- Hallucinations
b. Cognitive symptoms:
- disorganised speech
- disorganised behaviour
c. Negative symptoms:
- flat effect (appropriate emotions)
- alogia (poor speech)
- avolition (low interest/drive)
what are the stages in the development of schizophrenia?
- premorbid phase:
- cognitive/social’motor deficits - prodromal phase:
- brief attenuated positive symptoms or functional decline
- -> 1st psychotic episode - psychotic phase:
- florid positive symptoms - stable phase:
- negative symptoms
- cognitive/social deficits
- functional decline
according to the dimensional approach, what are the 3 subtypes of schizophrenia and what is the effectiveness of treatment in them?
a. paranoid-hallucination subtype- most frequent form; good response to antipsychotics
b. schizoaffective disorder- severe hallucinations and delusions combined w. major depression - hard to treat
c. deficit syndrome- severe negative symptoms and cognitive symptoms - very hard to treat
schizophrenia prevalence…
a. is about 1% worldwide
b. men are more affected than women
c. age of onset is the same in men and women
d. affecting a small portion of the population
e. is higher in western countries
a
what can be major risk factors of schizophrenia?
- prenatal infections
- low birth weight
- increasing age of the father
- genetic factors
- environmental factors (infections, stressful upbringing, urban upbringing)
what is the heritability rate of schizophrenia?
80%
which treatment strategies are available for treatment of schizophrenia?
positive symptoms:
- antipsychotic medications
- ECT
- rTMS (?)
negative symptoms:
- clozapine
- psychosocial interactions
- CBT
- adjunctive treatment
cognitive symptoms:
- cognitive remediation therapy
- rTMS (?)
- vocational training
antipsychotic medications…(which answer is WRONG?)
a. have 2 generations- first generation APs (typical), good for positive symptoms but are very ‘dirty’ and second generation (atypical) are ‘safer’
b. all target D2 receptors
c. target 5HT receptors
d. have many side effects
e. were first used in the 1950’s
c
side effects of antipsychotics…
All antipsychotics:
- sedation
- hyperprolactinemia
- neuroleptic malignant syndrome
- sexual dysfunction
- fatty liver
- Qt elongation
First generation:
- extrapyramidal symptoms (motor disabilities)
Second generation:
- agranulocytosis/nrueotropenia (clozapine)
- weight gain, diabetes, hyperlipidemia
- lower risk of extrapyramidal symptoms
why was clozapine referred to as the most effective antipsychotic? what are its side effects?
- Clozapine has high affinity for 5HTR and low affinity for D2 receptors.
- it is the only effective antipsychotic in treatment resistant patients
- may also be good for treating negative symptoms
BUT - BAD SIDE EFFECTS:
- Clozapine is the only antipsychotic that causes agranulocytosis (low white blood cells) –> was taken off the market for a while
what are the pros and cons of psychosocial interventions as treatment against schizophrenia?
pros:
- may be the only effective treatment for neg. symptoms
- overall increased quality of life
cons:
none really…(time, effort, $$)
what treatment strategy would you suggest to a patient with schizophrenia who hasn’t been responding to medications?
treatment resistant schizophrenia can be potentially treated with rTMS and ECT:
ECT:
- used to treat catatonic symptoms
- very effective at treating positive symptoms and somewhat effective at treating neg. symptoms
- -> however, there are many side effects (e.g. retrograde amnesia)
rTMS:
- more effective at treating negative symptoms
- no retrograde amnesia
- -> however, not as effective as ECT (more effective in MDD)
–> therefore, if the patient is treatment resistant, one may need to assess the current state of the patient in order to choose a suitable treatment- if the patient is in a psychotic phase with catatonia–> ECT may be the only efficient treatment, but if they are more stable, the negative symptoms may be treated with rTMS and psychosocial interventions
what was the best empirical evidence for the heritability of schizophrenia?
twin studies and adoption studies
what are the steps of genome-wide association studies (GWAS)? how did they contribute to understanding the genetics of schizophrenia?
- GWAS examine millions of SNPs for frequency differences between cases and controls.
- explains ~70% of the tot variants in the genome
- chi-square test
procedure:
for each SNP: 1. counts for G nucleotides in controls and cases–>2. frequency distribution–> 3. chi-square–> 4. P value–> 5. Manhattan plot of SNP frequency across genome
findings:
- they found that region MhC on chromosome 6 is highly associated with schizophrenia because the frequency of SNPs is the highest between control and cases.
- In addition they found that region Mir137 on chromosome 1 is associated with regulation of genes that have been linked to schizophrenia
