Schizophrenia Spectrum and Other Psychotic Disorders Flashcards
Psychotic Symptom Domains
- Delusions 2. Hallucinations 3. Disorganized speech- CORE 4. Disorganized behavior 5. Negative symptoms.
Delusions
a fixed belief that is not amenable to change even in light of conflicting evidence, .Grandeur- grandiose Persecution (Paranoid) Control (external force controlling behavior) reference- belief that an outside action refers directly to the person or ha s a special personal meaning to the person. Thought of broadcasting delusion
Hallucinations
A sensory perception without an external stimulus- auditory, voices, commentaries, derogatory
Disorganized Speech
Loss of normal logical connections between thoughts.
- Tangentiality- shifting off-topic
- Fight of Ideas- Rapid shifting of thoughts
- Clang Associations- Word associations based on rhyming
- Word Salad- No meaningful relationship between words and phrases.
Differential Dianosis for disorganized speech
post stroke aphasias. look for the presence of phonemic paraphasic errors, (speech errors characterized by additions/deletions of syllables.)
Grossly Disorganized or Catatonic Behavior
Disorganized- non-goal oriented behavior
Catatonia-multiple motor behavioral abnormalities that reflect diminished reactivity to the environment.
Negative Symptoms
Diminished emotional expression, avolition, alogia, anhedonia, asociality
Positive vs. Negative Symptoms
Postitive-thoughts, behaviors, or perceptions that are distorted or in excess of normal function.(symptoms 1-4)
Negative symptoms-(Symptom domain 5)
Schizophrenia-
DC-2 psychotic domain symptoms 1 must be a core symptom. Active phase persists for at least 1 month. must show signs of the disturbance for greater than 6 months.
Schizophrenia Timeline
greater than 6 months of Prodromal phase, active phase and residual phase. prodormal and residual phases manifest as only negative symptoms or sub-threshold domain symptoms.
Differential of schizophrenia
substance induced psychosis, consider psychotomimetic drugs such as stimulants and dissociative anaesthetics.
Associated features of schizophrenia
low socioeconomic attainment, nicotine addiction, suicide risk and aggressive tendencies, (if they are command hallucinations or feel threatened due to paranoid delusions)
onset of Schizophrenia
Typical onset: Late teens with slightly later onset in women. If late onset morelikely to be female with positive symptoms and less severe course. Childhood onset- Severe form of disorder with notable nerodegeneration.
Course and Outcome
Chronic with Slow gradual decline or fluctuating symptoms
-Moderate to severe disability with episodic hospitalization.
Predictors of Outcome
Better- older, rapid, positive, present, female
Worse- younger, slow, negative, absent, male
Neurochemical Changes and Dopamine hypothesis
Overactivity of mesolimbic DA relates to positive symptoms, Underactivity of mesocortical DA accounts for negative symptoms.
Neurostructural Changes of Schizophrenia
Enlarged cerebral ventricles, cortical atrophy, hippocampal atrophy, Hypofrontality (decreased pre-frontal lobe metabolism)
Cognitive Effects: Impairments in multiple cognitive areas. including attention, memory, executive functions, etc.
Etiology of schizophrenia
A lesion occurs during early brain development, when the affected structure come online with brain maturation symptoms emerge. Hippocampal Cellular disorganization, increased neurological soft signs, Increased minor physical anomalies.
Genetic risk factors are there and non-genetic risk factors, obstetric complications, maternal infection, and or other environmental factors that effect neurodevelopment.
Treatments for pharmacological
Antipsychotics are the mainstay treatment all are dopamine 2 receptor antagonists.
Traditional antipsychotics
Chlorpromazine- 1st antipsychotic drug, Haloperidol
Mechanism of Action DA2 antagonist.
It improves positive symptoms,
Side effects- extrapyramidal syndrome due to nigrostriatal DA2 blockade
