Schizophrenia Spectrum Disorders

Question 1

Gender difference with schizophrenia

Answer 1

Women with schizophrenia tend to have later illness onset, lower negative symptom severity, greater affective symptoms, and better social, cognitive, and premorbid functioning than men with schizophrenia.

Question 2

Neuropsychological expectations among schizophrenia

Answer 2

Moderate to severe deficits across almost all neuropsychological functions: with memory, attention, and executive functioning demonstrating the most robust impairments.

Question 3

Which treatment has shown consistent benefits for cognitive functioning in schizophrenia

Answer 3

Cognitive remediation

Question 4

Early-onset schizophrenia

Answer 4

Development of the disorder between the ages of 13 and 17.

Question 5

Childhood-onset schizophrenia

Answer 5

Development of the disorder before age 13

Question 6

The genetic risk for schizophrenia is best explained by…

Answer 6

Thousands of genetic variations, each of which has a small effect

Question 7

The diagnosis of schizophrenia requires continuous signs of disturbance lasting for at least what period of time?

Answer 7

6 months

Question 8

Brief psychotic disorder duration

Answer 8

lasts 1 day to 1 month

Question 9

Schizophreniform vs schizophrenia

Answer 9

Schizophreniform disorder has the same symptoms as schizophrenia but does not last 6 months and does not require a decrement in functioning for a diagnosis.

Question 10

Which of the following neurocognitive functions is generally best preserved among individuals with schizophrenia?

Answer 10

Visuospatial reasoning

Question 11

Average deficit in SD to be about how far below normative expectations for individuals with chronic schizophrenia?

Answer 11

1.0 to 1.5 standard deviations

Question 12

All of the conventional or first-generation and most of the atypical or second-generation antipsychotic drugs share which pharmacological property?

Answer 12

D2-type dopamine receptor antagonism

Question 13

Features of the prodromal phase:

Answer 13

marked by an increasing tendency toward social withdrawal, declines in role functioning, and brief, intermittent or subthreshold psychotic symptoms, including perceptual disturbances and odd, unusual, or suspicious thinking, that occurs with increasing frequency and conviction.

Question 14

Schizophrenia is approximately X% heritable.

Answer 14

80%

Question 15

Diagnosis of Schizophrenia

Answer 15

2 or more of the following symptoms:
- delusions
- hallucinations
- disorganized speech
- disorganized behavior or catatonia
- negative symptoms

Signs of disturbance lasting at least 6 months and impairments.

Question 16

What is the single specifier used for Schizophrenia?

Answer 16

Catatonia –> marked by motor immobility, excessive non purposeful motor activity, extreme negativism, peculiarities of voluntary movement, echolalia, or echopraxia.

Question 17

Neuropathology of Schizophrenia

Answer 17

Neurodevelopmental models with genetic diathesis or vulnerability –> genes underlying are involved in signal transduction, play a role in CNS signaling during embryogenesis leading to development faulty neurocircuitry.

Cortical + subcortical reductions in gray matter volume and decreased white matter integrity.

Neuroimaging has shown prominence of cortical sulk + ventricular enlargement, but etiology remains unknown.

Question 18

What are some neurodevelopment abnormalities seen in Schizophrenia?

Answer 18

premorbid behavioral and neurological signs

Adverse prenatal + perinatal events

reduced dendritic complexity and lower spine and synapse density on cortical pyramidal neurons.

Question 19

Summary of current evidence for neurodevelopment model of Schizophrenia

Answer 19

Schizophrenia is marked by widespread changes in the cortex, with cortical thinning, decreased neuropil, reductions in white matter integrity, ventricular enlargement, and abnormalities in subcortical structure.

• Multiple neurodevelopmental factors are suspected, including possible flaws in cell migration, establishment and/or pruning of synapses.
• A combination of genetic and early developmental risk factors probably serve as a substrate, increasing vulnerability to stressors, that may precipitate decompensation and further dysregulation of brain function.

Question 20

What are the risk factors as it relates to Genetic Liability?

Answer 20

• Family Hx (~50% for twins), with heritability estimates between 80-85%.

-Hundreds too thousands of generic variants with SMALL effect sizes.

• risk for schizophrenia spectrum disorder are shared with wide range of other syndromes including –> ADHD, MDD, bipolar dx, and ASD

Question 21

What are the risk factors in context to Obstetric complications?

Answer 21

Maternal infection during pregnancy

maternal malnutrition

labor & delivery complications

prematurity

low birth weight

Question 22

What are the risk factors in context to Premorbid Intelligence & Pervasive Developmental Disorder?

Answer 22

Presence of ID and ASD are considered risk factors, but could coincide with biological risk as well.

Question 23

What are the risk factors in context to Substance Use?

Answer 23

Frequent marijuana use during adolescence = increased risk for schizophrenia

Question 24

What are the risk factors in context to Age?

Answer 24

Develops during late adolescence and young adulthood.

Earlier onset = poorer prognosis

Reducing gap between psychosis and tx = improved outcomes

Question 25

What are the risk factors in context to Sex?

Answer 25

Females –> later onset, lower negative symptoms severity, greater affective symptoms, and better function (social, cognitive, premorbid).

Evidence of bio model age of onset distribution with second lead occurring after age 40.

Question 26

What are the risk factors in context to SES?

Answer 26

Higher rates in parents that are unmarried/divorced.

Low income

Poverty

Question 27

Medical comorbidities with schizophrenia

Answer 27

Cardiovascular morbidity –> due to smoking, obesity, diabetes, HTN, HLD

Other reasons for cardiovascular issues:
- Metabolic syndromes –> increase risk of heart attack and CVA
- Long-term antipsychotic use = risk of weight gain and metabolic issues
-malnutrition
-sedentary lifestyle
-Markers of abnormal coagulation
- TB

Question 28

Determinants of Severity

Answer 28

Question 29

Prodromal or Attenuated Psychosis Syndrome

Answer 29

There is an attentuated or “sub threshold” positive psychotic symptoms or brief intermittent psychotic symptoms.

May report more mild 1) perceptual abnormalities and 2) delusions

Question 30

Neuropsychological Impairment in youth

Answer 30

deficits in verbal + visual memory, attention, WM, verbal fluency, emotion recognition, and olfactory processing.

Question 31

Residual effects of Schizophrenia

Answer 31

Symptoms largely remit except maybe negative symptoms.

Cognitive impairment persists throughout all phases.

Question 32

Neuropsychological Assessment Profile

Answer 32

Intelligence/Achievement:
- Fluid intelligence abilities are more IMPAIRED than crystallized.
- academic achievement is BETTER than fluid intelligence.

Attention/concentration
- Core features – reaction time, vigilance, and selective attention.

*Processing speed = among the most significant

Language
- basic language abilities are preserved with higher level abilities (syntax comprehension, word-list generation) are impaired.
- speech/language disruptions are related to formal thought disorder.

Visuospatial skills
- typically better preserved but tasks requiring attention and psychomotor speed shower greater impairments.

Memory
- declarative memory = severely impaired, particularly in encoding, consolidation, and retrieval.

EF
- Impaired – planning, flexibility, cognitive control
- overlap between WM and attention

Sensorimotor
- motor side effects due to antipsychotic meds (e.g., Parkinsonism, akathisia)
- tardive dyskinesia and catatonia

Emotion/personality
- social cognition – emotion processing, theory of mind

PVT/SVT
- reduced test engagement or response bias is common

Question 33

Role of stimulants

Answer 33

inconsistent results and/or poor benefit risk ratio for meds treating cognitive disorders.

stimulants (e.g., amphetamines, methylphenidate) are prescribe but may increase vulnerability to the development of psychotic episode

Question 34

What other medications in addition to antipsychotics are individuals prescribed?

Answer 34

mood stabilizers and/or antipsychotics

sedatives –> added to address agitation

anticholinergic –> to address iatrogenic movement disorders

soporifics –> address sleep disturbance

Question 35

Neuroleptic malignant syndrome (NMS)

Answer 35

Uncommon incident, potentially life threatening.

Fever, altered mental status, muscle rigidity, and autonomic dysfunction.

Occurs within hours or days, nearly all cases occur within 30 days of exposure.

Question 36

Serotonin syndrome

Answer 36

Rare, life threatening.

Adverse reaction to drugs that overstimulate 5-HT1a receptors in the central gray nuclei and medulla.

Within 24 hours of introduction of the causative serotonergicc agent.

Usually linked to an antidepressant or mood stabilizer.

Question 37

Agranulocytosis

Answer 37

Rare, potentially fatal adverse reaction

lower of white blood cells that may arise in patients with variety of agent.

*Clozapine

Question 38

Other novel treatments

Answer 38

neurostimulation

transcranial pulsed ultrasound (TPU), transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), and transcranial magnetic stimulation (TMS).

Question 39

Late onset Schizophrenia (LOS)

Answer 39

Uncommon in men, observed more in women.

Thought to be related to hormonal changes due to menopause.

Question 40

Very late onset schizophrenia-like psychosis (VLOSP)

Answer 40

Special attention to rule out disorders with psychotic features

Question 41

Traditional (First generation) Antipsychotics

Answer 41

chlorpromazine (Thorazine)
haloperidol (Haldol)
fluphenazine (Prolixin)

All of which are thought to have their antipsychotic efficacy mediated by action at D2- type dopamine receptors.

*once called neuroleptic drugs.

Question 42

Second generation antiopsychotic agents

Answer 42

Activity at the D2-receptor but also tend to have more complex pharmacological profiles

clozapine (Clozaril) olanzapine (Zyprexa) aripiprazole (Abilify) risperidone (Risperdal)

Question 43

Extrapyramidal Side Effects

Answer 43

Signs and symptoms that occur following the use of antipsychotic medication; can be acute or chronic. The acute symptoms include parkinsonism, dystonia, and akathisia. Chronic signs include tardive dystonia and tardive dyskinesia.

Question 44

Tardive Dyskinesia

Answer 44

A neurological syndrome of involuntary movements of the head, tongue, trunk, or extremities associated with the long-term use of antipsychotic medications or drugs that block dopamine receptors. Signs of tardive dyskinesia include chorea, facial grimacing, dystonia, tics, tongue protrusion, and rapid eye blinking.

Question 45

Second generation medications ameliorate which symptoms in schizophrenia?

Answer 45

Positive

Question 46

Negative symptoms include:

Answer 46

flat affect and avolition/apathy

Negative symptoms, originally referred to as “negative” to signify a loss or decrease of normal function in contrast to positive symptoms, is a term that was first applied to the “five A’s,” affective flattening, alogia, anhedonia, avolition-apathy and attentional impairment. Alogia and attentional impairment, however, may better be considered part of the disorganization syndrome.