Schizophrenia - Sutherland Flashcards

1
Q

What year did the first antipsychotic medication come out in France?

A

1953 - Chlorpromazine

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2
Q

When is the peak age of onset for male and females?

A

Males 17-27 yoa

Females 17-37 yoa

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3
Q

In terms of positive family history, what percent of monozygotic twins will have schizophrenia?

A

50% concordance

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4
Q

What are the risk factors for schizophrenia?

A
  • positive family history
  • perinatal complications - infection
  • late winter/early spring births (feb/march)
  • Northeast/West areas of US
  • Immigration
  • Use of stimulant, hallucinogenic drugs
    • Marijuana use 2.9x increased risk
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5
Q

What is the goal of first episode psychosis programs (U of M)?

A

Prevent progression of illness to middle course.

Provide resources for social function impairment:

  • Educational
  • Vocational
  • Independent living
  • Small social networks
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6
Q

How much is the lifespan of a person diagnosed with schizophrenia reduced?

A

Reduced by more than 20 years

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7
Q

How can you tell the difference between depressive psychosis and schizophrenia?

A

Three questions:

  • How long has it lasted?
  • Environmental precursors?
    • trauma, stress, abuse
  • Are the delusions exclusively depressed delusions or non-depressed delusions?
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8
Q

What is the most disabling feature of schizophrenia?

A

Cognitive Decline

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9
Q

What is the prevalence of Schizophrenia?

A

Less than 1% of population.

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10
Q

What is the male to female prevalence ration of schizophrenia?

A

Male to female

1.4 : 1

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11
Q

What are some of the cognitive impairments associated with schizophrenia?

A
  • Precedes classical psychosis and last longer than hallucinations and delusions
  • Poor working memory
  • Poor Attention
  • Impaired Executive Function: Language impairment/Disorganized thoughts
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12
Q

What is the hallmark complaint of someone (usually family) that refers the patient to seek medical help?

A

“something just changed in this person”

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13
Q

What are the affective or “Negative Symptoms” of schizophrenia?

A
  • Apathy
  • Flat affect → blend into background
  • Withdrawal
  • Social avoidance
  • Poor motivation
  • Self neglect
  • Agitation → leads to violence and need for restraint in ER settings, higher risk of poor outcome
    • Treat the disorganization but worry most about agitation
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14
Q

What are the perceptual and thought disturbances or “Positive Symptoms” of schizophrenia?

A
  • Hallucinations (auditory > visual > other)
  • Delusions
    • Paranoid
    • Nihilistic → world is coming to an end
  • Odd behavior → way dress/act, behaviorism
  • Poverty of thought → brain is filled hallucinations and delusions so they cannot think clearly
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15
Q

What is the lifetime risk of suicide in people with schizophrenia?

A

HIGH

  • 4-5%
  • Some studies say up to 10%
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16
Q

What is the course of schizophrenia (include early, middle, and late illness)?

A
  • Early course: onset in late teens/20’s ⇒ try and stop progression here with early intervention
  • Middle course: 5-10 years of acute illness, followed by plateau
  • Late illness: positive symptoms gradually worsen, high mortality
17
Q

What neurotransmitter is increased in schizophrenia and can lead to psychosis when in excess?

A

Dopamine

18
Q

What physiologic changes are generally found in the brains of schizophrenics?

A
  • Loss of Brain Mass
    • dorsolateral prefrontal cortex deficit
    • enlarged ventricles
    • smaller temporal lobe
  • Loss of brain connections - especially white matter
    • Cortex/thalamus/cerebellum disturbance
19
Q

What other conditions do you need to rule out in your differential diagnosis before you can determine schizophrenia as the diagnosis?

A
  • Hepatic Encephalopathy
  • Autism Spectrum Disorder
  • Epilepsy
  • Demyelinating Disorders
  • Hypo/Hyperthyroidism
  • Graves’ Disease
  • Wilson’s Disease
  • Other psychiatric disorders
  • Mood disorders, autism
  • Schizophreniform disorder
  • Schizoaffective disorder
  • Delusional disorder
  • Brief psychotic disorder → postpartum depression
  • Substance use disorder
  • Drugs: amphetamines, stimulants, marijuana, PCP, hallucinogens
  • General medical disorder
  • Brain tumor, endocrine, metabolic, infectious, neurologic, medications, dementia
20
Q

What are the DSM-5 diagnostic criteria for Schizophrenia?

A
  • Acute psychotic episode
  • Decline in functioning
  • >6 month impairment (chronic illness)
  • Complex Psychotic symptoms (2+):
    • Hallucinations
    • Delusions
    • Speech disorganization
    • Disorganized behavior
    • Negative symptoms (antisocial)
  • Not better explained by another illness
  • Hallucinations in cultural context does not count
  • No subtypes anymore