Schizophrenia - Sutherland Flashcards
What year did the first antipsychotic medication come out in France?
1953 - Chlorpromazine
When is the peak age of onset for male and females?
Males 17-27 yoa
Females 17-37 yoa
In terms of positive family history, what percent of monozygotic twins will have schizophrenia?
50% concordance
What are the risk factors for schizophrenia?
- 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
What is the goal of first episode psychosis programs (U of M)?
Prevent progression of illness to middle course.
Provide resources for social function impairment:
- Educational
- Vocational
- Independent living
- Small social networks
How much is the lifespan of a person diagnosed with schizophrenia reduced?
Reduced by more than 20 years
How can you tell the difference between depressive psychosis and schizophrenia?
Three questions:
- How long has it lasted?
- Environmental precursors?
- trauma, stress, abuse
- Are the delusions exclusively depressed delusions or non-depressed delusions?
What is the most disabling feature of schizophrenia?
Cognitive Decline
What is the prevalence of Schizophrenia?
Less than 1% of population.
What is the male to female prevalence ration of schizophrenia?
Male to female
1.4 : 1
What are some of the cognitive impairments associated with schizophrenia?
- Precedes classical psychosis and last longer than hallucinations and delusions
- Poor working memory
- Poor Attention
- Impaired Executive Function: Language impairment/Disorganized thoughts
What is the hallmark complaint of someone (usually family) that refers the patient to seek medical help?
“something just changed in this person”
What are the affective or “Negative Symptoms” of schizophrenia?
- 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
What are the perceptual and thought disturbances or “Positive Symptoms” of schizophrenia?
- 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
What is the lifetime risk of suicide in people with schizophrenia?
HIGH
- 4-5%
- Some studies say up to 10%
What is the course of schizophrenia (include early, middle, and late illness)?
- 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
What neurotransmitter is increased in schizophrenia and can lead to psychosis when in excess?
Dopamine
What physiologic changes are generally found in the brains of schizophrenics?
- Loss of Brain Mass
- dorsolateral prefrontal cortex deficit
- enlarged ventricles
- smaller temporal lobe
- Loss of brain connections - especially white matter
- Cortex/thalamus/cerebellum disturbance
What other conditions do you need to rule out in your differential diagnosis before you can determine schizophrenia as the diagnosis?
- 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
What are the DSM-5 diagnostic criteria for Schizophrenia?
- 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
