Scizophrenia Flashcards
schizophrenia
chronic, debilitating illness associated with deterioration in mental function and behavior. involves a gene by environment interaction. not caused by known social or environmental factor, exacerbated by social stress.
hallmark symptom of schizophrenia
psychosis. impairment in reality testing that may present as alteration in sensory perceptions, abnormalities in thought content, abnormalities in thought process/organization.
illusion
misperception of real external stimuli
hallucinations
sensory perceptions not generated by external stimuli
ideas of reference
false convictions that one is subject of attention by other people. feeling as though people are referring to you in their conversations
delusions
false beliefs not correctable by logic or reason, not based on simple ignorance, and not shared by culture; delusions of persecution most common
loss of ego boundaries
not knowing where one’s mind and body end and those of others begin
alogia
lack of informative content in speech, lacking/poverty of speech
echolalia
repeating statements of others/associating words by their sounds, not by their meaning
thought blocking
abrupt halt in the train of thinking, often because of hallucinations
neologisms
inventing new words
circumstantiality
in responding to questions, one presents unneccessary and voluminous details before arriving at answer
tangentiality
beginning a response in a logical fashion but then getting further and further away from the point and failing to answer the original question
loose associations
loss of logical meaning between words or thoughts, when asked a question, illogically jumps from one subject to another
characteristics of schizophrenia
at least one episode of psychosis with persistent disturbances of thought, behavior, appearance, speech, and affect as well as impairment in occupation and social functioning. No clouding of consciousness! attention and memory are intact when not psychotic. alert and oriented.
DSM-5 diagnostic criteria for schizophrenia
2 or more of the following, each present for a significant portion of time during a 1-month period: delusions, hallucinations, grossly disorganized or catatonic behavior, negative symptoms, disorganized speech. One or more major areas of functioning are markedly below level achieved prior to onset. Continuous signs of the disturbance persist for at least 6 months!! Symptoms cannot be due to another illness. Symptoms cannot be due to substance use or a medical disorder or a drug.
positive symptoms
additional to expected behavior. delusions, hallucinations, agitation, talkativeness, thought disorder
negative symptoms
missing from expected behavior. lack of motivation, social withdrawal, flattened affect/emotion, cognitive disturbances, poor grooming, poor speech.
why were subtypes of schizophrenia eliminated?
poor validity, limited diagnostic stability, low reliability
prodromal phase
prior to first psychotic break. avoidance of social activities. quiet and passive or irritable. sudden interest in religion or philosophy. may have physical complaints. anxiety and depression common.
psychotic/active phase
loss of touch with reality. associated with the positive symptoms
residual phase
period between psychotic episodes. in touch with reality, but doesnt behave normally. negative symptoms, peculiar thinking, eccentric behavior, and withdrawal from social interactions
genetics of schizophrenia
more common in twins. advanced paternal age can hurt. equally in men and women. women respond better to antipsychotics. women have greater risk of tardive dyskinesia though.
environmental factors for schizophrenia
viral infection and exposure to drugs. increased incidence when born in cold weather months. third trimester maternal use of diuretics. anti-NMDA receptor antibodies?? (unsure about this)
neurological abnormalities
decreased use of glucose in prefrontal cortex. laterand and third ventricle enlargement. abnormal cerebral symmetry (loss of asymmetry). decreased volume of hippocampus, amygdala, and parahippocampal gyrus. decreased alpha waves, increased theta and delta waves and epileptiform activity on EEG. abnormalities in eye movements.
brain activity in schizophrenia
dorsolateral prefrontal cortex is hypoactive. ventromedial cortex is hyperactive. auditory cortex is hyperactive while hallucinations occur.
dopamine hypothesis
excessive dopaminergic activity in mesolimbic tract. negative symptoms can involve hypoactivity of mesocortical dopamine tract. elevated levels of homovanillic acid (metabolite of DA) suggests more DA activity and use in the CNS
serotonin hpyeractivity
hallucinogens such as LSD, which increase serotonin, cause hallucinations and delusions. newer atypical antipsychotics have anti 5HT2A receptor activity
norepinephrine hyperactivity
paranoid subtype may have increased metabolites
glutamate hypothesis
major excitatory neurotransmitter in CNS. antagonists of NMDA subtype of GLU receptors aggravate and create psychosis while agonists of NMDA receptors may experimentally relieve symptoms.
NMDA receptor hypoactivity hypothesis
NMDAR proteins become ineffective or underactive if mutated. if they sit on GABA interneurons, can cause loss of inhibition to lead to increase in firing and extra DA in the limbic system
normal functioning glutamate stuff
GLU-GABA-GLU-DA. Glu stimulates GABA, which turns off second Glu receptor, which causes minor increase in DA, but controlled.
positive symptoms in glutamate stuff
Glu cant reach GABA, due to bad receptor. no inhibition. second glu goes wild and causes tons of DA release
negative symptoms
GLU-GABA-GLU-GABA-DA. GABA receptor is messed up and doesnt get stimulated, lose inhibition, and pump out too much Glu. second GABA gets inhibited too much and you lose DA.
medication for schizophrenia
all effective antipsychotics block D2 receptors in the mesolimbic DA path. often a life long treatment. higher potency drugs cause more side effects. 5HT2a blockade allows DA to more freely flow in the nigrostriatal path. low compliance rates
psychotherapy for schizophrenia
provide long term support for patient and family. foster compliance with drug regimen. cognitive behavioral therapy improves executive dysfunction. family therapy. peer and mentor support or social skills groups.
