Sutherland- Schizophrenia Flashcards
What is schizophrenia and when is it’s onset?
Severe neurodevelopmental illness.
Onset in early adulthood after years of prodromal symptoms.
What are the key symptoms of schizophrenia?
Cognitive impairment
Affective sx
Perceptual and thought disturbance
Social function impairment
What is the prevalence of schizophrenia?
Less than 1% of pop M (17--27) >F (17-37) Loss of >20 years Urban > rural Low SES > high (social drift)
Describe cognitive impairment in schizophrenia.
Precedes onset of classical psychosis.
Outlasts hallucinations and delusions
Poor working memory/attention.
Impaired frontal-executive function and disorganized thought.
-disrupts relationships w/ friends, coursework in school
What are Negative Sx associated with schizophrenia?
Apathy Flat affect Withdrawal Social avoidance Poor motivation Self neglect
What are positive sx?
*Paranoid delusions/nihilistic
Hallucinations (auditory > visual > other)
Odd behavior
How is social funcitoning impaired with schizophrenia?
Educational, vocational, independent living, small social networks
What are the subtypes of schizophrenia?
Disorganized
Paranoid
Catatonic (movements slowed/excessive)
Undifferentiated
Where does mental illness come from?
Noted for 3000 years. 1700s psychosis seen as disease. 1900s asylum research identified as illness. 1950s de-institutionalization. 19902 first SGAs.
What are the risk factors associated with schizophrenia?
Positive family hx
Perinatal complications-infection
Late winter/early spring births have higher likelihood
Lower rates in village cultures
Use of stimulant, hallucinogenic drugs and marijuana have a 3x increase
What is the course of schizophrenia?
Onset: late teens
20s: 5-10 years of acute illness
Late illness: positive sx decline
High mortality: medical illness, accidents > suicide
What is suicide risk w/ schizophrenia?
HUGE risk of suicide 4-5%
Death by heart disease at lesat 50% higher than population rates
Lifespan reduce by more than 20 years.
What is the pathophysiology of schizophrenia?
Increased brain DA
Loss of brain mass (dorsolateral prefrontal cortex deficit, enlarged ventricles, decreased temporal lobe)
Loss of brain connections (white matter)
What is the genetic component of schizophrenia?
Increase in risk with first degree relative (both parents w/ schizophrenia)
Concordance with monozygotic twins
How do perinatal issues and infections relate to schizophrenia?
Maternal infections birth complications Rh incompatibility Malnutrition Late winter/early spring
How do immune issues and schizophrenia relate to schizophrenia?
*Higher incidence of schizo Higher latitude Influenza Borna disease Borrelia Toxoplasmosis REtrovirus Poliomyelitis
What is expressed emotion theory?
Difference in course of illness with families with harsher vs calmer environments.
What causes psychosis? What are the sx of psychosis? What drugs induce psychosis?
Increase in DA
hallucinations, paranoia, manic sx
Amphetamine, cocaine, L-dopa
What reduces psychotic sx? Drugs?
Decreased DA
Antipsychotics
Campazine, Reglan
What is observed in untreated schizophrenia?
Increased DA
How does 5HT relate to schizo?
5HT stimulates DA
How does Glutamate relate to schizo?
May cause an increase in DA
-PCP blocks Glu (best drug model of pschizophrenia)
How does GABA relate to schizo?
Modulates DA and Glu
Why do people w/ schizophrenia (80%) have a high rate of nicotine use?
Helps to stimulate primary nicotinic receptor decrease that’s a part of the disease. Increases metabolism to reduce blood levels of medication.
How does NE relate to schizo?
If it decreases may worsen neg sx
What are the neurodevelopmental factors related to schizo?
Disturbed brain development
Loss of brain development with enlarged ventricles
Superior temporal gyrus loss
Dorsolateral prefrontal and limbic disconnect
Cortex/thalamus/cerebellum disturbance (+ sx)
What are the key features for diagnosis?
Chronic illness > 6 mos Deterioration from previous funciton level Complex psychotic sx >2: -hallucinations -delusions -speech disorganization -disorganized behavior -negative sx Not better explained by another illness
What is the differential diagnosis for schizophrenia?
- Psychiatric Disordes
- Other psychotic disorders
- Mood disorders (20% have hallucinations)
- Autism: odd behavior, positive sx not as prominent - Substance use disorder
- Amphetamine and other stimulants
- synthetic cannabinoids, marijunana, PCP
- comorbidity up to 65% - General medical disorder
- brain tumor
- metabolic, endocrine, infectious, neurological
- drugs
- dementia
What is a schizoaffective disorder?
Schizophrenia + concurrent major mood sx that are persistent through disorder
What is a delusional disorder?
Paranoia, minimal hallucinations, GOOD FUNCTION
What is a schizotypal personality?
Social isolation, lack of desire for relationship
Odd ideas, experiences but no delusions/hallucinations
How can you differentiate between mania and schizophrenia?
Schizo-slow thought processing
Mania- fast thought processing
What is the treatment for schizophrenia?
- Medication: D2 DA blockers, NMDA receptors should work but we don’t have a drug yet
- Rehabilitation and Recovery: employment
