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1

In the United States, the lifetime prevalence of schizophrenia is

about 1 percent

2

Schizophrenia is (EQUALLY/UNEQUALLY) prevalent in men and women

Schizophrenia is equally prevalent in men and women

3

Schizophrenia onset is earlier in

a. men than in women
b. women than in men

Schizophrenia onset is earlier in men than in women

More than half of all male schizophrenia patients, but only one third of all female schizophrenia patients, are first admitted to a psychiatric hospital before age 25 years.

The peak ages of onset are 10 to 25 years for men and 25 to 35 years for women.

4

What are the peak ages of onset for

men
women

The peak ages of onset are 10 to 25 years for men

25 to 35 years for women

5

About 90 percent of patients in treatment for schizophrenia are between (xx to yy) years old

15 and 55

6

disorder is characterized as late-onset schizophrenia when

when onset occurs after age 45 years

7

First­ degree biological relatives ofpersons with schizophrenia have a (greater/lesser) risk for developing the disease than the general population.

ten times greater risk

8

The simplest formulation of the dopamine hypothesis of schizophrenia posits that schizophrenia results from (NOT ENOUGH/TOO MUCH) dopaminergic activity.

The simplest formulation of the dopamine hypothesis of schizophrenia posits that schizophrenia results from TOO MUCH dopaminergic activity.

9

Which biochemical factors are important in schizophrenia are:

* Dopamine

* Serotonin

Norepinephrine

GABA

Neuropeptides

Glutamate

Acetylcholine and Nicotine

10

What are the symptoms of schizophrenia?
(Criterion A)

1. Delusions

2. Hallucinations

3. Disorganized speech (e.g., frequent derailment or incoherence)

4. Grossly disorganized or catatonic behavior

5. Negative symptoms (i.e., diminished emotional expression or avolition).

11

What are the 3 most important symptoms of schizophrenia?

How many are required for diagnoses? (1/2/3)

At least one of these must be (1), (2), or (3)

1. Delusions

2. Hallucinations

3. Disorganized speech (e.g., frequent derailment or incoherence)

12

Diagnostic criteria A for the symptoms of schizophrenia

Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1 ), (2), or (3):

1. Delusions

2. Hallucinations

3. Disorganized speech (e.g., frequent derailment or incoherence)

13

Criterion B-F of Schizophrenia

B. Level of functioning in one or more major areas of functioning, such as work, interpersonal relations, or self-care, is markedly below the level achieved before the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of functioning).

C. Continuous signs of the disturbance persist for at least 6 months.

D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out. Either (1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or (2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.

E. The disturbance is not attributable to the physiological effects of a substance or another medical condition.

F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).

14

Subtypes of schizophrenia

Paranoid Type

Disorganized Type

Catatonic Type

Undifferentiated Type

Residual Type

15

Subtypes of schizophrenia

Paranoid Type

paranoid type of schizophrenia is characterized mainly by the presence of delusions of persecution or grandeur

16

Subtypes of schizophrenia

Disorganized Type

characterized by a marked regression to primitive, disinhibited, and unorganized behavior and by the absence of symptoms at meet the criteria for the catatonic type

17

Subtypes of schizophrenia

Catatonic Type

marked disturbance in motor function; this disturbance may involve stupor, negativism, rigidity, excitement, or postur­ing

18

Subtypes of schizophrenia

Undifferentiated Type

patients who clearly have schizophrenia cannot be easily fit into one type or another.

19

Subtypes of schizophrenia

Residual Type

charac­terized by continuing evidence ofthe schizophrenic disturbance in the absence of a complete set of active symptoms or of sufficient symptoms to meet the diagnosis of another type of schizophrenia

20

Differential Diagnosis of Schizophrenia-Like
Symptoms:

Medical and Neurological

*Substance induced

*Epilepsy-

* Neoplasm, cerebrovascular disease, or trauma-especially frontal or limbic

* Acute intermittent porphyria

* AIDS

* Vitamin B12 deficiency

* Carbon monoxide poisoning

* Cerebral lipoidosis

* Creutzfeldt-Jakob disease

* Fabry's disease

* Fahr's disease

* Hallervorden-Spatz disease

* Heavy metal poisoning

*Herpes encephalitis

* Homocystinuria

* Huntington's disease

*Metachromatic leukodystrophy

*Neurosyphilis

* Normal pressure hydrocephalus

* Pellagra

* Systemic lupus erythematosus

* Wernicke-Korsakoff syndrome

* Wilson's disease

21

Differential Diagnosis of Schizophrenia-Like
Symptoms:

Psychiatric

* Atypical psychosis

* Autistic disorder

* Brief psychotic disorder

* Delusional disorder

* Factitious disorder with predominantly psychological signs and symptoms

* Malingering

* Mood disorders

* Normal adolescence

* Obsessive-compulsive disorder

* Personality disorders-

* Schizoaffective disorder

* Schizophrenia

* Schizophreniform disorder

22

Course of Schizophrenia

* The classic course of schizophrenia is one of exacerbations and remissions.

* Patients usually relapse, however, and the pat­tern of illness during the first 5 years after the diagnosis gen­erally indicates the patient's course.

* Further deterioration in the patient's baseline functioning follows each relapse of the psychosis. This failure to return to baseline functioning after each relapse is the major distinction between schizophrenia and the mood disorders.

23

What is the major distinction between schizophrenia and the mood disorders?

* Further deterioration in the patient's baseline functioning follows each relapse of the psychosis.

This failure to return to baseline functioning after each relapse is the major distinction between schizophrenia and the mood disorders.

24

over the 5- to 10-year period after the first psychiatric hospitalization for schizophrenia, what percent is described as having a GOOD outcome?

over the 5- to 10-year period after the first psychiatric hospitalization for schizophrenia, only about 10 to 20 percent of patients can be described as having a good outcome

25

over the 5- to 10-year period after the first psychiatric hospitalization for schizophrenia, what percent is described as having a POOR outcome?

over the 5- to 10-year period after the first psychiatric hospitalization for schizophrenia, more than 50 percent of patients can be described as having a poor outcome, with repeated hospitalizations, exacerbations of symptoms, episodes of major mood disorders, and suicide attempts

26

What is a poor outcome of schizophrenia?

repeated hospitalizations, exacerbations of symptoms, episodes of major mood disorders, and suicide attempts

27

Features Weighting Toward to Good Prognosis in Schizophrenia

- Late onset

- Obvious precipitating factors

- Acute onset

- Good premorbid social, sexual, and work histories

- Mood disorder symptoms
(especially depressive
disorders)

- Married

- Family history of mood disorders

- Good support systems

- Positive symptoms

28

Features Weighting Toward to Poor Prognosis in Schizophrenia

- Young onset

- No precipitating factors

- Insidious onset

- Poor premorbid social, sexual,
and work histories

- Withdrawn, autistic behavior

- Single, divorced, or widowed

- Family history of
schizophrenia

- Poor support systems

- Negative symptoms

- Neurological signs and symptoms

- History of perinatal trauma

- No remissions in 3 years

- Many relapses

- History of assaultiveness

29

Treatment of schizophrenia

- antipsychotic drugs

- psychosocial treatment

- hospitalization

- ECT

30

first­ generation antipsychotics

aka

dopamine receptor antagonists

clozapine (Thorazine)

31

second-generation
antipsychotics

aka

serotonin dopamine antagonists (SDAs)

32

EMIL KRAEPLIN-

dementia precox

Emphasized the distinct cognitive process (dementia)

early onset (precox)

33

4 A’s EUGEN BLEULER

Associations
Affect
Autism
Ambivalence

34

Prevalence

Phil and US


Region 6 (Phil) 1996 - 4.3%

US Lifetime prevalence of Schizophrenia - 1 - 1.5%

NIMH-ECA Study - 1.3%

35

What percentage of patients with schizophrenia attempt suicide at least once?

50% of patients with schizophrenia attempt suicide at least once

36

What percentage of patients with schizophrenia die by suicide during a 20 year follow up period?

10 -15% of patients with schizophrenia die by suicide during a 20 year follow up period

37

Premorbid Signs and Symptoms of schizophrenia

SCHIZOID
SCHIZOTYPAL

38

5 symptoms dimensions of schizophrenia

1. positive symptoms

2. negative symptoms

3. cognitive symptoms

4. aggressive symptoms

5. anxiety/depression

39

Positive symptoms of schizophrenia

excess of normal function

- catatonic behavior

- delusions

- hallucinations

- distortions or exaggerations in language and communication

40

Positive symptoms are associated not just with schizophrenia, but also with

- bipolar disorder

- schizoaffective disorder

- childhood psychotic illnesses

- psychotic depression

- Alzheimer's

41

cognitive symptoms of schizophrenia

- thought disorder

- impaired attention

- impaired verbal fluency

- problems with serial learning

- impairment in vigilance for executive functioning

42

negative symptoms of schizophrenia

- blunted affect

- emotional withdrawal

- poor rapport

43

aggressive symptoms of schizophrenia

- hostility

- verbal abusiveness

- physical abusiveness

44

depressive / anxious symptoms of schizophrenia

- depressed mood

- anxious mood

- guilt

45

NEURODEVELOPMENTAL HYPOTHESIS of schizophrenia

proposes that a proportion of schizophrenia is the result of an early brain insult, either pre or perinatal which affects brain development leading to abnormalities which are expressed in the adult brain

46

5 symptoms of psychosis

- Hallucinations

- delusions

-disorganized speech

- disorganized behavior

- gross distortions of reality testing

47

Cognitive deficits found in schizophrenia show ( DETERIORATION / NO DETERIORATION) over the course of the illness

Cognitive deficits found in schizophrenia show NO DETERIORATION over the course of the illness

non-progressive

48

Risk factors for schizophrenia

- Nutrition

- Seasonality

- Infection or infectious agents

- Obstetric complications

49

Hyperdopaminergic state in (cortex / subcortical) area may underlie the (negative / positive) symptoms of schizophrenia

Hyperdopaminergic state
in SUBCORTICAL area may underlie
the POSITIVE symptoms of schizophrenia

50

Hypodopaminergic state in (cortex / subcortical) area may underlie the (negative / positive) symptoms of schizophrenia

Hypodopaminergic state in CORTEX may underlie
the NEGATIVE symptoms of schizophrenia

51

Nigrostiatal tract function

a. emotional expression

b. inhibit prolactin release

c. initiation and coordination of motor movements

c. initiation and coordination of motor movements

52

Mesolimbic/Mesocortical Tracts function

a. emotional expression

b. inhibit prolactin release

c. initiation and coordination of motor movements

a. emotional expression

53

Tuberoinfundibular tract function

a. emotional expression

b. inhibit prolactin release

c. initiation and coordination of motor movements

b. inhibit prolactin release