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NEURO 210 > Lecture 23: Schizophrenia > Flashcards

Lecture 23: Schizophrenia Flashcards

1
Q

What is the etymology of the word schizophrenia?

A

Greek

schizophrenia = skhizein + phren

skhizein: split
phren: mind

dissociation of different cognitive functions

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2
Q

What was Emil Kraepelin’s contribution to the classification of schizophrenia?

A

“dementia praecox” (1887)

onset in adolescence

chronic deteriorating course

permanent and pervasive functional deficits

core symptoms are loss of cognitive functions (memory, planning, complex decision making, etc.)

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3
Q

What What was Eugen Bleuler’s contribution to the classification of schizophrenia?

A

“schizophrenia” (1911)

hallucinations and delusions are secondary features (positive symptoms)

primary symptoms are: ambivalence (can’t make decisions), loosening of associations (don’t move between topic logically), incongruous affect (facial and behavioral expression of emotions), autism (responding to internal stimuli, only internal)

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4
Q

What is the DSM-5 criteria for the diagnosis of schizophrenia?

A

two or more of the following for a significant proportion of time over a one-month period: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, negative symptoms

significant social or occupational dysfunction

signs of the disturbance are present over 6-months

not due to schizoaffective disorder or exclusively occurring during the course of a mood disorder

not due to a substance or a general medical condition

if a pervasive developmental disorder is present, prominent delusions or hallucinations are present for a month

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5
Q

What are hallucinations?

A

a perception in a conscious state in the absence of a stimulus, nothing the environment, no external stimulus

no indicative of schizophrenia

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6
Q

What is an illusion?

A

a misperception of a stimulus

think you heard someone call your name

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7
Q

What are the different types of hallucinations?

A

can be in any sensory domain: auditory, visual, olfactory, gustatory, tactile (formication, intoxication, or withdrawal), nociceptive (pain), chronoceptive (perception of time)

auditory hallucinations are the most common in schizophrenia

visual hallucinations are more common with substance use

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8
Q

What are some other causes of hallucinations separate from schizophrenia?

A

substances

dementia

delirium

migraine (aura, flashing lights)

epilepsy

intracranial infection or tumor

associated with sleep (hypnagogic or hypnopompic)

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9
Q

What are delusions?

A

a fixed, false belief not in keeping with an individual’s culture

defined as bizarre when not possible or patently untrue

non-bizarre: possible, but not true

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10
Q

What are the negative symptoms of schizophrenia?

A

deficit symptoms of schizophrenia

apathy: lack of motivation

anhedonia: lack of pleasure

amotivation: won’t even eat without being told

alogia: don’t make sense

poor social function: causes lots of impairment

contribute more to functional impairment than hallucinations or delusions

less amenable to treatment

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11
Q

What are cognitive symptoms of schizophrenia?

A

slowed processing speed

impaired attention

impaired memory

impaired executive function (decision making, social cognition, extraction)

impaired social cognition

impaired verbal comprehension

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12
Q

What is the chronic course of schizophrenia?

A

schizophrenia is a chronic illness

patients are usually diagnosed when they begin to exhibit disorganized behavior or hallucinations or delusions

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13
Q

What is the age of onset of schizophrenia?

A

male: 15-25 years
female: 25-35 years

age of onset before 15 years and after 50 years is rare

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14
Q

What is the initial prodromal phase of schizophrenia?

A

attenuated symptoms (not hallucinations or delusions, but perhaps off ideas or sensory misperceptions)

hard to know until positive symptoms occur

anxiety, sleep disturbances, mood problems

functional decline

precedes pychosis by 1 year on average

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15
Q

What is the first episode of psychosis in schizophrenia?

A

treatment results in remission of positive symptoms

negative symptoms will persist

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16
Q

What are the residual symptoms of schizophrenia?

A

half of patients require social supports

still causes impairment

negative and cognitive symptoms persist

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17
Q

What happens to the symptoms of schizophrenia over time?

A

over the course of the lifetime, positive symptoms become less prominent (learn that when they talk about symptoms they get hospitalized, so stop talking about them)

negative symptoms and cognitive symptoms persist

the best predictor of future functional impairment is the level of function after the first episode, if you don’t achieve functional levels then it’ll get worse

18
Q

What is the course of schizophrenia in males?

A

males with schizophrenia are less likely to marry, and have a worse prognosis than females with schizophrenia

social factor: it occurs later in life in females

biological: estrogen might be a protective factor

19
Q

What is the epidemiology of schizophrenia?

A

sex ratio: M:F = 1:1, recent research shows a slightly higher risk for males

annual incidence 1 in 10,000

lifetime prevalence 0.7-1%

20
Q

What is the relationship between the Dutch famine of 1944 and the prevalence of schizophrenia?

A

children conceived during the famine had an increased rate of schizophrenia (2%)

likely this was due to poor nutrition during pregnancy and while breastfeeding, insults in the brain during development

21
Q

What are the risk factors of schizophrenia?

A

family history: monozygotic twins have a 40-50% concordance

urban birth: psychotic individuals migrate to cities and give birth there

first-generation immigrant: related to the stress of culturization, true of refugees too

winter birth: seasonal birth

prenatal infection or malnutrition

obstetrical complications

increasing paternal age

22
Q

What is the ultra high risk phenotype for schizophrenia?

A

most commonly defined as family history of psychosis and at least 1 of: attenuated positive symptoms, brief psychotic symptoms, functional decline

about 50% of these individuals will present with symptoms of schizophrenia within a year of identification

show executive dysfunction, working memory problems

23
Q

What are “refrigerator mothers”?

A

idea from the 1940’s

mothers fail to give appropriate emotional feedback to children

children become autistic or psychotic

no evidence to suggest this is the case

increased paternal age leads to increased risk

24
Q

What is the genetics involved in schizophrenia?

A

22q11 deletion: Velocardiofacial syndrome

linkage analysis shows up to 4000 genes associated with schizophrenia, mostly involved with development, or dopamine, or glutamate pathways

candidate genes include those for: Catechol-O-methyl transferase (COMT), neuroregulin 1, dysbindin, dopamine receptors, glutamate receptors

25
Q

What is the neurodevelopmental theory of schizophrenia?

A

best evidence suggests that there is a predisposition to schizophrenia based on abnormal neural development in childhood and adolescence (stress-diathesis model)

this the prevailing explanation of the development of schizophrenia

26
Q

What is the neurodegenerative theory of schizophrenia?

A

previously thought that individuals with schizophrenia had typical brain development before some form of incident that led to disease onset

this is no longer felt to be the case

27
Q

What are the brain volume changes associated with schizophrenia?

A

increased ventricular size (most common finding)

temporal lobe asymmetry

loss of frontal grey matter

however, no evidence of gliosis on pathology (gliosis is scaring that would suggest some form of process damaging normal neurons)

28
Q

What is the relationship between cannabis and schizophrenia?

A

long thought to be an independent risk factor for schizophrenia

recent evidence suggests that cannabis use can precipitate psychosis in individuals with specific genetic risk factors

people with psychosis are more likely to use

Catechol-O-methyl transferase (COMT) polymorphism: if you have this gene and use cannabis, you can have pre-psychosis

29
Q

What is the relationship between amphetamines and schizophrenia?

A

takes 6 months to recover from one hit

agitation, illusions, paranoia during withdrawal, tactile hallucinations

30
Q

What is the relationship between cocaine and schizophrenia?

A

agitation, paranoia during withdrawal, visual hallucinations

31
Q

What is the relationship between phencyclidine (PCP) and schizophrenia?

A

causes both positive and negative symptoms

best substance model of schizophrenia

causes hallucinations, delusions, and negative symptoms

32
Q

What is the dopamine hypothesis of schizophrenia?

A

initially thought excess dopamine was responsible for symptoms

amphetamine induces psychotic symptoms

first-generation antipsychotics act as D2 receptor antagonists

PET scanning shows increased dopaminergic activity in the striatum , proportional to the severity of psychosis

33
Q

What is the glutamate hypothesis of schizophrenia?

A

antagonists of NMDA-type glutamate receptors induce psychotic symptoms

individuals with schizophrenia demonstrate a glutamatergic deficit in temporal and striatal regions

34
Q

What is the neurochemistry of the negative symptoms of schizphrenia?

A

associated with cholinergic deficits, serotonergic deficits particularly in the prefrontal cortex

antipsychotics with D4 receptor antagonism and serotonin receptor activity have netter effects on negative symptoms

PET scanning reveals decreased metabolism in prefrontal cortex

35
Q

What are the biological treatments of schizophrenia?

A

antipsychotics

electroconvulsive therapy

36
Q

What are the psychosocial treatments of schizophrenia?

A

cognitive interventions

family interventions: education about the illness

occupational interventions

37
Q

What are antipsychotics?

A

originally discovered when looking for new surgical anesthetics

dopamine receptor antagonists

divided into first-generation (typical) and second generation (atypical)

38
Q

What are first generation antipsychotics?

A

separated on potency (how much they bind to the D2 receptor)

high potency (i.e. haloperidol)
mid potency (i.e. trifluoperazine)
low potency (i.e. chlorpromazine)

higher D2 binding affinity than atypicals

higher risk of akathisia, Parkinsonism, dystonias (sustained muscle contractions), tardive dyskinesia

39
Q

What are second generation antipsychotics?

A

aripiprazole, clozapine, olanzapine, riseridone, quetiapine, ziprasidone, paliperidone, asenapine, lurasidone

less D2 binding
more D4, serotonin recpetor binding

better for negative symptoms

common side effects include weight gain, sedation, erectile dysfunction

40
Q

What is the relationship between violence and schizophrenia?

A

individuals with schizophrenia are more likely to be victims of violence than the general population

after controlling for drug use, individuals with schizophrenia have no higher rates of violence than their community cohort

NEURO 210 (23 decks)

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