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1

What is included in the Criteria A signs and symptoms in schizophrenia

Hallucinations (auditory MC),
Delusions,
Disorganized Thinking,
Disorganized Behavior,
Negative Symptoms

2

What are Negative Symptoms?

5A’s=Anhedonia, Affect (flat), Alogia (don’t speak), Avolition (apathy), Attention (poor)

3

how many negative symptoms do patients need to meet criteria?

2 out of the 5 for at least 1 month

4

how long do symptoms need to last for diagnosis for schizophrenia

Total duration of illness (including prodrome, residual sx) needs to be at least 6 months
1-6 months=schizophreniform
<1 mo=brief psychotic reaction or psychosis NOS

5

What is Criteria “B” for schizophrenia?

Social-Occupational Dysfunction
-Work, interpersonal relationships, self-care

-downward drift hypothesis- gradually lose their resources due to dysfunction

6

what developmental disorders could present w/psychosis?

Asperger’s, Rett's disorder, Autism

7

what medications (rx) could cause psychosis?

steroids!

8

Do more men or more women get schizophrenia?

Males=Females but males w/more severe illness

9

At what age is the onset of schizophrenia?

-males age 15, then 18-25years
-women age 25-35, up to 40 years (3/4 after age 30)

10

When is the most common time schizophrenics may attempt suicide?

During remission of illness just following a relapse
-note that younger males who are DOING WELL with good insight into illness are at highest risk for attempt and often complete suicide.

11

What are the cognitive deficits of schizophrenia?

S-Speed of thinking
M-Memory
A-Attention
R-Reasoning
T-Tact (Social cognition)

12

What is the general lifespan for someone with schizophrenia?

Shortened to about 50 (comparison: 78 general pop)
Why? -Substance abuse (smoking, EtOH)
-Higher completion rates of suicide (8-10% complete)
-Increased CV Risks (smoking, antipsychotics, obesity)

13

4 dopamine tracts

Nigrostriatal=EPS (dystonia, parkinsonism, akathisia, tardive dyskinesia)

Tuberoinfundibular=endocrine changes like prolactin, gynecomastia, menstrual changes
Mesolimbic=target system-psychosis

Mesocortical= May be responsible for negative signs/symptoms

14

algorithm for schizophrenia treatment

Stage 1: SGA

2: Different SGA or try FGA
Stage 3: Consider Clozapine (3rd line)
Stage 4: Clozapine +SGA or FGA
Stage 5: Modify SGA or FGA in Stage 4
Stage 6 (last line): Give 2 FGA’s, 2 SGA’s or one of each

15

How long is an adequate antipsychotic trial?

About 4 weeks of therapeutic dose
*patients should have SOME response in first 2 weeks.

16

What is the 1st and 2nd most common method of suicide for both sexes?

1st- firearms
2nd: men- hanging, women-drug OD

17

What country has highest suicide rate?

Lithuania. Japan is #2.

18

What are risk factors for suicide?

Men, Age >65 or adolescents, Whites, Prior Attempt (repeat is usually within 2 years), Divorced, Family hx, History of Abuse in childhood, Mental illness (50% of suicides d/t MDD, aso think bipolar, then schizo), Substance Abuse, other Co-Morbid medical conditions.

19

Of the anxiety disorders, which one carries the highest risk of suicide?

Panic Disorder

20

Of the personality disorders, which one carries the highest risk of suicide?

Borderline PD