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PHS 931 > Block 4 Lecture 3 -- Psychosis: Schizophrenia > Flashcards

Block 4 Lecture 3 -- Psychosis: Schizophrenia Flashcards

1
Q

What are the types of schizophrenia?

A

1) catatonic
2) disorganized (hebephrenic)
3) paranoid
4) residual
5) undifferentiated

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2
Q

What are sxs of catatonic schizophrenia?

A

withdrawn; little to no movement;

– possibly vegetative

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3
Q

What are sxs of disorganized (hebephrenic) schizophrenia?

A

verbally incoherent; flat effect; inappropriate emotions or behavior

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4
Q

What are sxs of paranoid schizophrenia?

A

delusion; hallucinations; false beliefs of grandeur

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5
Q

What are sxs of residual schizophrenia?

A

long-term

    • negative symptoms remain
    • most other sxs have disappeared
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6
Q

What are sxs of undifferentiated schizophrenia?

A

multiple symptom types

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7
Q

What is a hallucination?

A

hearing/seeing/feeling things that aren’t real

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8
Q

What is a delusion?

A

holding unusual beliefs not shared by others

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9
Q

What are causes of psychosis?

A

1) schizophrenia
2) bipolar/unipolar
3) HIV or other infection
4) genetics
5) drug-induced

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10
Q

Define psychosis.

A

abnormal condition of the mind; loss of contact with reality

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11
Q

Define schizophrenia.

A

chronic brain disorder affecting thinking, feeling, and actions
– not a split/multiple personality

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12
Q

What are positive symptoms of schizophrenia?

A

1) delusions
2) hallucinations
3) disorganized speech/thinking
4) grossly disorganized behavior
5) catatonic behaviors
6) psychomotor agitation

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13
Q

What are negative symptoms of schizophrenia?

A

1) affective flattening
2) avolition
3) alogia
4) anhedonia
5) attentional deficits
6) social withdrawal

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14
Q

Define avoliton.

A

lack of motivation for initiating tasks

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15
Q

Define alogia.

A

difficulty or inability to speak

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16
Q

Define anhedonia.

A

lack of interest/enjoyment in life

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17
Q

What are cognitive sxs of schizophrenia?

A

1) slow/disorganized thinking
2) difficulty understanding
3) poor concentration, memory
4) difficulty expressing and integrating thoughts/feelings/behavior

– impaired attention, memory, and executive function

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18
Q

What are the mood sxs of cognitive schizophrenia?

A

1) depression
2) dysphoria
3) hopelessness
4) demoralization
5) anxiety
6) guilt

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19
Q

What are the symptom categories of schizophrenia?

A

1) positive
2) negative
3) cognitive
4) mood

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20
Q

What are the current hypotheses for schizophrenia pathophys?

A

1) DA hypothesis
2) serotonin hypothesis
3) Glu hypothesis
4) GABA hypothesis

21
Q

What structural abnormalities are present in schizophrenia?

A

1) enlargement of lateral ventricles
2) slight reduction in cerebral cx thickness
3) reduced total brain volume

22
Q

What are the 4 main brain DA pathways?

A

1) mesolimbic
- - VTA to NA, HP, Amygdala
2) mesocortical
- - VTA to FCx
3) nigrostriatal
- - SN to striatum
4) tuberoinfundibular
- - HT to AP

23
Q

What is the role of the ML system in schizophrenia?

A

positive sxs; worsened by DA

24
Q

What is the role of the MC system in schizophrenia?

A

negative sxs; mitigated by DA

25
Q

What is the role of the NS system in schizophrenia?

A

posture and involuntary movement; worsened by DA

26
Q

What is the role of the TI system in schizophrenia?

A

involved with ADRs

– DA decreases PRL release

27
Q

Describe the DA hypothesis of schizophrenia.

A

1) ML system overactive
2) MC system underactive
- - disturbed, hyperactive dopaminergic system
- - hyperactivity of D2r

28
Q

What is DA’s function in the CNS (effects)?

A

1) reward
2) pleasure
3) motor function (fine tuning)
4) compulsion
5) perserverance

29
Q

What are the strengths of the DA hypothesis in schizophrenia?

A
    • amphetamines increase DA to produce psychotic symptoms

- - antipsychotic drugs (block DA) reduce positive sxs

30
Q

What are weaknesses of the DA hypothesis?

A

1) amphetamines only mimic positive sxs; FGAs only reduce positive sxs
2) D2r blockade is rapid, but clinical effects take weeks
3) studies show no change in DAr density
4) hallucinogens and anesthetics also cause dose-dependent psychotic sxs

31
Q

What is serotonin’s function in the CNS (effects)?

A

1) mood
2) memory
3) processing
4) sleep

32
Q

What are the strengths of the serotonin hypothesis?

A

5-HT2a agonists (LSD, psilocybin) cause hallucination like schizophrenia

33
Q

What are the weaknesses of the serotonin hypothesis?

A

5-HT2a agonists typically ONLY associated with VISUAL hallucinations

34
Q

What are the strengths of the Glutamate hypothesis?

A

1) decreased [Glu] in CSF
2) decreased [NMDAr]
3) decreased [presynaptic VGLUT]
4) noncompetitive NMDAr agonists (PCP, ketamine) cause positive/negative/cognitive sxs
- - exacerbation in schizophrenics

35
Q

What are the strengths of the GABA hypothesis?

A

1) decreased [GABA] in CSF
2) decreased no. of GABA neurons
3) decreased expression of glutamic acid decarboxylase (necessary for GABA synthesis)

36
Q

What are the weaknesses of the GABA hypothesis?

A

1) cause/effect relationship unclear

2) no supportive results from BZD studies

37
Q

How is schizophrenia diagnosed?

A

2 or more sxs for 1+ mos during last 6 mos

– markedly decreased level of functioning

38
Q

What is the prognosis for schizophrenic patients?

A

of the 45% who receive treatment:

1) 1/3 recover
2) 1/3 improve with relapses and residual disability
3) 1/3 remain incapacitated

39
Q

What factors correlate with good prognosis?

A

1) late/sudden onset
2) married, female, no f/h
3) high IQ
4) positive sxs
5) compliance and good support

40
Q

What factors correlate with poor prognosis?

A

1) young age of onset
2) unmarried, male, f/h
3) low IQ
4) negative sxs

41
Q

What “therapies” are used for schizophrenia? (non-drug)

A

1) support groups, etc.
2) Assertive Community Treatment
3) Social Media and Smartphone apps
- - better socialize outside home
4) skills training
- - social interaction, independence
5) CBT
- - strategies for coping with sxs

42
Q

What is ACT?

A

Assertive Community Treatment

    • multidisciplinary team of providers for high-risk patients
    • psychiatrist (MD), psychologist, psychiatric nurse, social worker, case manager
43
Q

What are environmental factors that lead to schizophrenia?

A 
prenatal
-- prenatal virus exposure
-- poor maternal nutrition
perinatal
-- poor perinatal nutrition
-- perinatal hypoxia
-- birth trauma
-- advanced paternal age
-- birth order
adolescence
-- stress, drug abuse, age, neurotrauma, psychotrauma
44
Q

Describe the genetic causes of schizophrenia.

A

lots of small genetic defects scattered across genome

– genes are huge factor

45
Q

What causes schizophrenia?

A

– critical genetic load

or,
– healthy patient w/ environmental factors

46
Q

Describe incidence/relative prevalence of schizophrenia?

A

top 10 cause of disability in developed countries

    • 0.6-2% of world
    • highest in males early in life; females later
47
Q

How much does suicide risk increase in a schizophrenic patient?

A

50x

48
Q

What kind of hallucinations do schizophrenic patients experience?

A

auditory
visual
tactile
olfactory

PHS 931 (29 decks)

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