Block 4 Lecture 3 -- Psychosis: Schizophrenia Flashcards Preview

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Flashcards in Block 4 Lecture 3 -- Psychosis: Schizophrenia Deck (48):
1

What are the types of schizophrenia?

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

2

What are sxs of catatonic schizophrenia?

withdrawn; little to no movement;
-- possibly vegetative

3

What are sxs of disorganized (hebephrenic) schizophrenia?

verbally incoherent; flat effect; inappropriate emotions or behavior

4

What are sxs of paranoid schizophrenia?

delusion; hallucinations; false beliefs of grandeur

5

What are sxs of residual schizophrenia?

long-term
-- negative symptoms remain
-- most other sxs have disappeared

6

What are sxs of undifferentiated schizophrenia?

multiple symptom types

7

What is a hallucination?

hearing/seeing/feeling things that aren't real

8

What is a delusion?

holding unusual beliefs not shared by others

9

What are causes of psychosis?

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

10

Define psychosis.

abnormal condition of the mind; loss of contact with reality

11

Define schizophrenia.

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

12

What are positive symptoms of schizophrenia?

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

13

What are negative symptoms of schizophrenia?

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

14

Define avoliton.

lack of motivation for initiating tasks

15

Define alogia.

difficulty or inability to speak

16

Define anhedonia.

lack of interest/enjoyment in life

17

What are cognitive sxs of schizophrenia?

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

18

What are the mood sxs of cognitive schizophrenia?

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

19

What are the symptom categories of schizophrenia?

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

20

What are the current hypotheses for schizophrenia pathophys?

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

21

What structural abnormalities are present in schizophrenia?

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

22

What are the 4 main brain DA pathways?

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

23

What is the role of the ML system in schizophrenia?

positive sxs; worsened by DA

24

What is the role of the MC system in schizophrenia?

negative sxs; mitigated by DA

25

What is the role of the NS system in schizophrenia?

posture and involuntary movement; worsened by DA

26

What is the role of the TI system in schizophrenia?

involved with ADRs
-- DA decreases PRL release

27

Describe the DA hypothesis of schizophrenia.

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

28

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

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

29

What are the strengths of the DA hypothesis in schizophrenia?

-- amphetamines increase DA to produce psychotic symptoms
-- antipsychotic drugs (block DA) reduce positive sxs

30

What are weaknesses of the DA hypothesis?

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

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

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

32

What are the strengths of the serotonin hypothesis?

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

33

What are the weaknesses of the serotonin hypothesis?

5-HT2a agonists typically ONLY associated with VISUAL hallucinations

34

What are the strengths of the Glutamate hypothesis?

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

What are the strengths of the GABA hypothesis?

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

36

What are the weaknesses of the GABA hypothesis?

1) cause/effect relationship unclear
2) no supportive results from BZD studies

37

How is schizophrenia diagnosed?

2 or more sxs for 1+ mos during last 6 mos
-- markedly decreased level of functioning

38

What is the prognosis for schizophrenic patients?

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

What factors correlate with good prognosis?

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

40

What factors correlate with poor prognosis?

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

41

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

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

What is ACT?

Assertive Community Treatment
-- multidisciplinary team of providers for high-risk patients
-- psychiatrist (MD), psychologist, psychiatric nurse, social worker, case manager

43

What are environmental factors that lead to schizophrenia?

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

Describe the genetic causes of schizophrenia.

lots of small genetic defects scattered across genome
-- genes are huge factor

45

What causes schizophrenia?

-- critical genetic load

or,
-- healthy patient w/ environmental factors

46

Describe incidence/relative prevalence of schizophrenia?

top 10 cause of disability in developed countries
-- 0.6-2% of world
-- highest in males early in life; females later

47

How much does suicide risk increase in a schizophrenic patient?

50x

48

What kind of hallucinations do schizophrenic patients experience?

auditory
visual
tactile
olfactory