Lecture 78: Schizophrenia Flashcards Preview

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Flashcards in Lecture 78: Schizophrenia Deck (33):
1

Age of onset of schizophrenia is typically ________ for women

Later

2

Diagnosis for schizophrenia is based on...

Clinical symptoms

3

Clustered groups of schizophrenia symptoms

Positive, negative, and cognitive

4

Positive symptoms (3)

Hallucinations, delusions, disorganized thinking/speech/behavior

5

Negative symptoms

Alogia (speech poverty), affective blunting, avolition, anhedonia

6

Cognitive symptoms

Attention, memory, verbal fluency

7

Formal schizophrenia dx requires

Several positive symptoms for at least a month + ongoing illness for at least 6 months

8

Describe cognitive abnormalities in schizophrenia

Present prior to onset, pts generally perform below average

9

Why are cognitive symptoms so important?

No pharmacological treatment available, but these symptoms are important for long-term dysfunction

10

Four disorders often confused with schizophrenia

Bipolar manic episodes, schizoaffective, schizophreniform (shorter duration), delusional disorder (less bizarre, often fixed delusions)

11

What symptoms start first? What is this phase called?

Cognitive symptoms; premorbid phase

12

Describe prodromal phase of schizophrenia

"Attenuated psychotic symptoms," which may include obsessions, sleep problems, negative symptoms, school/relationship trouble

13

What happens at the end of the prodromal phase? What happens next?

Acute, active psychotic symptoms; treatment initiated

14

What is the final phase, describe pos, cog, neg symptoms

Postpsychotic phase: positive symptoms decrease, cognitive symptoms fixed, and negative symptoms still existent, though somewhat better

15

Patients with sustained remission (%). Do patients generally make it back to work?

77%; no

16

Untreated psychosis is related to...

Poorer outcomes

17

Medical co-morbidities of schizophrenia

Suicide, accidents, substance abuse, CV mortality (sedentary, obesity); ~15 year reduction in lifespan

18

Environment risk factors for schizophrenia (7)

Prenatal infections, obstetrical complications, season of birth (winter), place of birth (urban), paternal age, drug use, head injury

19

What is the largest risk factor for developing schizophrenia? Heritability (%)?

Family history; 80%

20

Describe the Threshold Liability Model

Multiple genetic factors contribute --> the overall number inherited place you closer from a critical number of factors to reach the disease threshold

21

What study methodology has been used to examine genetic risks for schizophrenia? What are two important findings from this work?

GWAS; 1. Risk factors are shared across SCZ, BD, and MDD; 2. DNA deletions and duplications are enriched in SCZ in patients (STRONG influence on risk)

22

T/F: De novo mutations are enriched in schizophrenia

False: no increase in over all rate of mutations

23

Where are de novo mutations found in schizophrenia? What about clinical presentations...

Synaptic genes; more common in patients who do poorly in school

24

Three take home messages about genes and schizophrenia and final point

1. Rare, risk-increasing CNVs; 2. Common SNPs by GWAS; 3. Very rare SNPs by deep sequencing --> Highly polygenic participate in increasing individuals risk

25

DA hypothesis (what it's based on)

Based on fact that antipsychotic drugs block DA receptors and enhancing DA --> schizophrenic symptoms

26

Positive symptoms related to what DA system?

Overactivity of mesolimbic system

27

Glutamate hypothesis (5 supporting facts)

PCP and ketamine --> psychosis; increased sensitivity of schizophrenia to NMDA antagonists; dementia in schizophrenics; genetic risk in glutamate receptor genes; glutamate abnormalities found in patient cells

28

Glutamate hypothesis take home...

Decreased inhibition

29

Macroscopic changes (3)

Smaller hippocampus, amygdala, cerebellar vermis; enlarged ventricles; lower brain weights

30

Histological changes (3)

Disarray of pyramidal cells in CA1/CA2 in hippocampus, increased neuronal density in PFC; reduced dendritic spines

31

Neuroimaging functional finding

Reduced prefrontal activation during executive cognitive functioning = hypofrontality

32

Neurodevelopmental hypothesis (background + hypothesis)

Structural abnormalities prominent in neurodevelopmental disorders and enriched in schizophrenia; SCZ might be related to an early defect --> later pathology

33

What are the early defects of the neurodevelopmental hypothesis (3) and what is a histological correlation

Problems myelinating, WM abnormalities, problems with synaptic pruning; fewer dendritic spines

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