Lectures 2 & 3-Schizophrenia Flashcards Preview

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Flashcards in Lectures 2 & 3-Schizophrenia Deck (50):
1

What is schitzophrenia? Are there genetic, social, or stress components? Does it get better?

Schizo-phrenia =“Split mind-” irrational divergence between behavior and thought content

Chronic, debilitating illness associated with deterioration in mental function and behavior

Clearly involves a gene by environment interaction

Not caused by any known social or environmental factor

Exacerbated by social stress

Schizophrenia does not get better, the term “Downward drift” represents the social loses that occur with progression of disease.

2

Describe and define the main symptom of Schizophrenia?

Psychosis

Psychosis consists of hallucinations, delusions, and abnormalities in thought process/organization

3

Define the term Illusion (symptom of psychosis)

Misperception of real external stimuli

4

Define the term Hallucination (symptom of psychosis)

Sensory perceptions not generated by external stimuli

5

Define the term Idea of reference (symptom of psychosis)

False conviction that one is subject of attention by other people (Crowds, TV, Radio, Internet). Feeling as though people are referring to you in their conversations…

6

Define the term Delusion (symptom of psychosis)

False beliefs not correctable by logic or reason, not based on simple ignorance, and not shared by culture; delusions of persecution most common

7

Define the term Loss of ego boundaries (symptom of psychosis)

Not knowing where one’s mind and body end and those of others begin

8

Define the term Alogia (symptom of psychosis)

Lack of informative content in speech, lacking/poverty of speech
ex. “Patient is mute or speaks few words.”

9

Define the term Echolalia (Clanging) (symptom of psychosis)

Repeating Statements of Others/Associating words by their sounds, not by their meaning
ex. “I’m very sure I’ve got the cure and I’m not pure.”

10

Define the term thought blocking (symptom of psychosis)

Abrupt halt in the train of thinking, often because of hallucinations
Ex. I have to take my……….

11

Define the term Neologisms (symptom of psychosis)

Inventing new words
Ex. Patient states he is ‘fatigloo’ which means he is tired

12

Define the term Circumstantiality (symptom of psychosis)

In responding to questions, one presents unnecessary and voluminous details ultimately arriving at an answer to the question posed

13

Define the term Tangentiality (symptom of psychosis)

Beginning a response in a logical fashion but then getting further and further away from the point and fail to answer the question initially posed (can understand topic transition)

14

Define the term Loose associations (symptom of psychosis)

Loss of logical meaning between words or thoughts; when asked a question, illogically jumps from one subject to another

15

In contrast to delirium or substance abuse, patients with schizophrenia do not have clouding of ______.

Attention and memory capacity typically ______, when not psychotic.

Schizophrenics are alert and oriented, do _____ fluctuate in/out of consciousness/stupor

consciousness; intact; not

16

In schizophrenia, you have ____ or more of the following symptoms for a significant portion of time during a 1-month period (or less if successfully treated):

Delusions

Hallucinations

Grossly disorganized or catatonic behavior

Negative symptoms (flat affect, alogia, or avolition)

Disorganized speech (frequent derailment or incoherence)

2

17

For diagnosing schizophrenia, ____ or more major areas of functioning (ie. work, interpersonal relations, or self care) are markedly below level achieved prior to onset.

one

18

For diagnosing schizophrenia, continuous signs of the disturbance persist for at least ___ months. This ___-month period must include at least ___ month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active phase symptoms) and may include periods of prodromal (symptomatic of the onset) or residual symptoms.

6; 6; 1

19

In schyzophrenia positive symptoms are ____ to us and negative symptoms are ______ from us.

added; subtracted

20

List some positive symptoms. Do positive symptoms respond better to typical or atypical antipsychotics?

Delusions

Hallucinations

Agitation

Talkativeness

Thought Disorder

Positive symptoms Respond well to most traditional and atypical antipsychotic agents

21

List some negative symptoms. Do negative symptoms respond better to typical or atypical antipsychotics?

Lack of motivation

Social withdrawal

Flattened affect/emotion

Cognitive disturbances

Poor grooming

Poor/impoverished speech

Negative symptoms Respond better to atypical than to traditional antipsychotic agents

22

What are the 3 phases of schizophrenia?

1. Prodromal: prior to first psychotic break

2. Psychotic/Active: loss of touch with reality-positive symptoms

3. Residual: period between psychotic episodes, in touch with reality, but doesn’t behave normally-
Negative symptoms

23

Schizophrenia occurs ____ in men and women, but age of onset is lower in ____

equally; mens

24

The greater the number of days on D2 receptor antagonists, the greater the risk of what disease?

TD-Tardive Dyskinesia

25

______ infection and exposure to _____ during development have been implicated in the etiology of schizophrenia

Viral; drugs

26

What are the 3 main neurological abnormalities in Schyzophrenia?

Abnormalities of the frontal lobes: Decreased use of glucose in prefrontal cortex = hypofrontality

Lateral and third ventricle enlargement

Abnormal cerebral symmetry (loss of asymmetry)
Asymmetry is normal

27

What is the dopamine hypothesis of Schyzophrenia?

excessive dopaminergic (DA) activity in mesolimbic tract.

28

In Schyzophrenia (& othe diseases) psychosis comes from too much DA in the ______ system (middle), and not enough in the ______ lobes.

In Schyzophrenia there is excess dopaminergic activity via excessive # of DA _____, excessive _____ of dopamine or ______ of receptors to DA.

mesolimbic; frontal; receptors; concentration; hypersensitivity

29

Positive symptoms in schizophrenia come from _____ DA & negative symptoms come from _____ DA.

high; low

30

What is the Glutamate hypothesis of Schizophrenia?

The NMDA (excitatory) Glutamate receptors (NMDARs) are hypoactive and fire to little in Schizophrenia. NMDARs may sit on GABA (inhibitory) interneurons that spit our inhibitory GABA at high quantities, if NMDA receptor is defective this leads to decreased GABA and elevated DA.

31

If someone gets a virus and makes antibodies vs the ______ receptor that sit on GABA, and destroy ______ receptors, they get Schizophrenia.

NMDA; NMDA

32

Describe how you get positive symptoms in Schyzophrenia.

GLUGABAGLUDA:

is the normal circuit and DA output is low. When the GLU NMDA receptor on the GABA interneuron is damaged, there is increased GLU & thus increased DA.

where GLU = +, GABA = -, & DA gives positive symtoms of schyzophrenia

33

Describe how you get negative symptoms in Schyzophrenia.

GLUGABAGLU-GABA-DA:

The first GABA interneuron is inactive so mad GLU hits the GABA receptor in the midbrain. The hyperactive GABA receptor then acts on the ventral tegmental area and releases a LOW amount of DA to the forebrain. Usually, a HIGH amount of DA hits the forebrain. Negative symtoms = loss of affect.

where GLU = +, GABA = -, & DA gives positive symtoms of schyzophrenia

34

______ pathway = negative symptoms

Positive symtoms = _____ pathway

Mesocortical; mesolymbic

35

Psychotic disorder caused by a general _____ condition: B12/Folate deficiency, temporal lobe epilepsy, cortico-steroid induced, can give symtoms simmilar to Schyzophrenia.

medical

36

Manic phase of _____ disorder can give symtoms simmilar to Schyzophrenia.

bipolar

37

_______-induced psychotic disorder: Cocaine, crystal meth, ritalin/adderall(stimulants, ketamine, PCP, LSD, bath salts can give symtoms simmilar to Schyzophrenia.

Substance

38

_____ psychotic disorder (1-29 days of schizophrenia symptoms) can give symtoms simmilar to Schyzophrenia.

Brief

39

Schizophreniform disorder __-___ months of symptoms) can give symtoms simmilar to Schyzophrenia.

1 - 6

40

______ disorder (schizophrenia + mania and/or depression) can give symtoms simmilar to Schyzophrenia.

Schizoaffective

It has psychotic + mood symptoms

41

_____ disorder (delusions, but no other schizophrenia symptoms) can give symtoms simmilar to Schyzophrenia.

Delusional

42

______ psychotic disorder (one person is delusional and a second person develops same delusion) can give symtoms simmilar to Schyzophrenia (Charles Manson's family).

Shared

43

_____ generation antipsychotics side effects = weight gain (used first to avoid neuromuscular issues)

_____ generation antipsychotics side effects = neuromuscular issues (give to fat people)

Second; First

44

Since compliance rate of Schyzophrenia drugs are low due to side effects, long acting injectable _____ forms of antipsychotic meds are used for noncompliant patients who do not take their pills. Name the ____ drugs.

depot; depot

Haloperidol decanoate, fluphenazine decanoate, (typical)

Risperidone, Paliperidone, and aripiprazole (atypical)

45

All effective antipsychotics block _____ receptors in the mesolimbic DA path & is often a ____ long treatment

D2; life

46

Traditional high- and low-potency (D2 receptor affinity) typical first generation antipsychotics (Prior to 1995) ____ (high potency), _____ (low potency), respectively

High potency/affinity drugs are _____ at binding and sticking to D2 receptors and may cause _____ side effects in the nigrostriatal and tuberoinfundibular pathway (see above)

haloperidol; chlorpromazine; better; more

47

Atypical ____ generation antipsychotics also block _____ receptors (after 1995): Clozapine, risperidone, paliperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, asenapine, iloperidone, lurasidone

They are first line agents due to fewer negative neurological effects such as parkinsonism or tardive dyskinesia because the _____ blockade allows dopamine to more freely flow in the nigrostriatal path

second; 5HT2a; 5HT2a

48

There is a lot of post-psychotic ______ and suicides in Schyzophrenia (there are "______" hallucinations that tell you to kill yourself).

depression; command

49

A 24-year-old male presents with auditory hallucinations. He says he hears 3 distinct voices. He perceives voices coming from the television when it is turned off. He states this started 7 months ago. He feels that his family is plotting against him and he is being spied on. What is the most likely diagnosis ?

A. Brief psychotic disorder

B. Schizophreniform disorder

C. Schizophrenia

C. Schizophrenia

Since greater than 6 months

50

A 57 year old male has had schizophrenia with continuous symptoms for 30 years despite treatment. Which brain morphometric finding is most likely increased in size?

A. Ventricles

B. Hippocampus

C. Cortical Gray Matter

A. Ventricles