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Flashcards in Psych - Schizophrenia Deck (19):

Schizophrenia facts

1% of population is affected

Ranks 9th in global disease burden

30% of patients will attempt suicide at some point in their lives and 8-10% WILL DIE FROM SUICIDE

Peak diagnosis in late adolescence and early 20s, continues for a lifetime


Difference between BPD and Schizophrenia?

In BPD, there can be psychosis but only in episodes of severe mania. The main symptoms are MOOD.

In Schizophrenia, the PSYCHOSIS IS CONSTANT; there is also a continuous downward and worsening trend.


Positive and Negative Symptoms


Negative Symptoms --> BLUNTED AFFECT, ALOGIA (reduced speech), AVOLITION (lack of motivation), ANHEDONIA (lack of pleasure), ATTENTION DEFICIT

***the negative symptoms are non-specific and thus may be hard to differentiate from other illnesses***



Major disturbance in the content of a person's thoughts or just plain false beliefs; range from plausible but unlikely to completely messed up

Severity is graded on:
CONVICTION (how much patient believes it)
PRODUCTIVITY (delusions getting more elaborate?)

Most frequently paranoid/persecutory, grandiose (only I can change the world! Only I can fix this!), or religious

THOUGHT BROADCASTING -- idea that everybody can hear your thoughts

THOUGHT WITHDRAWAL -- idea that people can come into your head and steal your thoughts



False perceptions

Can be of sensory modality, but are most commonly AUDITORY

To the patent, they feel exactly as any other perception they have. Even the right parts of the brain light up as they normally should if somebody was indeed speaking to them

COMMAND HALLUCINATIONS -- severe and dangerous potentially; patient hears a voice telling them they have to do something, such as hurting themselves or somebody else


Disorganized Speech

Exactly how it sounds -- disordered thoughts coming out through their words; can be RAPID and TANGENTIAL; patient may jump from topic to topic; talking a lot, but there is little content in their speech! May, in extreme cases, make up new words!!!

Net effect is that they struggle to communicate with others, leading to social isolation and dysfunction


Disorganized or Catatonic Behavior

Another highly debilitating symptom

Severe form = WAXY FLEXIBILITY, where the patient literally stays in one position until somebody moves them; this is RARE

Milder forms include excessive or purposeless immobility, mannerisms, or posturing; inability to complete simple tasks


Blunted Affect

Negative symptom -- don't get emotionally excited about anything



Negative symptom - reduced speech; typically respond with only "yes" or "no" without elaborating on the topic at all; these patients are hard to interview (no open ended questions)


Avolition and Anhedonia

Negative symptoms - Lack of motivation (avolition) and lack of pleasure (anhedonia)

These are common symptoms of MDD too, so be careful

Schizophrenics seem to have a more permanent state of unhappiness -- haven't had fun or experienced pleasure in several years, before diagnosis


Concordance Rates of Schizophrenia

General Pop = 1%
One parent = 5-6%
One sibling = 10%
One parent and one sibling = 17%
Two parents = 48%

DZ Twins = 15%
MZ Twins = 30-89% --> means there must be some environmental factors at play!

Susceptibility gene may be the COMT Enzyme!



Used in determining genetic associations

A group of behavioral symptoms that occur together in a disease, and have a clear genetic connection. An appropriate endophenotype is associated with the illness, is heritable, is stable in the disease, and is found in NON-AFFECTED FAMILY MEMBERS AT A HIGHER RATE THAN THE POPULATION!

Eye tracking has been implicated


Environmental Factors

Social classes are ALL EQUALLY LIKELY TO DEVELOP SCHIZOPHRENIA, but those with the disease do tend to drift into poverty

Obstetrical complications
Seasons (winter and spring!!!!)
Maternal infections, maternal starvation

MARIJUANA -- In certain people it can be a factor; COMT genes predispose --> there are polymorphisms (Val or Met) for this gene. IF THE PERSON HAS 2 COPIES OF VALINE and has EXPOSURE TO MARIJUANA, there is an INCREASED RISK OF SCHIZOPHRENIA

Heterozygous or 2 Met copies have NO INCREASED RISK


Outcome/Course of Schizophrenia

Lifelong illness that usually begins in the late teenage years

Only 13% of patients are considered recovered after 5 ears of treatment

Dx can be DEVASTATING because we have to be treated for life

The disease is episodic and waxes/wanes throughout life (positive symptoms)

Once a patient recovers from a psychotic episode, they may feel like they no longer need treatment or meds, but meds are essential for PREVENTING more episodes!

Compliances is a huge issue


Dopaminergic Theory

States that schizophrenia is caused by an imbalance in dopamine pathways and signaling in the brain

The limbic system has OVERACTIVE DA PATHWAYS, which generates the positive symptoms, while the cortex has HYPOACTIVE DA NEURONS causing the NEGATIVE symptoms


Typical Anti-psychotics

Block D2 Receptors, and are very effective at curbing the POSITIVE symptoms, but are not helpful for negative symptoms, and can actually make them worse.

Cognitive function is also impaired still, despite the meds


Important for reducing psychotic symptoms in acute episodes and n preventing relapse and rehospitalization


Atypical Anti-psyhcotics

Clozapine remains the MOST EFFECTIVE antipsychotic, but it is a dirty drug with LOTS of side effects --> agranulocytosis, weight gain, insulin resistance, new onset diabetes; BUT it does NOT cause EPS


Depo Formulations

Injection 1x per month, and this improves compliance

Hard to sell patients on getting an injection every month, but it could be sold as not having to take pills every single day for the rest of their lives


Diagnosing Schizophrenia

Need to have at least TWO SYMPTOMS (all negative symptoms count as ONE)

Must cause SIGNIFICANT distress and social/occupational dysfunction, and last for 6 months at a minimum