loss of touch with reality
psychosis
disorders with psychosis
schizophrenia
bipolar disorder
depression
organic (head injury, ETOH, etc)
this meets criteria for schizophrenia but less than 6 months duration
pchizophreniform disorder
schizophrenia + mood disorder
schizoaffective disorder (major depression or bipolar d/o)
delusional disorder
paranoid disorders, delusions about things that could not happen in real life (being followed, poisoned)
diagnosis for shizophrenia
greater than 6 months duration of illness with 1 month of acute sx along with FUNCTIONAL DECLINE & 2 or more symptoms: 1. hallucinations, 2. delusions, 3. disorganized speech, 4. disorganized/catatonic sx, 5. negative symptoms
symptoms of schizophrenia
- paranoid: preoccupied with delusions of persecution or grandeur: usually tense and guarded
- disorganized: unorganized behavior, disorganized speech, inappropriate affect
- catatonic: silent, doesn’t respond to external stimuli
- residual: socially withdrawn
pathophysiology of positive sx of schizophrenia
excess dopamine receptors in mesolimbic pathway
hallucinations, delusions, disorganized speech and thinking, movement disorders (catatonic behavior
pathophysiology of negative sx of schizophrenia
flat emotional affect, caused by dopamine dysfunction in the mesocortical pathway
(flat emotional affect: social withdrawal, lack of emotional expression, communication and reactivity, silent patients)
% of population who is schizophrenic
1% - 10% incidence in pts with 1st degree relative that is schizophrenic
management of schizophrenia
- antipsychotics: dopamine receptor antagonists –> 2nd generation is 1st line treatment!! Ex : clozapine, risperidone, olanzapine
1st generation: chlorpromazine or haloperidole (increased extrapyramidal sx)
