Flashcards in Schizo Deck (13):
1
Schizophrenia - Diagnosis
Two or more of the following for one month
or more:
– Delusions
– Hallucinations
– Disorganized speech
– Disorganized or catatonic behavior
– Negative symptoms
(1 of the criteria has to be delusions or hallucinations)
2
hallmark of schizophrenia
psychosis
3
Schizophrenia and dopamine
– The stronger the D2 blockade, the more
efficacious the drug.
– Drugs that enhance DA transmission (cocaine,
amphetamines) worsen schizophrenia.
4
Positive symptoms of schizo
▪ Hallucinations, usually auditory
▪ Disorganization – thought disorders (tangentiality, loose associations, word salad), catatonia (mutism, extreme negativism, waxy flexibility)
5
Negative symptoms of schizo
▪ Alogia: poverty of speech
▪ Affective flattening: reduction in intensity of emotional expression
▪ Anhedonia: inability to experience pleasure
▪ Avolition: inability to initial goal directed behavior
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Alogia
poverty of speech
7
Cognitive impairment & schizo
▪ Defect in working memory, defect in filtering extraneous sensory information
▪ Mild deterioration throughout illness but not as dramatic as once thought
▪ Appears to be best predictor of functional outcome in disorder
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● Course of Schizophrenia
o Prodrome: withdrawal, eccentricity, depression or anxiety
o Active Phase: active psychotic symptoms, diagnosis usually made
o Residual Phase: less intense positive symptoms
o Exacerbations: occur throughout lifetime
9
Outcomes and Schizo
20% do well long-term, 5% suicide rate (esp. early illness), receive worse medical care, but some protective factors (married, short duration, mood symptoms, higher social class, developing countries)
10
Schizo treatment
o Mainstay is antipsychotic medications (neuroleptics). Often lifelong treatment.
11
First generation (typical) antipsychotics for Schizo
, more strongly D2 blocking. (Prototypical: Haldol). Efficacious against positive symptoms only. Less commonly used due to side effect profile.
▪ Extrapyramidal symptoms
- dystonic in hours, akithisia in days, shuffle in weeks
▪ Tardive dyskinesia (TD)
- involuntary choreiform movements
▪ Hyperprolactinemia
▪ Cardiac conduction effects (QTc prolongation)
▪ Neuroleptic malignant syndrome
12
Second generation (atypical) antipsychotics
block a number of different receptor sites, including serotonin (5HT). They are less strongly D2 blocking. More strongly D1 and D4 blocking.
▪ SGAs are equally efficacious for treating positive symptoms. Large unbiased studies: no more efficacious for negative symptoms/cognitive deficits.
▪ Lower incidence of EPS, TD and NMS. Tend to be more sedating, cause weight gain. More likely to be associated with the metabolic syndrome.
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