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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

6

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

8

● 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.

13

▪ Clozapine

original SGA and is the only antipsychotic effective in patients resistant to treatment with other neuroleptics.
▪ Associated with agranulocytosis and lethal infections, need regular blood draws
▪ Seizures, myocarditis, sedation, weight gain