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Flashcards in Schizophrenia Deck (63):
1

Define illusions

disorder of perception: misperception of real external stimuli

2

Define hallucinations

disorder of perception: sensory perceptions not generated by external stimuli (auditory hallucinations are most common)

3

Define Ideas of reference

disorder of thought content: false conviction that one is the subject of attn by other ppl or the media

4

define delusions

disorder of thought content: false beliefs not correctable by logic or reason, not based on simple ignorance, and not shared by a culture or subculture; delusions of persecution are most common.

5

Define loss of ego boundaries

disorder of thought processes: not knowing where one's mind and body and those of others begin (e.g. a pt feels she is "merged" into others)

6

Define impaired abstraction ability

disorder of thought processes: difficulty in discerning the essential qualities of objects or relationships despite normal intelligence (e.g. when asked what brought him to the hospital, a pt says "bus")

7

define magical thinking

disorder of thought processes: the idea that thoughts cause or prevent external events from happening

8

define alogia

disorder of form of though: lack of informative content typically seen in normal speech/"poverty of speech"

9

define echolalia

disorder of form of thought: associating words by their sounds, not by their logical meanings

10

define loose assoications

disorder of form of thought: loss of logical meaning btw words or thoughts (eg. pt talking about parents then about world hunger)

11

define neologisms

disorder of form of thought: inventing new words

12

define perserveration

disorder of form of thought: repeating the same word or phrase over and over

13

define tangentiality

disorder of form of thought: beginning a response in a logical fashion but then getting further and further from the point

14

define thought blocking

disorder of form of thought: abrupt halt in the train of thinking, often because of hallucinations

15

define word salad

disorder of form of thought: uttering unrelated combinations of words or phrases

16

What is psychotic disorder caused by a general medical condition (PDMC)?

medical illnesses that cause psychotic symptoms are referred to as PDMC. Examples of PDMCs are MS, Parkinson's disease, Huntington's disease, neoplasms, neurologic infections, temporal lobe epilepsy, cerebrovascular disease. Endocrine disturbances like thyroid disease, Cushing's, Addison's, SLE. Metabolic disorders, vitamin deficiencies.

17

How to differentiate btw schizophrenia and psychotic disorder caused by a general medical condition (PDMC) (e.g Huntington's, Parkinson's)?

Schizophrenia itself is characterized by psychotic symptoms occurring concurrently with CLEAR CONSCIOUSNESS, the diagnosis of PDMC can be made only in the absence of delirium or dementia.

18

Psychosis in schizophrenia vs psychosis brought on by medications -how are they different?

schizophrenia --> flat affect
meds --> preservation of affect

19

What's considered firstline therapy for schizophrenia?

atypical anti-psychotics aka second generation anti-psychotics (e.g. clozapine, riseridone, aripiprazole) because they cause fewer negative neurological effects (e.g. parkinsonism, tardive dyskinesia)

20

Not super high yield: but what are the 5 DSM-IV-TR subtypes of schizophrenia

1) undifferentiated (characteristic of more than 1 subtype)
2) paranoid
3) residual (no current frank psychotic symptoms but h/o of at least one previous psychotic episodes)
4) disorganized (hebephrenic)
5) catatonic

21

T/F: more than 50% of ppl with schizophrenia attempt suicide.

True
-often due to postpsychotic depression or when experiencing "command" hallucinations ordering them to harm themselves

22

List 8 factors that lead to better prognosis in schizophrenic patients

-are older at onset of illness
-are married
-have social relationships
-are female
-have good employment histories
-have mood symptoms
-have positive symptoms
-have experienced relatively few relapses

23

List the 3 characteristics and the prognosis of schizophrenia

-psychotic and residual symptoms lasting at least 6 months
-normal consciousness and memory function
-auditory hallucinations predominate

lifelong social and occupational impairment

24

List the 3 characteristics of psychotic disorder caused by a general medical condition (PDMC)

-hallucinations that are visual and changeable rather than auditory and recurrent
-occurs in context of an acute medical illness
-symptoms not due to delirium or dementia

psychotic symptoms remit when medical condition improves

25

List the 2 characteristics of brief psychotic disorder

-psychotic and residual symptoms lasting more than 1 day but less than 1 month
-obvious precipitating psychosocial factors

50-80% recover completely

26

List the 2 characteristics of schizophreniform disorder

-psychotic and residual symptoms lasting 1-6 months
-obvious precipitating psychosocial factors

33% recover completely

27

List the 4 characteristics of schizoaffective disorder

-fit criteria for both a mood disorder and schizophrenia
-psychotic symptoms present for at least 2 week without mood symptoms
-mood symptoms during the psychotic and residual phases
-chronic social and occupational impairment

lifelong social and occupational impairment but less severe than in schizophrenia

28

List the 2 characteristics of delusional disorder

-fixed, nonbizarre delusional system present for at least 1 month
-absence of other thought disorders

50% recover completely, many have relatively normal social and occupational functioning

29

List a characteristic of shared psychotic disorder (folie a deux)

development of a delusion in a person in a close relationship with someone with delusional disorder

30

List a characteristic of manic phase of bipolar disorder

-psychotic symptoms, elated mood, rapid onset, hyperactivity, rapid speech, and increased sociability.
-delusions of grandeur

31

List 2 characteristics of schizoid personality disorder

-voluntary social withdrawal
-no evidence of a thought disorder

lifelong

32

List 3 characteristics of schizotypal personality disorder

-negative symptoms
-bizarre behavior and odd thought patterns
-no frank hallucinations or delusions

lifelong

33

List 2 characteristics of borderline personality disorder

-extreme mood swings with uncontrollable anger and episodic suicidal thoughts
-transient episodes of paranoia and/or dissociation

lifelong

34

When patient presents with psychotic symptoms, what should be examined next before coming up with possible conditions?

if there are mood symptoms and if they are residual or not

yes --> bipolar, depressive disorder, schizoaffective disorder

no --> delusional disorder, brief psychotic disorder, schizophreniform disorder, schizophrenia

35

List 5 psychotic disorders that have similar symptoms to schizophrenia but do not include all required for diagnosis

-brief psychotic disorder
-schizophreniform disorder
-schizoaffective disorder
-delusional (psychotic) disorder
-shared psychotic disorder

36

Unlike schizophrenia that affects younger people, delusion disorder commonly starts in middle age and patients are usually socially and occupationally functional. Delusional disorder has 3 subtypes. List them.

1) Erotomanic type: conviction that a famous person is in love with the patient

2) Jealous type: belief that one's partner is having romantic or sexual relations with someone else

3) Persecutary type: belief that someone is trying to harm the patient.

37

Explain downward drift of schizophrenia

the average patient loses social stature, income, relationships, support network

38

define circumstantiality

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

39

List some positive symptoms of of schizophrenia

are additional symptoms to expected behavior; gaining symptoms
-delusions
-hallucinations
-agitation
-talkativeness
-thought disorder

40

List some negative symptoms of schizophrenia

are missing from expected behavior
-lack of motivation
-social withdrawal
-flattened affect/emotion
-cognitive disturbances
-poor grooming
-poor/impoverished speech

41

DSM-5 requires how many symptoms to be present for diagnosis of schizophrenia

at least 2 of the specified symptoms

42

What are the three phases of schizophrenia?

-Prodromal: prior to first psychotic break
avoidance of social activities
quiet and passive or irritable
sudden interest in religion or philosophy
may have physical complaints
anxiety and depression

-Psychotic/Active: loss of touch with reality; Positive symptoms
hallucinations
delucions

-Residual: period btw psychotic episodes, in touch with reality, but doesn't behave normally; Negative symptoms
peculiar thinking
eccentric behavior
withdrawal from social interactions

43

Schizophrenia affects men and women equally, but onset is different. Explain

age of onset in men: 15-25 years
age of onset in women: 25-35 years

women also respond better to antipsychotic meds

44

what's the relationship btw amt of days on anti-psychotics and tardive dyskinesia?

cumulative days of anti-psychotics (D2 receptor blockers) can lead to permanent movement disorder -tardive dyskinesia

45

In schizophrenia, do you have increase or decrease use of glucose?

decrease use of glucose in the prefrontal cortex --> hypofrontality

46

In schizophrenia, what happens to the ventricles?

lateral and third ventricles are enlarged

47

In schizophrenia, what happens to the asymmetry of the cerebrum?

It is abnormally symmetric

48

In schizophrenia, what happens to the volume/density of hippocampus, amygdala, and parahippocampal gyrus?

decreased volume of hippocampus, amygdala, and parahippocampal gyrus

49

What are some changes that are seen on EEG with someone in schizophrenia?

-decreased alpha waves
-increased theta and delta waves
-epileptiform activity

50

Are there abnormalities in eye movements in someone with schizophrenia?

Yes (poor saccadic smooth visual pursuit)

51

What NT abnormalities account for the positive and negative symptoms found in schizophrenia?

positive symptoms --> due to increase dopamine in mesolimbic tract

negative symptoms --> due to decrease dopamine in mesocortical tract

52

Elevated levels of which metabolite of DA in bodily fluids of pts with schizophrenia suggests more DA activity and use in CNS.

homovanillic acid

53

T/F: There is a link btw serotonin hyperactivity and schizophrenia but little is known about it.

True

54

T/F: NE hyperactivity may be involved in schizophrenia

True

55

State the dopamine hypothesis

-excessive dopaminergic activity in mesolimbic tract
-hypoactivity of mesocortical dopamine tract/pathway

56

What's the glutamate hypothesis? Antagonists and agonists of NMDA subtype of of glutamate receptors have what effects on schizophrenia?

-glutamate is the major excitatory NT in the CNS
-antagonists of NMDA subtype of glutamate receptors aggravate and create psychosis
-agonists of NMDA receptors experimentally relieve symptoms

57

Part of the glutamate hypothesis is the NMDA receptor (NMDAR) hypoactivity hypothesis.

some NMDAR sit on GABA interneurons positioned between a cortical glutamate pyramidal neuron and its secondary neuron. A loss of inhibition occurs in the secondary glutamate allows excessive firing and an increase in firing in the ventral tegmental area which sends extra DA into the limbic system thus causing psychosis.

so mutation in NMDAR or antagonism of it --> loss of inhibition of dopamine release --> increase dopamine --> psychosis

58

Explain normal functioning of GLU-GABA-GLU-DA

glutamate works on GABA interneuron, GABA once activated will inhibit glutamate release, which will inhibit dopamine release

**this GLU-GABA-GLU-DA helps maintain balance of dopamine

59

Explain what is wrong with the GLU-GABA-GLU-DA circuit in explaining positive symptoms in mesolimbic circuit.

1st glutamate doesn't bind NMDA receptors --> nonfunctional so does not excite GABA interneuron--> loss of inhibition of second glutamate which excites VTA to make excess dopamine --> positive symptoms of schizophrenia

*deficient GABA and hypofunctional NMDA receptors

60

Explain normal circuitry of GLU-GABA-GLU-GABA-DA

Glutamate is excitatory to GABA--> inhibits 2nd glutamate --> no GABA --> no inhibition of dopamine (a lot of dopamine)

61

How does the GLU-GABA-GLU-GABA-DA contribute to negative symptoms in mesocortical pathway?

second glutamate receptor is over-active ("hot")--> increase GABA --> decrease dopamine --> negative symptoms in mesocortical pathway.

62

atypical antipsychotics block D2 receptors as well as 5-HT2a. What does 5HT2a blockade lead to?

allows dopamine to more freely flow in the nigrostriatal pathway

63

Someone with schizophrenia often stabilizes in midlife with positive or negative symptoms predominating?

negative symptoms predominating