Flashcards in Schizophrenia and Other Psychotic Disorders Deck (79):
Peak age of onset for schizophrenia is ...?
15-25 for males.
25-35 for females.
Any epidemiologic preference for schizophrenia?
NO - Equally in men and women, all cultures, and all ethnic groups.
2 types of symptoms in schizophrenia:
Positive symptoms are what?
Things ADDITIONAL to expected behavior and include:
Negative symptoms are what?
Things MISSING from expected behavior:
1. Lack of motivation.
2. Social withdrawal.
3. Flattened affect.
4. Cognitive disturbances.
5. Poor grooming.
6. Poor (eg impoverished) speech content.
Positive symptoms respond well to ...?
Most traditional + Atypical antipsychotics.
Negative agents respond better to ...?
What distinguishes patients with negative symptoms from those with positive symptoms?
Patients with predominantly negative symptoms have more NEUROANATOMIC + METABOLIC abnormalities (eg decr. cerebral metabolism of glucose) than those with predominantly positive symptoms.
Symptoms of schizophrenia - Disorder of (4):
2. Thought content.
3. Thought processes.
4. Form of thought.
Symptoms of schizophrenia - Disorder of perception - Symptoms:
Illusions - Definition:
MISPERCEPTION of real external stimuli.
Illusions - Example:
Interpreting the appearance of a coat in a dark closet as a man.
Hallucinations - Definition:
False sensory perception.
Hallucinations - Example:
Hearing voice when alone in a room.
Symptoms of schizophrenia - Thought content - Symptoms:
2. Ideas of reference.
Delusions - Definition:
False belief not shared by others.
Delusions - Example:
The idea of being followed by the FBI.
Ideas of reference - Definition:
False belief of being referred to by others.
Ideas of reference - Example:
The feeling of being discussed by someone on television.
Symptoms of schizophrenia - Thought processes - Symptoms:
1. Impaired abstraction.
2. Magical thinking.
Impaired abstraction ability - Definition:
Problems concerning the essential qualities of objects or relationships.
Magical thinking - Definition:
Belief that thoughts affect the course of events.
Impaired abstraction ability - Example:
When asked what brought her to the ER, the patient says, "An ambulance".
Magical thinking - Example:
Knocking on wood to prevent something bad from happening.
Symptoms of schizophrenia - Form of thought - Symptoms:
2. Loose associations.
Circumstantiality - Definition:
Inclusion of too much detail.
Circumstantiality - Example:
When asked about her health, the patient explains everything that she did since getting up that day before getting to the subject of health.
Loose associations - Definition:
Shift of ideas from one subject to another in an unrelated way.
Loose associations - Example:
The patient begins to answer a question about her health and then shifts to a statement about baseball.
Perseveration - Definition:
Repeating words or phrases.
Perserveration - Example:
The patient says, "I'm evil, I'm evil, I'm evil".
Tangentiality - Definition:
Getting further away from the point as speaking continues.
Course of schizophrenia - The 3 phases of schizophrenia:
2. Active (psychotic).
Mention some prodromal signs/symptoms:
1. Avoidance of social activities.
2. Physical complaints.
3. New interest in religion, the occult, or philosophy.
What happens in the active phase of schizophrenia?
1. The patient loses touch with reality.
2. Disorders of perception + thought content + thought processes + form of thought.
In the residual phase (time period between psychotic episodes), the patient is ...?
In touch with reality, BUT DOES NOT BEHAVE NORMALLY.
Positive or negative symptoms characterize the residual phase?
What happens to the memory of the patient during the residual phase?
--> Oriented to person, place, and time --> Normal level of consciousness.
Prognosis of schizophrenia - Course:
Usually involves repeated psychotic episodes and a chronic, downhill course over years.
--> The illness often stabilizes in midlife.
Suicide in schizophrenia?
>50% attempt suicide and 10% of those die in the attempt.
Suicide in schizophrenia - Often during ...?
Post-psychotic depression or when having hallucinations "commanding" them to harm themselves.
The prognosis is better and the suicide risk is lower ...?
If the patient is:
1. Older at onset of illness.
3. Has social relationships.
5. Good employment history.
6. Mood symptoms.
7. Few negative symptoms.
8. Few relapses.
The genetics of schizophrenia - The general population:
The genetics of schizophrenia - Person who has one parent or sibling (or dizygotic twin) with schizophrenia?
The genetics of schizophrenia - Person who has 2 parents with schizophrenia?
The genetics of schizophrenia - Monozygotic twin of a person with schizophrenia:
Etiology of schizophrenia - Markers on chromosomes:
1, 6, 7, 8, 13, 21, 22.
Etiology of schizophrenia - Other interesting factors ...?
THE SEASON OF BIRTH --> Related to the incidence of schizophrenia.
--> Born during the cold weather months (January to April in the northern hemisphere).
One possible explanation = Viral infection of the mother during pregnancy.
Etiology of schizophrenia - Social or environmental factor?
NO - However, because patients with schizophrenia tend to drift down the socioeconomic scale as a result of their social deficits (the "downward drift" hypothesis), they are often found in lower socioeconomic groups (eg homeless people).
Neural pathology of schizophrenia - Anatomy (5):
1. Abnormalities of the frontal lobes (seen in PET - Decr. glucose uptake).
2. Lateral + 3rd ventricle enlargement.
3. Abnormal cerebral symmetry.
4. Changes in brain density.
5. Decr. volume of LIMBIC STRUCTURES (eg amygdala, hippocampus) is also seen.
Schizophrenia - The dopamine hypothesis:
The POSITIVE symptoms result from excessive dopaminergic activity.
Lab test to support the dopamine hypothesis:
Elevated levels of HOMOVANILLIC ACID (HVA), a metabolite of dopamine, in the body fluids of patients with schizophrenia.
The NEGATIVE symptoms of schizophrenia are believed to result from ...?
REDUCED DOPAMINERGIC ACTIVITY in the FRONTAL cortex.
Why is SEROTONIN hyperactivity implicated in schizophrenia?
1. Because hallucinogens that increase serotonin concentratons cause PSYCHOTIC SYMPTOMS.
2. Because some effective antipsychotics, such as CLOZAPINE, have anti-serotonergic-2 (5HT2) activity.
Glutamate is implicated in schizophrenia:
NMDA BLOCKERS (amantadine) are useful in treating some of the neurodegenerative symptoms (eg loss of cognitive abilities) in patients with schizophrenia.
DSM-IV-TR Subtypes of schizophrenia (5):
Catatonic subtype of schizophrenia - Characteristics:
1. Stupor or agitation.
2. Lack of coherent speech.
3. Bizarre posturing (waxy flexibility).
4. Rarely seen since the introduction of antipsychotic agents.
Disorganized subtype of schizophrenia - Characteristics:
1. Poor grooming and disheveled personal appearance.
2. Inappropriate emotional responses (eg silliness).
3. Facial grimacing.
4. Mirror gazing.
5. Onset before the age of 25yr.
Paranoid subtype of schizophrenia - Characteristics:
1. Delusions of persecution.
2. Better functioning and older age at onset than other subtypes.
Residual subtype of schizophrenia - Characteristics:
1. At least one previous psychotic episode.
2. Subsequent residual symptoms but no current frank psychotic symptoms.
Undifferentiated subtype of schizophrenia - Characteristics:
Of MORE THAN ONE SUBTYPE.
DDx of schizophrenia:
1. Medical illnesses.
3. Psychiatric illnesses.
4. Schizotypal, paranoid, and borderline personality disorders.
Medical illnesses that may mimic schizophrenia?
1. Neurologic infections.
4. HD + MS.
5. Temporal lobe epilepsy.
6. ENDOCRINE DISORDERS (Cushing + AIP).
Medications that can cause psychotic symptoms:
6. Cardiac glycosides.
7. Steroid hormones.
Psychiatric illnesses other than schizophrenia that may be associated with psychotic symptoms include:
1. Other psychotic disorders.
2. Mood disorders (eg the manic phase of bipolar disorder, major depression).
3. Cognitive disorders (eg delirium, dementia, and amnestic disorder).
4. Substance-related disorders.
Management of schizophrenia - Pharmacologic management:
1. Traditional antipsychotics (D2 blockers).
2. Atypical antipsychotics = 1st line.
Psychological management of patients with schizophrenia:
Useful to provide long-term support and to foster adherence to the drug regimen.
Other psychotic disorders (5):
1. Brief psychotic disorder.
2. Schizophreniform disorder.
3. Schizoaffective disoder.
4. Delusional disorder.
5. Shared psychotic disorder (folie a deux).
Brief psychotic disorder:
Psychotic symptoms lasting >1day but Often precipitating psychosocial factors.
Brief psychotic disorder - Prognosis:
50-80% recover completely.
Psychotic + residual symptoms lasting 1-6mos.
Schizophreniform disorder - Prognosis:
33% recover completely.
Symptoms of BOTH a mood disorder + schizophrenia.
--> Presence of psychotic symptoms for at least 2 wks without mood symptoms.
Schizoaffective disorder - Prognosis:
Lifelong social and occupational impairment (somewhat higher overall level of functioning than in schizophrenia).
Fixed, persistent, non-bizarre delusional system (paranoid in the persecutory type and romantic [often with a famous person] in the erotomanic type).
--> Few, if any, thought disorders.
Delusional disorder - Prognosis:
50% recover completely; many have relative normal social and occupational functioning.
Shared psychotic disorder (folie a deux):
Development of delusions in a person in a close relationship (eg spouse, child) with someone with delusional disorder (the inducer).
Shared psychotic disorder (folie a deux) - Prognosis:
10-40% recover completely when separated from the inducer.