Schizophrenia and Psychotic Disorders

Schizophrenia results in impaired functioning because there is disturbance of what?

Thought content, thought process, speech, behavior, orientation, and perception

What are 5 common NEGATIVE symptoms of schizophrenia? (5 A's)

1) Alogia - poverty of speech 2) Affective blunting/flattening 3) Avolition - general lack of motivation/drive 4) Anhedonia - Loss of capacity to experience pleasure 5) Attentional impairment

Schizophrenia can manifest as 3 main sets of symptoms, which are?

1) Positive symptoms (hallucinations, delusions) 2) Negative symptoms (affective blunting, avolition, anhedonia, etc...) 3) Cognitive symptoms (poor exec function, attention problems)

Peak age of onset of schizophrenia

25 - 30 years old (young adult)

In monozygotic twins, there is a ___% chance of developing schizophrenia in their lifetime (assuming the other twin has it and there is family Hx of it). What does this suggest?

50% Suggests that many people with an increased risk for the disorder NEVER FULLY MANIFEST the illness (which means there are other factors besides genetics that play a role) If one monozygotic twin has it, theoretically the other twin should have a 100% lifetime prevalence of getting it too. But they don't.....

Positive symptoms are things that are _____ to a person that they normally wouldn't have

ADDED

TEST: What is the difference between AFFECT and MOOD?

AFFECT: Observable behaviors, how the emotion is CONVEYED by the patient (expansive, constricted, euthymic, blunted, flat) MOOD: How the patient actually feels

Of the types of hallucinations, what is the most common?

Auditory (commonly voice, in or outside the head)

TEST: Schizophrenic hallucinations are MOST commonly: A) Tactile B) Auditory C) Visual D) Olfactory E) Gustatory

B) Auditory

TEST: Regarding the DA hypothesis of Schizophrenia, all of the following are correct EXCEPT: A) Is the most widely accepted hypothesis B) Decreased DA activity is the core deficit in Schizophrenia C) Is based upon evidence from studies of D-amphetamine D) Is substantiated by evidence from anti-psychotic drug studies E) D1 and D5 receptors are present in high concentrations in the cortex and striatum

B) Decreased DA activity is the core deficit in Schizophrenia

TEST: Schizophrenic pts are at a higher risk of mortality due to all of the following EXCEPT: A) Increased cigarette smoking B) Increased sensitivity to drug side effects C) Obesity D) Diabetes E) Hypertriglyceridemia

B) Increased sensitivity to drug side effects They experience side effects to the same extent as us

TEST: Negative symptoms of schizophrenia include all of the following except: A) Flattened affect B) Loose associations C) Avolition D) Anhedonia E) Loss of spontaneity

B) Loose associations (cognitive symptom)

TEST: Clozapine (Clozaril) is an excellent antipsychotic because it: A) Has a low risk of agranulocytosis B) Produces almost no EPS side effects C) Starts working immediately D) Is relatively inexpensive E) Can be used as a first line drug

B) Produces almost no EPS side effects * has a HIGH risk of agranulocytosis, is NOT a first line drug

TEST: Which of the following are effective FIRST line treatments for Schizophrenia? A) Anti-depressants B) Zydis (Zyprexa, Olanzapine) C) Clozapine (Clozaril) D) ECT E) CBT alone

B) Zydis (Zyprexa, Olanzapine)

TEST: The difference between Schizophrenia and Schizophreniform d/o is? A) Delusions do not have to be present in schizophreniform d/o B) The total duration for schizophreniform can be no longer than 6 months C) Social or occupational dysfunction is only present in schizophrenia D) Major depression must be present in schizophreniform d/o

B) total duration for schizophreniform can be no longer than 6 months

All drugs with established anti-psychotic effects have what MOA?

Blocks dopamine receptors (D2) Makes sense you are blocking D2, because this way dopamine cannot bind and inhibit the indirect pathway, so you get LESS movement and LESS psychotic symptoms

Positive symptoms can be seen with what other mental disorders?

Bipolar Schizoaffective Psychotic depression Alzheimer's

Psychotic behavior is manifested as what?

Delusions Prominent hallucinations Disorganized speech (loose associations) Disorganized behavior or catatonic behavior All POSITIVE symptoms

TEST: What is the DSM IV diagnostic criteria for schizophrenia?

CRITERIA A: 2 or more of the following: - Delusions (positive Sx) - Hallucinations (positive Sx) - Disorganized speech/incoherence (positive) - Disorganized/ catatonic behavior (positive) - Negative symptoms Reduction in social/occupational functioning Duration > 6 MONTHS Rule out other mental d/o and substances

Studies found that D-amphetamine resulted in what kind of psychosis? What was the reason behind this?

Caused PARANOID PSYCHOSIS Increased DA and NE levels and inhibited re-uptake

TEST: The DSM IV criteria for Schizophrenia include all of the following EXCEPT: A) Prominent delusions B) Hallucinations C) Disorganized behavior or speech D) Cont' signs of disturb < 1 month E) Significant social/occup impairment

D) Continued signs of disturbance for less than 1 month For schizophrenia, must be greater than 6 months

TEST: What are the subtypes of schizophrenia? Are these subtypes in DSM IV or 5?

DSM IV Schizophrenia subtypes Paranoid Undifferentiated Disorganized Residual (absence of prominent delusions, hallucinations, and disorganized speech/behavior) Catatonic (motoric immobility or excess)

What NT is the PRIMARY hypothesis for the dysregulation in schizophrenia? Therefore, what are some of the treatments for schizophrenia?

DOPAMINE Tx: DA agonists/antagonists

What are some common positive symptoms?

Delusions (fixed false belief) Hallucination (SENSORY perception occurs without external stimuli) Illusion - Actual external stimulus, just misperceived

What is the primary hypothesis for how schizophrenia works?

Dopamine hypothesis, primarily D2 Excess dopamine causes psychosis

Cognitive symptoms are primarily modulated through what area of the brain?

Dorsolateral prefrontal cortex (responsible for cognition, higher order thinking)

TEST: What can improve the long term outcome of schizophrenia?

Early diagnosis and treatment

What is the treatment of choice for refractory schizophrenia?

Electroconvulsive therapy (ECT)

What are mood congruent emotions?

Emotions that are appropriate for the mood

TEST: What is the hallmark of delusional disorder? What are some types of this disorder?

Hallmark: NON-BIZARRE delusions Types: Erotomanic, grandiose, jealous, persecutory, somatic, mixed

Dopaminergic drugs can (minimize/induce) psychosis

INDUCE

TEST: What is the goal of treatment for schizphrenia?

Improve functioning by treating the underlying cause of symptoms

What is the difference between hallucinations and illusions?

In hallucinations, you have a perception with your senses WITHOUT an external stimuli (nothing is actually there) In illusions, there IS an external stimuli, it's just you are perceiving it wrong (example is seeing heat waves coming off the desert floor as water)

With many schizophrenic treatments, as you treat the positive symptoms in schizophrenic symptoms, you make the ______ and ______ symptoms worse

Make the NEGATIVE and COGNITIVE symptoms worse

To Dx Schizophrenia, you must rule out what?

Medical causes (hormonal, postpartum, B12 def) Substance use/abuse Prescription drugs

Negative symptoms are primarily modulated through what brain circuit?

Mesocortical/prefrontal cortex (responsible for emotions)

Positive symptoms are primarily modulated through what brain circuit? What are the primary NTs involved in this circuit?

Mesolimbic (DA, GABA, Glu, and 5HT)

What are some common side effects to atypical antipsychotics?

Metabolic syndrome (HTN, DM, hyperlipidemia) Cardio toxicity, QT prolongation ELEVATED PROLACTIN (especially with Risperdal)

TEST: In schizo-affective d/o, what symptoms predominate?

Mood symptoms

How is the criteria for schizoaffective d/o different from schizophrenia?

Must have symptoms of schizophrenia CONCURRENT with major depression, mania, or mixed

How is the criteria for delusional d/o different from schizophrenia?

NON-BIZARRE delusions (these beliefs are PLAUSIBLE, such as wife divorcing), high functioning

TEST: What is the Dx criteria for delusional disorder?

Non bizarre delusions Criteria A Schizophrenia met (pos/neg symptoms) HIGH function Mood component is minimally involved

(Overactivity/underactivity) of the mesolimbic area results in (positive/negative) symptoms

OVERACTIVITY --> POSITIVE symptoms

What are loose associations?

One thought or idea is associated to another in odd or loosely connected ways

Why are some antipsychotics called ATYPICAL?

They have less or no extrapyramidal symptoms or side effects

Schizophrenia has a predominance in (men/women), but (men/women) respond to treatment better

Predominance in MEN, but WOMEN respond to tx better

Drugs that block postsynaptic dopa receptors (exacerbate/reduce) symptoms of schizophrenia

REDUCE

Negative symptoms are things that are ______ from a person that they normally have, and they represent a _______ of normal functioning

REMOVED (represent a DEFICIT of normal functioning)

What are some key negative symptoms you can identify with some questioning?

Reduced emotional responsiveness (affect blunting) Reduced interest Reduced social drive (avolition)

What are some key negative symptoms you can identify just by observation?

Reduced speech Poor grooming LIMITED EYE CONTACT

Psychosis is a (disease/symptom)

SYMPTOM

How is the criteria for brief psychotic d/o different from schizophrenia?

Symptoms must be GREATER than 1 day but LESS than 1 month Schizophreniform d/o is GREATER than 1 month, but less than 6 months

How is the criteria for schizophreniform disorder DIFFERENT from schizophrenia?

Symptoms must be MORE than 1 month but LESS than 6 months

(Overactivity/underactivity) of the mesocortical area results in (positive/negative) symptoms

UNDERACTIVITY --> NEGATIVE symptoms (and cognitive symptoms)