Term
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Definition
An abnormal condition of the mind that results in difficulties telling what is real and what is not.
Symptoms may include false beliefs and seeing or hearing things that other do not see or hear. Other symptoms may include incoherent speech and behavior that is inappropriate for the situation. |
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Term
| Schizophrenia Spectrum Disorders (SSDs) |
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Definition
• Brief psychotic disorder
• Schizophreniform disorder
• Schizophrenia
• Schizoaffective disorder |
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Term
| Key Features of Schizophrenia Spectrum Disorders SSDs |
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Definition
• Hallucinations
• Disorganized thinking (speech)
• Delusions*
• Grossly disorganized or abnormal motor behavior (including catatonia)*
• Negative symptoms* |
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Term
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Definition
• Fixated beliefs that are not amenable to change in light of conflicting evidence.
• Themes:
• Persecutory
• Referential
• Erotomanic
• Somatic
• Nihilistic
• Grandiose
• Religious
• Bizarre vs. Non-bizarre delusions |
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Term
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Definition
-Behavior may manifest itself in a variety of ways, ranging from childlike “silliness” to unpredictable agitation.
-Catatonic behavior
• Abnormal reactivity to the environment
• Abnormal muscle tone (rigidity, waxy flexibility, posturing)
• Ranges from resistance to instruction (negativism); to maintaining a rigid, inappropriate or bizarre posture; to a complete lack of verbal and motor responses (mutism, staring, and stupor).
• Purposeless and excessive motor activity without obvious cause (catatonic excitement).
• Stereotyped movements, mannerism, repetition or echoing of speech/behavior.
• Bush-Francis Catatonia Rating Scale (23 items) |
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Term
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Definition
• Account for a substantial portion of the morbidity associated with schizophrenia
• Diminished emotional expression • Avolition
• Alogia
• Anhedonia
• Asociality |
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Term
| DSM-V Brief Psychotic Disorder |
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Definition
A.
Presence of one (or more) of the following symptoms. • Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized or catatonic behavior
B. Duration of an episode of the disturbance is at least 1 day but less than 1 month with eventual full return to premorbid level of functioning
C. Rule out: Major depressive disorder or bipolar disorder with psychotic features, another psychotic disorder such as schizophrenia or catatonia, disturbances attributable to the effects of a substance or another medical condition |
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Term
| DSM-V Schizophreniform Disorder |
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Definition
A. Two (or more) of the following for a significant portion of time during 1-month period:
• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized or catatonic behavior
• Negative symptoms (i.e., diminished emotional expression or motivational self-initiated purposeful activities)
B. An episode of the disorder lasts at least 1 month but less than 6 months. |
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Term
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Definition
A. Two (or more) of the following for a significant portion of time during 1-month period:
• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized or catatonic behavior
• Negative symptoms (i.e., diminished emotional expression or motivational self-initiated purposeful activities)
B. Functional impairment falls below baseline.
C. Continuous signs of the disturbances persist for at least 6 months.
D. Rule out: Schizoaffective disorder, depressive or bipolar disorder with psychotic features, disturbances attributable to effects of a substance or another medical condition. |
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Term
| DSM-V Schizoaffective Disorder |
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Definition
A. An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia.
B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime during of the illness
C. Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness
D. The disturbance is not attributable to the effects of a substance or another medical condition. |
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Term
| Schizophrenia: Epidemiology |
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Definition
• 1.1 % of US adult populations or more than 21 million people worldwide (Regier et al., 1993)
• The peak age at onset for the first psychotic episode:
• Early-to mid-20s for males and in the late-20s for females
• Disability: Among the top 20 worldwide causes of YLD (Vos et al., 2012)
• Mortality:
• Die 15-20 years earlier (Reininghaus et al., 2015)
• 20% attempt suicide; 5-6% die by suicide (Hawton et al., 2005)
• Associated medical conditions: DM, Metabolic syndrome, CV/Pulmonary disease (Hennekens et al., 2007)
• Economic Cost: (Cloutier et al., 2016)
• Schizophrenia leads U.S. expenditures on mental illness
• 2013: $155.7 billion |
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Term
| Schizophrenia: Risk Factors |
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Definition
• Genetics:
• Many different genes may increase the risk of schizophrenia, but that no single gene causes the disorder by itself.
• Concordance rates in monozygotic twins: about 50%
• Heritability estimates: 80 %
• Environment factors:
• Prenatal complications: Maternal infection, malnutrition, stress, and obesity
• Pregnancy and birth complications with hypoxia
• Exposure to stress or trauma (i.e. childhood adversities)
• Exposure to certain infections
• Living in urban settings
• Extensive exposure to toxin, such as marijuana
• Greater paternal age |
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Term
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Definition
• The most consistent findings from neuroimaging studies are ventricular enlargement and reduced total brain volume (gray matters).
• Disrupted or altered connectivity
• Disruption in white matter tracts (uncinate fasciculus, cingulum bundle, corpus callosum, and internal capsule)
• Decreased connectivity between brain cells |
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Term
| schizophrenia w good prognisis |
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Definition
| acute onset, age of onset, high IQ, precipitating factor, positive symptoms |
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Term
| schizophrenia w poor prognosis |
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Definition
| insidious onset, young age of onset, low IQ, no precipitating factor, negative symptoms |
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Term
| Schizophrenia: Suicide Risk |
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Definition
• Approximately 5%-6% of individuals with schizophrenia die by suicide.
• About 20% attempt suicide on one or more occasions.
• Many more have significant SI.
• Increased suicide risk
- History of suicide attempt(s)
- Younger males with comorbid substance use
- Depressive symptoms or feeling of hopelessness
- Unemployed
- In the period after a psychotic episode or hospital discharge |
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Term
| DSM-V Delusional Disorder |
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Definition
A. The presence of one (or more) delusions with a duration of 1 month or longer
B. Criteria A for schizophrenia has never been met
C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd
D. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods
E. The disturbance is not attributable to the physiological effects of a substance or other medical condition and is not better explained by mental disorder, such as BDD or OCD. |
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Term
| Differentials: Non-psychiatric |
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Definition
• CNS
• Infections
• Rheumatological/Inflammatory
• Endocrine
• Metabolic
• Substances/Medication-induced
• Other general medical conditions |
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Term
| Medical Work-up for First-episode Psychosis |
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Definition
• Basic screening and baseline:
• CBC
• Electrolytes including calcium
• RFTs
• LFTs
• ESR
• ANA
• Fasting glucose
• Lipid profile
• Consider prolactin level
• Pregnancy test
• Urine drug screen
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Specific treatable disorders:
• TSH
• FTA-ABS
• HIV
• Ceruloplasmin
• Vitamin B12
Neuroimaging (MRI)
Consider only if indicated:
• EEG
• LP
• Karyotype
• Heavy metal testing |
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Term
| Treatments for schizophrenia |
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Definition
• Pharmacologic treatment
• Psychosocial therapy
• Coordinated Specialty Care (CSC)
• Hospital-based treatment
• Electroconvulsive therapy (ECT) |
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Term
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Definition
• Remains as the cornerstone of treatment of schizophrenia
• Typical and Atypical antipsychotics are distinguished by the unique receptor-binding profiles of antipsychotics with dopamine and serotonin receptors.
-Typical (first generation): high-, mid-, and low-potency
-Atypical (second generation): Antagonism at the serotonin 2A receptor in addition to D2 blockade
• All antipsychotics are equally effective in the treatment of psychosis, with the exception of Clozapine, which is more effective for treatment refractory schizophrenia.
• The choice of antipsychotics should be made based on the past history of response to a particular antipsychotic, family history of response, and likelihood of tolerance to side effects.
• At least 2 weeks of treatment is required before significant antipsychotic effect is achieved |
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Term
| Antipsychotics 1st generation |
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Definition
High Potency
• Haloperidol (Haldol)
• Fluphenazine (Prolixin)
• Pimozide (Orap)
• Thiothixene (Navane)
• Trifluoperazine (Stelazine)
Mid Potency
• Perphenazine (Trilafon)
• Molindone (Moban)
• Loxapine (Loxitane) Low Potency
• Chlorpromazine (Thorazine)
• Thioridazine (Mellarill) |
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Term
| antipsychotics 2nd generation |
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Definition
• Risperidone (Risperidal) • Paliperidone (Invega)
• Quetiapine (Seroquel)
• Olanzapine (Zyprexa)
• Aripiprazole (Abilify)
• Brexpiprazole (Rexulti) • Ziprasidone (Geodon) • Lurasidone (Latuda)
• Asenapine (Saphris)
• Clozapine (Clozaril) |
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Term
| Antipsychotic Side Effects from Dopamine-2 |
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Definition
• Extrapyramidal side effects
• Involuntary movements due to blockade of dopamine receptors in the nigrostriatal pathway of the basal ganglia.
• Acute dystonia: torticollis, oculogyric crisis
• Parkinsonian syndrome: cogwheel rigidity, mask-like face, bradykinesia, and shuffling gait
• Akathesia
• Tardive dyskinesia (TD)
• An involuntary movement disorder involving tongue, mouth, fingers, toes, and other body parts
• Neuroleptic Malignant Syndrome
• Characterized by severe muscle rigidity, fever, AMS, and autonomic instability.
• Elevated WBC, CPK, and LFTs
• May lead to kidney damage and 30% mortality (medical emergency!)
• Hyperprolactinemia
• Gynecomastia, galactorrhea, and menstrual dysfunction. |
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Term
| Antipsychotic muscarinic side effects |
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Definition
• Dry mouth, constipation, blurry vision, urinary retention, and ECG changes
• In severe cases, can cause a central anticholinergic syndrome, characterized by confusion or delirium, dry flushed skin, dilated pupils, and elevated HR
• More common with low-potency agents, such as chlorpromazine or thioridazine. |
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Term
| antipsychotic alpha-1 adrenergic side effects |
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Definition
• Orthostatic hypotension, lightheadedness, tachycardia, sedation, and sexual dysfunction
• More common with low-potency agents or Clozapine. |
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Term
| antipsychotic histamine-1 side effects |
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Definition
• Sedation, weight gain, fatigue
• More common with low-potency agents. |
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Term
| antipsychotic serotonin 1-c side effects |
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Definition
| • May mediate weight gain |
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Term
| Metabolic syndrome from antipsychotics |
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Definition
-weight gain
• Related to blockade of Serotonin 2C and Histamine receptors
• Olanzapine, Clozapine > Quetiapine, Risperidone > Aripiprazole, Ziprasidone
• Hyperlipidemia
• Elevation of TG and CHOL
• Diabetes
• Development of insulin resistance or type II DM
• Should monitor metabolic parameters: BMI, BP, fasting Glc, and fasting lipid profile |
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Term
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Definition
• Superior therapeutic benefit for treatment of psychosis including treatment-resistant psychosis.
• An antagonist of Serotonin-2A, Alpha-1, Dopamin-1, 2, and 4 receptors. Clozapine also has significant antihistamine and anticholinergic properties.
• Unique side effects:
• Agranulocytosis (1-2% incidence): weekly monitoring of CBC for the first 6 months
• Myocarditis (5-100 cases/100,000 patient years). |
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Term
| other nonspecific antipsychotic side effecrts |
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Definition
| • Lowered seizure threshold, hyperthermia, hypothermia, hepatitis, jaundice, photosensitivity, hematologic changes, and rash |
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Term
| Psychosocial Treatment for schizophrenia |
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Definition
• Individual psychotherapy
• Supportive therapy, CBT
• Rehabilitation
• Social skills and job training
• Cognitive remediation
• Substance use education and treatment
• Group therapy and support groups
• Family therapy
• Social, occupational, and educational support
• Risk management(suicide risk) |
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Term
| Duration of Untreated Psychosis (DUP) |
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Definition
• Time between onset of frank psychotic symptoms and effective treatment
• Patients with shorter DUP have:
• Less severe symptoms on first admission to services
• Better response to treatment
• Faster, more complete remission
• Less negative impact on vocational/educational achievements
• Decreased likelihood of compulsory admission
• Lower treatment costs
• Fewer relapses
• Lower risk of suicide attempts
• Fewer, shorter hospital admissions
• Median DUP in the US: 1.5-2 years (Marshall et al., 2005; Addington et al., 2015; Judge et al., 2005) |
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Term
| Coordinated Specialty Care (CSC) for schizophrenia |
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Definition
This is a multi- disciplinary team approach towards treating schizophrenia when the first symptoms appear.
• OnTrack
• First-episode and Early Psychosis Program (FEPP)
• Recovery in Shared Experiences (RISE)
• Prevention and Recovery in Early Psychosis (PREP)
• Specialized Treatment Early in Psychosis (STEP) |
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Term
| take home message for schizophrenia |
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Definition
| Early treatment of Schizophrenia can be a key in helping our patients lead a normal life! |
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