Term
| What are the major Positive symptoms of Schizophrenia? |
|
Definition
With Cognitive Symptoms and Negative symptoms as well
1) Perception
- Hallucinations 75% (auditory most common)
- Illusions
- "efferent copy theory" and inner speech
2) Thought content/"Delusions"
- False, fixed beliefs despite contrary evidence
- Misrepresentation of saliency corresponding to NMDA receptor dysfunction and DA control of signal:noise
3) Form of thought
- word salad, neologisms, looseness of association
- PFC GABA, glutamate and DA pathways
4) Behavior
- Variable psychomotor behaviors (stereotypes to catatonic states) |
|
|
Term
| What is the "efferent copy" proposal with reference to positive symptoms seen in Schizophrenia? |
|
Definition
Explanation of hallucinations that posits they are the result of a breakdown in monitoring on internal speech by "efferent copies".
They can't tell the difference between internal/external speech, perceiving the inner speech as "alien." |
|
|
Term
| What biological mechanisms are thought to underly delusions in Schizophrenia? |
|
Definition
Misrepresentations of saliency (attribute attention to strange events) due to
1) NMDA receptor dysfunction
2) DA control of signal:noise |
|
|
Term
| What biological mechanisms are thought to underly formal thought disturbances in Schizophrenia? |
|
Definition
Form of Though Positive Symptom
- GABA/glutamate and dopamine signaling in PFC |
|
|
Term
| What are the major Negative symptoms of Schizophrenia? |
|
Definition
1) Amotivation- lose of initiative, interests and drive (goal-directed behavior)
2) Alogia (poverty of speech and restriction in amount- can cause mutism). Volume is sufficient, but content is strange.
3) Affecting Blunting- Poverty of emotion and inappropriate affect (flat or blunted)
4) Asociality- Withdraw from social situations |
|
|
Term
| What cognitive symptoms are seen in Schizophrenia? |
|
Definition
- Executive functions involving planning, sequencing, concept formation, set shifting.
- Specifically WM unrelated to motivation (DLPFC)
- linked to functional prognosis but poorly treated |
|
|
Term
| How do you diagnose a case of Schizophrenia as per the DSM-IV? |
|
Definition
Criterion A-D
A)
2 of 5 for significant part of 1-month period
1) Delusions
2) Hallucinations
3) Disorganized speech
4) Disorganized or catatonic behavior
5) Negative symptoms
B) Significant social or occupational dysfunction, if onset is adolescent
C) Continued disturbance for 6 months
D) Rule out Schizoaffective disorder and mood disorder with psychotic features
- No MD or Manic Episodes in active phase
- If mood syndromes present in active phase, must be brief in duration relative to active and residual illness phases |
|
|
Term
| What subtypes of Schizophrenia are there? |
|
Definition
Unstable and likely to be eliminated in DSM V
1) Catatonic
2) Disorganized
3) Paranoid
4) Undifferentiated
5) Residual |
|
|
Term
| What epidemiological features define Schizophrenia? |
|
Definition
1) Begins in adolescence or early adulthood in 0.5-1 % of population
2) 1.4:1 M:F with males having earlier onset
3) Lower social economic status ("downward drift due to illness")
4) Late winter births (as well as birth complications) and immigrant association
5) Life stressors and lack of marital status are positively correlated |
|
|
Term
| Which environmental factors contribute to the development of Schizophrenia? |
|
Definition
1) Father > 55
2) Cannabis interacts with genetic features
3) Viral exposures in utero |
|
|
Term
| What is the neuroanatomical/pathological basis of Schizophrenia? |
|
Definition
Smaller and fewer neuron cells, but without Gliosis
** reduced in synaptic neurophil-exagerated pruning
1) Reduced whole brain volume with reduction in grey
2) Enlarged lateral and 3rd ventricles (40%)
3) Decreased cortical gray matter (superior temporal gyri and medial temporal cortex, notably hippocampus)
4) Subtle reduction in PFC volume |
|
|
Term
| What neurochemical abnormalities underlie Schizophrenia? |
|
Definition
1) Dopamine
- Negative symptoms arise from decreased function of mesocortical path via D1 receptors
- Positive symptoms arise from over functioning of mesolimbic path via D2 (lack of inhibition by mesocortical)
2) 5-HT
- LSD recapitulates hallucinations
- Drugs that block 5-HT and DA (clozapine) are highly effective
- DA:5-HT interaction may be "off"
3) GABA interneuron loss in hippocampus and cingulate
- overactive DA
4) Glutamate
- glutamatergic receptor antagonist causes symptoms similar to schizophrenia (reduced glutamate?) |
|
|
Term
| What is the role of genetic factors in the development of Schizophrenia? |
|
Definition
1) Aggregates in families (BUT 55% discordance of identical twins suggests enviorment also)
2) Complex multifactorial/threshold model of transmission
3) Smooth pursuit eye movement dysfunction and deficiencies in sustained attention may serve as biological vulnerability makers. |
|
|
Term
| What are the 5 major stages of early Schizophrenia? |
|
Definition
Remember, every individual will look different!
1) Premorbid- Disturbance in neurological maturation cognition and emotional capacity (may show up in school performance)
2) Prodromal- Unusual preoccupation, perceptual disturbances, ideas of reference and vague thinking.
3) Acute/Florid/Psychotic-
4) Stabilization/Convalescent- Recovery begins, and symptoms may re-emerge in stressful situations
5) Stable/Maintenance- will either recover or relapse |
|
|
Term
| Why do some patients relapse after early schizophrenic phenomena, while others recover? |
|
Definition
1) Non-adherence to treatment
2) Inadequate life support
3) Inadequate socialization/recreation
4) Substance abuse
5) High expressed emotion |
|
|
Term
| What is the breakdown of outcome/prognosis for patients with Schizophrenia? |
|
Definition
30-40% recover, 20-30% continue with moderate symptoms and 20-30% have permanent impairment
Good outcomes are predicted by (Bad are opposite)
1) Acute onset
2) Short duration
3) Females
4) Good pre-morbid feelings
5) Low brain abnormalities
6) Low expressed emotion
7) Low negative/cognitive symptoms
8) No substance abuse |
|
|
Term
| What general principles of treatment for Schizophrenia hold true for all phases of the disease? |
|
Definition
Manage, Not Cure
1) Disease management
2) Rehab/recovery
3) Continuum of care
4) Integration/coordination
5) Pharmacotherapy is essential but inneficient |
|
|
Term
| How should pharmacotherapy be applied to Schizophrenia treatment in the acute/florid phase |
|
Definition
Works for + and - symptoms in 70% of people
** also use psychotherapy**
1) Conventional anti-psychotics to hit D2 receptors and have extrapyramidal symptoms (EPS)
- High potency (haloperidol)- Most EPS/Least Autonomic/anti-Cholinergic SE
- Medium potency (Perphenazine)
- Low potency (Chlorpromazine)- Lease EPS/Most autonomic/anti-cholinergic
2) Atypical, Serotonin-Dopamine antagonists (SDA) have less EPS (FRONT LINE) |
|
|
Term
| What/When psychosocial treatments are available for the acute/convalescent/stable phases of Schizophrenia? |
|
Definition
Acute Phase
1) Psycho-education (overcome denial and adress non-adherence)
2) Psychotherapy (not Psychodynamic)
Convalescent (continuation) phase
1) Case management
2) Family issues/intervention
3) Suicide prevention
4) Address non-adherence
Stable (maintenance)
- Reintegration and Remediation
- Develop self-management |
|
|
Term
| What other Psychotic Disorders may be confused for Schizophrenia? |
|
Definition
1) Schizoaffective Disorder
- Psychotic symptoms of Schizophrenia and mood symptoms of depression or mania
- No mood symptoms without psychosis
- Better prognosis (treat mood and psychosis)
2) Delusional Disorder
- Rare with non-bizarre delusions but no hallucinations
3) Schizophreniform Disorder
- Schizophrenia sx <6mo and often progresses to Schizophrenia
4) Brief Psychotic Disorder
- Psychosis <1 mo but >1d in context of psychosocial stressor (good prognosis)
5) Shared Psychotic Disorder
- Similar psychotic symptoms in 2 people simultaneously (one usually dominates)
- Separate the partners! |
|
|
Term
When screening for psychosis, the BEST question to ask a patient would be:
a. Are you having auditory hallucinations?
b. You’re not hearing voices, are you?
c. Has your imagination been playing tricks on you lately?
d. Did anything unusual happen to you today? |
|
Definition
|
|
Term
All of the following are psychotic disorders EXCEPT:
a. Schizophrenia
b. Schizotypal
c. Schizoaffective
d. Delusional |
|
Definition
|
|
Term
Which of the experiences would be considered a “negative symptom”?
a. Poverty of thought
b. Catatonia
c. Disorganized thought
d. Visual hallucinations |
|
Definition
|
|
Term
Which statement most accurately reflects the gender distribution of schizophrenia?
a. More males than females
b. More females than males
c. Males later than females
d. Females later than males |
|
Definition
|
|
Term
The cognitive deficits of schizophrenia derive from abnormalities in what part of the brain?
a. Prefrontal cortex
b. Striatum
c. Ventral tegmentum
d. Cerebellum |
|
Definition
|
|
Term
In patients with schizophrenia, all of the following brain structures are generally smaller EXCEPT:
a. Thalamus
b. Lateral ventricles
c. Cerebellum
d. Total (whole) brain volume |
|
Definition
|
|
Term
All of the following are characteristic symptoms of schizophrenia, EXCEPT:
a. Poor working memory
b. Alogia
c. Apraxia
d. Amotivation |
|
Definition
|
|
Term
What proportion of patients with schizophrenia complete suicide?
a. 1%
b. 5%
c. 10%
d. 20% |
|
Definition
|
|
Term
Which subtype of schizophrenia has the poorest outcome?
a. Paranoid
b. Catatonic
c. Undifferentiated
d. Disorganized |
|
Definition
|
|
Term
Atypical antipsychotics antagonize which neurotransmitters?
a. GABA and dopamine
b. Serotonin and dopamine
c. Serotonin and glutamate
d. Norepinephrine and GABA |
|
Definition
|
|
