Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
93 Cards in this Set
- Front
- Back
% of U.S. population w/ Schizophrenia
|
1%
|
|
% of schizo pts. that attempt suicide
% of schizo pts. that die by suicide |
30%
10% |
|
DSM (short) definition of Schizophrenia
|
Decline in functioning
6 months or greater of symptoms (at least 1 month active) |
|
Schizophreniform Disorder
|
Same criteria as schizophrenia, BUT SHORTER
1 - 6 MONTHS |
|
Brief Psychotic Disorder
|
< 1 MONTH
|
|
Schizoaffective Disorder
|
Criteria for BOTH schizo and Mood disorder
Symptoms occur together Preceded/followed by >= 2 weeks of delusions W/O mood symptoms |
|
Delusional Disorder
|
NON-bizarre delusions >= 1 month
ABSENCE of other active-phase Schizo symptoms NOTE: this is often MORE REFRACTORY to anti-psych meds |
|
Shared psychotic disorder (Folie a deux)
|
Disturbance in individual influenced by someone w/ an established delusion
Disturbances have similar content |
|
What is a positive symptom
|
Symptom that is present in schizophrenia, but NOT seen in normal people
|
|
What is a negative symptom
|
Area where schizo pt. is lacking normal abilities
Also called "deficit" symptom |
|
Which type of schizo symptom do traditional anti-psychotics affect LESS?
|
Negative symptoms
|
|
Prevalence of positive symptoms in Type I vs Type II schizo
|
Type 1 -- Prominent positive symptoms
Type 2 -- LESS prominent positive symptoms |
|
Premorbid functioning in Type I vs. Type II schizo
|
Type 1 -- GOOD premorbid functioning
Type 2 -- POOR premorbid functioning |
|
Onset in Type I vs. Type II schizo
|
Type 1 -- ACUTE
Type 2 -- INSIDIOUS |
|
Efficacy of traditional antipsychotics in Type I vs Type II schizo
|
Type 1 -- responds to traditional anti-psychotics
Type 2 -- poor response |
|
Cognition in Type I vs. Type II schizo
|
Type 1 - Good cognition between episodes
Type 2 - Prominent cognitive impairment |
|
Neuroimaging in Type I vs. Type II schizo
|
Type 1 -- Normal
Type 2 -- Atrophy & enlarged ventricles |
|
Three Dimensions of the 3-D model os Schizo
|
Psychotic
Disorganized Negative |
|
Time frame of disturbance/symptoms to qualify as Schizo
|
6 MONTHS of signs of the disturbance
At least 1 MONTH of two or more of following: Delusions, hallucinations, disorganized speech Disorganized/catatonic behavior Negative symptoms |
|
When is only ONE Criterion A symptom required for a diagnosis of Schizo?
|
When delusions are bizarre
OR Hallucinations are a running commentary or >= 2 voices conversing |
|
Does Schizophrenia have any mood components?
|
NO
|
|
When can Schizo be classified in terms of its longitudinal course?
|
Only after at leat 1 year has elapsed since onset
|
|
Paranoid Type Schizo
|
One or more delusions or frequent auditory hallucinations
Doesn't meet criteria for other types |
|
Disorganized Type Schizo
|
ALL of the following are prominent:
Disorganized speech Disorganized behavior FLAT/INAPPROPRIATE AFFECT Criteria is not met for Catatonic Type |
|
Catatonic Type Schizo
|
AT LEAST TWO of the following:
Motoric immobility Excessive motor activity Extreme negativism Peculiarities of voluntary movment Echolalia or echopraxia |
|
Undifferentiated Type Schizo
|
Criterio A Schizo symptoms are present
BUT, doesn't fit any subtype |
|
Residual Type Schizo
|
Continued evidence of the disturbance
Indicated by negative symptoms OR two or more Criterion A symptoms |
|
Criterion A symptoms for Schizo (5)
|
Hallucinations
Delusions Negative symptoms Disorganized speech Disorganized/catatonic behavior |
|
Age of onset of Schizo in men? women?
|
Men - early to mid 20s
Women - late 20s |
|
Prodromal phase of Schizo
|
Gradual development of NEGATIVE symptoms
|
|
Active phase of Schizo
|
Development of POSITIVE symptoms
Often occurs abruptly -- PSYCHOTIC BREAK |
|
Akinetic Depression
|
Depression presenting in Schizo from anti-psychotic-induced Parkinsonism
|
|
Typical course of Schizo
|
EPISODIC exacerbations
CHRONIC social disability Negative symptoms get worse with time Positive symptoms often lessen with time |
|
Good prognostic factors in Schizo
|
Good premorbid adjustment
Acute onset Precipitating events Being FEMALE FAMILY HISTORY OF MOOD DISORDER NO family history of Schizo |
|
Relapse rate if pts. stop taking their meds
|
10% PER MONTH
|
|
Ultimate relapse rate w/o meds
|
70%
|
|
Relapse rate for pts. who are compliant w/ meds
|
30 - 50%
15% in the 1st yr. |
|
Family risks of Schizo
|
One parent - 5-6%
One sibling - 10% One sibling & parent - 17% Two parents - 46% |
|
Risk in twins for Schizo
|
Dizygotic - 15%
Monozygotic - 50% |
|
What does Dopamine Theory of Schizo postulate?
|
That Schizo is due to EXCESS Dopamine
|
|
Problems w/ "classic" DA theory
|
NOT cofirmed by CNS studies
Doesn't explain negative symptoms Cocaine psychosis resembles POSITIVE symptoms, NOT NEGATIVE D2 blocking antipsychotics may actually exacerbate negative symptoms |
|
In addition to being weak D2 blockers, what do ATYPICAL antipsychotics block
|
They are serotonin antagonists
|
|
How do atypical antipsychotics compare to traditional ones?
(in terms of symptoms they treat) |
More effective against positive symptoms
(PSYCH notes) More effective against negative symptoms (PHARM notes) |
|
Mesolimbic tract
|
Involved in "reward circuitry"
Overstimulation may lead to hallucinations/delusions D2 blockers may work here to treat POSITIVE symptoms |
|
Nigrostriatal tract
|
Degeneration of this --> Parkinson's
Increased DA activity --> choreoform, dystonic movements Increased D2 sensitivity here is responsible for Tardive Dyskinesia |
|
Mesocortical tract
|
Mediates effects of DA on attention & planning
Involved in GABA-mediated feedback on brainstem DA neurons |
|
Neuroimaging in Schizo shows decreased activity where?
|
Frontal lobe
|
|
Tuberoinfundibular tract
|
DA here INHIBITS prolactin release
SO, blockade --> Increased prolactin --> galactorrhea Antipsychotics suppress LH & FSH (can cause amenorrhea, anorgasmia) |
|
Efficacy wise, how do traditional antipsychotics stack up against each other?
|
They are all equally efficiacious
|
|
Receptor types that traditional anti-psychotics interact with
|
Histamine-1
Alpha-1 M1 ACh D2 - blockade causes EPS, Inc. prolactin |
|
Type of relationship between ACh and DA in nigrostriatal pathway
|
Reciprocal
DA neurons synapse on ACh neurons --> Decr. ACh release D2 blockade --> Inc. ACh --> EPS |
|
Benztropine or Trihexyphenidyl
|
Anti-cholinergic drugs that reduce Parkinsonism
Do so, W/O affecting anti-dopaminergic effect |
|
Akathisia
|
Severe motor restlessness
Very common LESS responsive to anti-cholinergic medication |
|
Acute Dystonia
|
Sustained, involuntary muscle spasms
Most often involves muscles of face/neck |
|
When does acute dystonia usually occur?
|
During 1st week of treatment with previously unexposed pts.
|
|
In what situation(s) is acute dystonia more common (2)?
|
Young male patients
High potency medications |
|
How is acute dystonia treated (2)?
|
Anticholinergic (benztropine)
OR Antihistamine (diphenhydramine) Many clinicians start antichilinergics before antipsychotics |
|
What parts of body are most likely involved in tardive dyskinesia?
|
Tongue & Jaw
Limbs (50%) |
|
Incidence of tardive dyskinesia
(age groups) |
Younger pts. - 5% per yr.; 20-30% after several yrs.
Older pts. - 30% 1st yr.; 50% w/ long-term treatment |
|
Who usually first notices TD?
|
Clinician
TD is subtle, so if often missed by patients and their families TD is usually NOT progressive |
|
Risk factors for TD
|
Age
Greater number of drug holidays Mood Disorder > Schizophrenia |
|
What can TD be masked by
|
INCREASED dose of anti-psychotic
|
|
Which pts. is spontaneous dyskinesia more common in?
|
Pts. w/ prominent negative symptoms and cognitive dysfunction
|
|
What can you do to resolve TD?
|
Gradual taper off of traditional anti-psychotics
Switch to atypical antipsychotics |
|
Sex predilection for TD
|
Equal prevalence among young men and women
More common in elderly women than in men |
|
When does neuroleptic malignant syndrome usually develop?
|
Within a month of first starting on antipsychotics
Most often within the first week |
|
Treatment for NMS
|
Sepsis workup
Discontinuation of meds Anitpyeretics, IV fluids, COOLING BLANKETS DA agonists (bromocriptine) Muscle relaxants (dantrolene) ECT is primary treatment strategy |
|
How long does neuroleptic malignant syndrome take to resolve?
|
Typically about 2 weeks
|
|
How do traditional antispychotics worsen symptoms?
(pathway effects) |
DECREASED nigrostriatal DA --> Parkinsonism
DECREASED mesocortical DA --> problems w/ attention and planning |
|
What relationship does 5-HT have to the nigrostriatal DA system?
|
It inhibits it
|
|
What relationship does 5-HT have to the mesocortical DA system?
|
Inhibits it
|
|
What relationship does 5-HT have to the mesolimbic system?
|
Does NOT play a role in it
|
|
Key points about Clozapine
|
Atypical antipsychotic
WEAK D2 blocker STRONG 5HT2 blocker Virtually NO EPS Effective against negative symptoms More effective for positive symptoms |
|
Problems w/ Clozapine (6)
|
Anti-histaminergic -- WEIGHT GAIN, Sedation
Anti-cholinergic Anti-alpha-1 AGRANULOCYTOSIS -- NEEDS weekly CBC Seizures Hypersalivation |
|
When is clozapine used?
|
In treatment-resistant cases
|
|
Risperidone key points
|
Lower weight gain
MORE D2 antagonism --- Greater risk of EPS (esp. > 6 mg/day) --- Greater likelihood of prolactin elevation |
|
Olanzapine (Zyprexa) key points
|
Most likely to cause significant weight gain
Lower EPS than Risperidone Also approved for treatment of mania (acute) |
|
Quetiapine (Seroquel) key points
|
Very low rate of EPS
Very little weight gain |
|
Ziprasidone (Geodon)
|
Lowest risk of weight gain
Very low rate of EPS NOTE: can lengthen QTc interval --- Need to examine ECG and other meds |
|
Atypical antipsychotic (non-clozapine) w/ most significant weight gain
|
Olanzapine
|
|
Atypical antipsychotic w/ least significant weight gain
|
Ziprasidone
|
|
What (pathway wise) are positive symptoms mostly due to?
|
Overactivity in the mesolimbic pathway
|
|
What (pathway wise) are negative symptoms mostly due to?
|
Underactivity in the mesocortical pathway
|
|
Aripiprazole (Abilify) key points
|
Dopamine System Stabilizer
5HT2A antagonist 5HT1A partial agonist D2 PARTIAL AGONIST Like adding lukewarm water to a tub |
|
Most consistent CT/MRI finding in Schizo
|
Ventricular enlargment & sulcal dilatation
NOTE: non-specific Remember, also found in Stage 3 Alzheimer's NOTE: statistical finding; scans can also be normal |
|
What brain finding in Schizo pts. correlates w/ auditory hallucinations?
|
Temporal lobe atrophy
Especially in superior temporal gyrus |
|
Common EEG finding in Schizo pts.
|
Blunting and delay of P300 wave
|
|
In Northen latitudes, Schizo is more common in what people?
|
Those born in the winter
|
|
Progression of symptomology after insult to mesocortical pathway
|
Negative symptoms first
Ultimately, decreased negative feedback to limbic system Decreased feedback --> positive symptoms |
|
Erotomanic subtype of delusional disorder
|
Believes another person, of higher status, is in love with them
|
|
Persecutory subtype of delusional disorder
|
Pt. is being malevolently treated somehow
|
|
Somatic subtype of delusional disorder
|
Pt. has some physical defect or medical condition
|
|
Which atypical anti-psychotic can lengthen the QTc interval?
|
Ziprasidone
|