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21 Cards in this Set
- Front
- Back
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how common is schizophrenia?
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1% population incidence world-wide
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what's the death rate like?
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early mortality:
5 to 10% suicide rate Excessive deaths by lung cancer, CV disease |
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what are their symptoms like?
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hearing voices 24-7, cognitive disarray, persecutory delusions
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how do patients function socially?
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Full employment, independent living are uncommon
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why do patients die so early?
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Smoking
Obesity Suicide Substance Abuse Inadequate Medical Care |
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what's the smoking prevalence?
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high! 65-85%
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why do schizophrenics smoke so much?
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Self-medication
- nicotine impacts cognition, may improve motor side effects Shared Diathesis - schizophrenia and nicotine addiction share a common neurobiology e.g., dopamine and reward pathways e.g., alph-7-nicotinic acetylcholine receptor mutation |
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how has schizophrenia been classified over the years?
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dementia praecox = “early dementia” - Kraeplin (1856-1926)
Schizophrenia: “schiz” = split; “phrenia” = mind 4As – affect, association, autism,ambivalence - Bleuler (1857-1939) first rank symptoms - specific delusions and hallucinations, e.g., thought broadcasting |
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what's the clinical presentation of schizophrenia?
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Schizophrenia is a disorder of impaired thought
Psychotic or “positive” symptoms Hallucinations (disturbed perceptions) Delusions (disturbed thought content) Disorganization (disturbed thought formation) “Negative” symptoms Restricted or inappropriate affect Cognitive impairment Attention, information processing, verbal memory |
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what's the DSM-IV- TR criteria for schizophrenia?
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2 or more of the following for at least 1 month:
Delusions Hallucinations Disorganized speech Disorganized/catatonic behavior Negative symptoms Causes social/occupational dysfunction Continuous signs for 6 months or longer Rule out mood diagnoses (schizophreniform, bipolar, etc.) Rule out substance-related/medical disorder In PDD (e.g., autism) only if prominent > 1 month |
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how do you diagnose schizophrenia?
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The presence of a pattern of symptoms
Longitudinal picture Absence of other causes (substances, mood, medical, CD) |
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how do you figure out if it's a good outcome?
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onset- acute
duration of prodrome- short age at onset- late 20s, 30s premorbid func- good family history of schiz- negative mood symptoms- present gender- female intelligence level- high marital status- married |
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how do you figure out if it's a bad outcome?
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onset- insidious
duration of prodrome- since childhood age at onset- early teens premorbid func- poor family history of schiz- positive mood symptoms- absent gender- male intelligence level- low marital status- never married |
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describe schizo prodrome:
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Period of increasing symptoms and decreasing function immediately prior to the onset of schizophrenia
Months to years in duration Marked by progressive suspiciousness, social isolation, mood changes, unusual thinking |
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Shorter duration of untreated psychosis is associated with:
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Better response to antipsychotic treatment
Less severe negative symptoms Improved social functioning |
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how do you predict psychosis in youth at high clinical risk?
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Genetic risk for schizophrenia with recent deterioration
Unusual thought content Suspicion/paranoia Social impairment Substance abuse |
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what are some etiology correlates with schizo?
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Excess birth complications
Maternal infections during second trimester Association with pregnancies during influenza epidemics Excess winter births Immune dysfunction e.g., impaired T-cell proliferative response, elevated antinuclear antibody |
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what's the best molecular model of schizophrenia?
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Glutamate and N-Methyl-D-aspartate Receptor (NMDA)
Essential for attention, memory, information processing Glutamate-NMDA antagonists e.g., PCP, ketamine mimic schizophrenia symptoms |
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All antipsychotic drugs bind to ...
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dopamine D2 receptors
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what are the risks for schizophrenia?
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Monozygotic twin -48%
Offspring of dual mating -46% Dizygotic twin 17% Sibling with one affected parent 17% Other 1st degree relative (siblings, parents) 6-13% 2nd degree relative (uncles, aunts, etc) 2-6% 3rd degree relative (cousins)-2% General population -1% |
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what's the genetic basis of schizophrenia?
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Schizophrenia is a complex inherited disorder involving multiple genes of small effect influencing numerous CNS trait deficits
Large deletions and duplications Genes in neurodevelopmental pathways affected – including glutamate, neuroregulin |
