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21 Cards in this Set

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how common is schizophrenia?
1% population incidence world-wide
what's the death rate like?
early mortality:
5 to 10% suicide rate
Excessive deaths by lung cancer, CV disease
what are their symptoms like?
hearing voices 24-7, cognitive disarray, persecutory delusions
how do patients function socially?
Full employment, independent living are uncommon
why do patients die so early?
Smoking
Obesity
Suicide
Substance Abuse
Inadequate Medical Care
what's the smoking prevalence?
high! 65-85%
why do schizophrenics smoke so much?
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
how has schizophrenia been classified over the years?
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
what's the clinical presentation of schizophrenia?
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
what's the DSM-IV- TR criteria for schizophrenia?
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
how do you diagnose schizophrenia?
The presence of a pattern of symptoms
Longitudinal picture
Absence of other causes (substances, mood, medical, CD)
how do you figure out if it's a good outcome?
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
how do you figure out if it's a bad outcome?
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
describe schizo prodrome:
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
Shorter duration of untreated psychosis is associated with:
Better response to antipsychotic treatment
Less severe negative symptoms
Improved social functioning
how do you predict psychosis in youth at high clinical risk?
Genetic risk for schizophrenia with recent deterioration
Unusual thought content
Suspicion/paranoia
Social impairment
Substance abuse
what are some etiology correlates with schizo?
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
what's the best molecular model of schizophrenia?
Glutamate and N-Methyl-D-aspartate Receptor (NMDA)
Essential for attention, memory, information processing
Glutamate-NMDA antagonists e.g., PCP, ketamine mimic schizophrenia symptoms
All antipsychotic drugs bind to ...
dopamine D2 receptors
what are the risks for schizophrenia?
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%
what's the genetic basis of schizophrenia?
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