(Iii-Psych) Schizophrenia And Related Disorders

Front 1

Four A's of Schizophrenia:

Back 1

Abnormal (loose) association
Autistic behavior
Affect (flat)
Ambivalance

Front 2

Risk factors for schizophrenia:

Back 2

First degree relative
Perinatal insults
Winter birth

Front 3

Concordance rate of schizophrenia in monozygotic twins:

Back 3

40 - 50%

Front 4

Concordance rate of schizophrenia in silings:

Back 4

10%

Front 5

Liftime prevalance rate for schizophrenia:

Back 5

1/10,00

Front 6

Gender ratio for schizophrenia:

Back 6

1:1

Front 7

Which gender responds to antipsycotics more?

Back 7

Women

Note that they are also at higher risk for developing tardive dyskinisia

Front 8

What is the most important factor determine whether a patient is employable?

Back 8

Negative symptoms

Front 9

How does the life expectancy of those with schizophrenia compare to those without the disease? Why?

Back 9

10 years less than general population

Higher suicide rates (10%)
Poor self care
Substance abuse
Institutional illnesses

Front 10

What evidence supports the dopamine hypothesis of schizophrenia?

Back 10

Drugs that increase DA levels (amphetamines, levodopa) can cause psychosis. And the opposite is true with DA antagonists.

Also, homovanillic acid (assoc with DA) is increased in pts with acute psychosis

Front 11

Regions of the brain most commonly associated with schizophrenia?

Back 11

Basal ganglia, limbic system, cerebral cortex

** Most studies show reduced volume of hippocampus

Front 12

What does the link between PCP (angel dust) and psychosis tell us?

Back 12

NMDA glutamate receptor is blocked by PCP and produces similar findings as seen in schizophrenia.

Coincidentally (or not?) glutamate is the primary neurotransmitter between frontal cortex and hippocampus.

Front 13

Indications for an MRI in psychiatry?

Back 13

First episode psychosis
Confusion
Dementia of unknown cause
Prolonged catatonia
Mvmt disorder (unknown etiology)
Personality changes or moed disorder after the age of 50

Front 14

Findings on MRI in pt with schizophrenia:

Back 14

Enlergement of cortical sulci
Ventriculomegaly in lateral and third ventricles
Reduction in temporal lobe gray mater
Cerebellar atrophy
Decr in temporal lobe structures
*Increased ventricle to brain ratio is best replicated finding

Front 15

Substances that can cause psychosis:

Back 15

Hallucinogens
PCP
Amphetamine
Cocaine
EtOH
Prescriptions including anticholinergics, corticosteroids, and levodopa

Front 16

What single symptom satisfies criterion A for diagnosing schizophrenia:

Back 16

Bizarre delusions
Or auditor hallucinations experienced as conversations / running commentary

Front 17

What are the three symptom domains of schizophrenia?

Back 17

Hallucinations / delusions / paranoia

Thought disorder / bizarre behavior

Anhedionia / thought poverty

Front 18

Which subtype of schizophrenia has the best prognosis with treatment?

Back 18

Paranoid subtype

Fewer negative symptoms as well

Front 19

List the DSM-IV criteria for schizophrenia:

Back 19

2 of the following: [Delusions, hallucinations, disorganized speech, disorganized behavior negative symptoms]

Sx present for 1 month

Cannot be attributed to a mood disorder or other disorder

Front 20

5 subtypes of schizophrenia

Back 20

Paranoid
Disorganized
Undifferentiated
Catatonic
Residual

Front 21

Which subtype of schizophrenia has the worst outcome?

Back 21

Disorganized

Front 22

DDx of schizophrenia

There's a lot, but this is a k-n-o-w

Back 22

Schizophreniform disorders
Schizoafective disorder
Mood disorder
Delusional disorder
Personality disorder
Brief psychotic disorder
OCD

Front 23

Differentiate schizophrenia from schizophreniform disorder:

Back 23

Schizophrenia requires psychotic symptoms for at least 1 month with a 6 month prodromal period

Schizophreniform ust be present for 1 month but less than 6 months.

Front 24

What is the prognosis of schizophrenifom disorder:

Back 24

1/3 of individuals will recover with no further issues

2/3 will go on to develop scizoaffective disorder, schizophrenia, or psychotic mood

Front 25

Rank the following in terms of risk for substance abuse

Schizophrenia
Antisocial personality disorder
Bipolar disorder
General population

Back 25

General Population < Bipolar disorder (56%) < Scizophrenia (35-50%) < Antisocial personality disorder (84%)

Front 26

Discuss suicide in schizophrenia, in terms of timeline with dx, rate, age, subtype of schizo, comorbidities:

Back 26

10% of schizophrenics commit suicide
First 10 years of illness
Age < 30
College educated
Paranoid subtype is at higher risk
Co-morbid depression / substance use
Unemployment
Prior suicide attempts
Suicide risk factors (living alone)
Frequent exacerbations

Front 27

Are people with schizophrenia more likely to be diabetics? Why?

Back 27

Yes due to many reasons

Poor socioeconomic class
Poo diet and exercise

Front 28

What is the proposed theory for why antipsychotics cause metabolic syndrome?

Back 28

Inhibiion of pancreatic cells 5HT1A receptors

Front 29

Which atypical antipsychotics are most associated with high triglycerides?

Back 29

Clozapine
Olanzapine
Quetiapine

Front 30

What are the recommendations for checking for metabolic syndrome in a patient on antipsychotics?

Back 30

Before starting Rx, establish family Hx, BMI, blood pressure, fasting glucose, and lipids.

Recheck every month for 3 months, followed by every quarter for 1 year, after that recheck every year

Front 31

What is the role of family therapy in treating schizophrenia.

Back 31

Help families understand the nature of the illness and set realistic expectations for their loved ones.

Front 32

What symptoms characterize postpartum psychosis:

Back 32

Appearance of Sx 48 to 72 hrs postpartum, and includes delusions, thoughts of the mother harming the infant, cognitive defects, mood abnormalities, or hallucinations.

Front 33

When it comes to postpartum psychosis, who is at more risk the baby or the mother?

Back 33

The mother - Rate of suicide is 4% vs infanticide being <1%

Front 34

Treatment for postpartum psychosis:

Back 34

Antipsychotics and mood stabilizers

ECT is a good option as well and poses little risk to the fetus.

Front 35

Time duration needed to diagnose delusional disorder?

Back 35

Delusion has to be present for >1 month

Front 36

What neuroanatomical structures are usually associated with delusions?

Back 36

Basal ganglia and limbic systems

Front 37

What is a brief psychotic disorder?

Back 37

Presence of >1 psychotic symptom lasting for 1 day, but less than 1 month

Front 38

What is the diagnostic criteria for schizoaffective disorder:

Back 38

Uninterrupted period of illness where there is a major depressive episode, a manic episode, or mixed, concurrent wih psychotic symptoms, AND during the same period there have been delusions/hallucinations > 2 weeks in the absence of mood symptoms.

In other words, you can diagnose psychotic disorder and mood disorder simultaneously and independently of each other.

Front 39

Time frames for mood disorders versus schizoaffective disorder:

Back 39

Mania = 1 week, depression = 2 weeks, 1 month for psychotic symptoms

Front 40

Minimum time needed to diagnose delusional disorder?

Back 40

1 month