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11 Cards in this Set

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Clinical symptoms of Schizophrenia?
Positive (abnormal that should not be present), Negative (absence of normal fn), and Abnormal behaviors?
(+) = delusions- abnormal thoughts
hallucinations- hearing voices/seeing things that have no sensory basis
(-) = Alogia, lack of speech content, volume, long latency, etc
Behavior- bizarre, stereotypical stuff
Epidemiology? (rural vs urban)? Age of onset?
Cross cultures and outcmes?
.5% rural and 2.5% urban
15-35, can have childhood onset or later in life; also see abrupt and insiduous (long time in development)
Same rates across cultures, but shocking developing countries have better 2 yr outcomes
What system is screwed up with schizophrenia?
Major comorbidites? 2
Destroys limbic system
Depression- 30-60%
Suicidality- 10%
Outcomes from treatment? 1/3, 1/3, 1/3? All due to anti-psychotic treatment compliance/pharmacogenetics
Prognosticators for good outcomes?
1/3 complete recovery with no psychoses
1/3 partial recovery
1/3 No sig recovery
Good outcomes with
1. later and abrupt onset
2. high level of premorbid functioning
3. Prominent affective symptoms
Subtypes of Shizophrenia?
1. Paranoia
2. Disorganized
3. Catatonic
4. Undifferentiated
Which has best outcomes?
1. Paranoia- mostly delusional and hallucinations; religious grandiosity ***Best Outcomes*
2. Disorganized- disorganized speech or behavior; flat/inappropriate affect
3. Catatonic- abnormal motor movements, posture, or speech
4. Undifferentiated- does not meet criteria for others
Genetic Predisposition to Shizophrenia?
Paternal Age?
COMT mutation?
Environmental factors?
Highly heritable; 60-80%. Higher prevalence in siblings than general pop and very high risk ir monozygotic twins.
Risk increases as Father is older at conception; sperm has more mutations
COMT- breaks down DOPA; now have more active breakdown system and possibly a dysregulation that leads to hyperdopaminergi state; bad
increased risk when viral infection occurs in 1st half of pregnancy and varies seasonally (i.e think when most likely to get virus
Where is the lesion in schizophrenia? What developmentally could be wrong What genetic knockout is responsible? What system is lost and what results? Accounts for (+) and (-) symptoms?
Pre-frontal cortex due to an interruption of neuronal migration (DISC1). Some areas don't functioning. Lose GABA inhibition. Get HYPER DOPA State- leads to POSITIVE symptoms
PFC as posibily lesion in Schizophrenia? Why? 2 reasons.
NET RESULT?
Alternative, yet complementary theory involving syanptic transmission? What genetic evidence?
Screwy neuronal migration
Differential GENE expression
NET: dysregulation of cortical circuitry "Brain is miswired"
Shizophrenia is a genetic disorder of the synapse..due to neuregulin issues
Schizophrenia Treatment?
Dopamine and Glutamate Hypothesis? Which accounts for positive/negative symptoms? What gene involved in less reduction in startled responses?
Want an agent that decreases DOPA. Developed D2 antagonists. The better the binding, the better the drug.
Eliminates (+) symptoms.
Idea: high GLUT causes both (+) and (-) symtpoms and linked with high DOPA. Hits both positive (psychotic) and negative symptoms.
Neuregulin
Typical and Atypical Antipsychotics: effect what?
what psychotherapy is effectivbe?
All effect dopaminergic transmission in basal ganglia, temporal lobe, and frontal lobes
CBT and femily education are great!
What gross changes in a schizophrenic can be seen on Immaging? Cognitive functioning?
decreased brain size due to loss of both grey and white matter, enlarged ventricles
disturbances of connectivity

Impaired cognitive integration as proven by the square no-square phenomenon.