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11 Cards in this Set
- Front
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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 |
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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 |
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What system is screwed up with schizophrenia?
Major comorbidites? 2 |
Destroys limbic system
Depression- 30-60% Suicidality- 10% |
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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 |
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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 |
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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 |
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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?
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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
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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 |
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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 |
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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! |
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What gross changes in a schizophrenic can be seen on Immaging? Cognitive functioning?
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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. |