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24 Cards in this Set
- Front
- Back
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schizophrenia |
chronic disabling psychiatric d/o marked by sig disturbences in perception, cognition, mood, and behavior
positive symptoms
negative symptoms
disorganized symptoms
cog sx increasingly recognized as core features of the illness |
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schizophrenia and DSM V |
took out classifiers (no more disorganized, paranoid, etc.) Now just Dx of schiz and you can specify "with catatonia" as appropriate |
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with catatonia |
describes cases marked by motoric immobility, excessive non puposeful motor activity, extreme negativism, peculiarities of voluntary movement, echolalia, or echopraxia |
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neuropathology |
not fully elucidates, but conceptualized as a multifactorial neurodevelopmental disorder with genetic diatheses |
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genetic basis |
supported by twin studies
increased liability for the disorder proprotionate to the percentage of genes shared with an individual
manner of inheritance is complex, involving many genes and a small envoronmental effect
diathesis stress model
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neurodevelopmental abnormalities |
substantial evidence that there are premorbid behavioral and neurological signs, adverse prenatal and perinatal events, reduced dedritic complexity and lower spine and synapse density on cortical pyramidal neurons
show cortical and subcortical grey matter reductions in volume
decreased white matter integrity |
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genetic liability |
family Hx increases risk
risk goes up with degree of genetic relationship
established heritability estimates range from 80-85%
hundreds, if not thousands of common genertic variants , each with small effects, may be involved in multiple pathogenic pathways to disorder
researchers have found rare genetic mutations and de novo pathways, some have larger effects- but since so rare account for few cases |
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obstetric complications |
maternal infection, malnutrition, delivery complications, prematurity, and low birth weight inc risk of schizophrenia |
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premorbid IQ and PDD |
the presence of ID and ASDs are risk factors
may be better described as coincident symptoms of shared biological risks
retrospective studies of people who later developed schiz have found inc rates of IDs and ASDs in childhood, as well as evidence of language, motor, and social abnomalities
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substance use |
substance abuse, including freq cannabis use during adolescence, assoc with inc schiz. risk |
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age |
although it can occur at any age, it tends to occur during late adolescence and early adulthood.
earlier onset generally assoc with poorer prognosis
reducing gap btwn onset of psychosis and Tx initiation improves outcome- highlighting value of early intervention |
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sex |
females tend to have later onset, lower neg sx severity, greater affective sx, and better social, cognitive, and premorbid fx than male patients |
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schizophrenia |
occurs at higher rates in families where parents are unmarried or divorced when compared to married or widowed. low income and povery increase illness risk |
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incidence |
.5-2% of world population
predominantly impacts those from ages 15-35 years
incidence is low but prevalence is high due to chronicity of the illness
within top 10 of disabilities worldwide |
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medical comorbidities |
greater cardiovascular co morbidity- due to inc prevelance of smoking obesity, DM, HTN, high chol
collectively results in a 20% reduction in lifespan
other medical risk factors: malnutrition, sedentary lifestyle, COPD, TB |
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morbidity |
people with schiz have a 2-3 fold increase in mortality due to inc risk of suicide, high risk beh, accidents, and substance abuse
rate of suicide 12 times higher than general pop |
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illness severity may be rated using |
Brief psychiatric Rating scale Positive and Negative Symptom Scale Scale for the assessment of positive symptoms Scale for the assessment of negative symptoms |
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amelioration of positive sx |
not assoc with major benefits in interepisode functioning, including occupational attainment, independent living, or social relations
Cognitive impairment and other symptoms (negative, disorganized) are stronger determinants of functional outcome in schizophrenia |
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other correlates of poor prognosis |
younger age of onset insidious onset family Hx greater # of relapses poor social support assault Hx |
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premorbid presentation |
early pre and perinatal neurodevelopmental abnormalities are thought to occur in schizophrenia
retrospective studies suggest cognitive, emotional, and beh changes prior to the prodromal phase of the illness
poor social adjustment and intelligence premorbidly
behavioral signs include increased shyness, learning difficulties in Elem school, poor social interaction, withdrawn behavior, clumisness, and depressed mood |
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prodromal presentation |
the adolescent or young adult is often experiencing attenuated positive psychotic Sx or brief intermittent psychotic Sx
often the person may have a dx of anxiety, mood or substance use d/o
NP impairment, including deficits in verbal mem, attn, emotion recognition, and olfactory processing |
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1st episode psychosis |
the appearance of full threshold psychotic Sx occurs
severe NP deficits, with most prominent impairments in mem, attn, EF
px with social, academic, occupational Fx
cog impairments persist despite resolution of florid psychosis |
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Acute |
any period, including the first episode, where an individual has active psychosis, including thought d/o, hallucinations, and delusions.
Acute period can last several weeks or months or left untreatedand can require IP admission
Psychotic sx tend to fluctuate from acute exacerbation to relative stability or remission |
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residual |
psychotic sx have largely remitted and indiv is stable. Negative Sx, odd beliefs, poor social Fx may continue. cog impairment persists through all stages of the illness. |
