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MED-SURG
Schizophrenia and Other Psychotic Disorders
| Term | Definition 1 | Definition 2 |
|---|---|---|
| SCHIZOPHRENIA SPECTRUM | ● Defined as abnormalities in one or more of the following domains: delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behavior and negative symptoms | ● Includes schizophrenia and other psychotic disorders and schizotypal (personality disorder) |
| SCHIZOPHRENIA | ● A clinical syndrome of variable, but profoundly disruptive, psychopathology that involves cognition, emotion, perception and other aspects of behavior | ● Clinical presentations, treatment response and courses of illness vary ● Usually severe and chronic ● Diagnosis based entirely on the psychiatric history and MSE |
| EMIL KRAEPELIN | ● Previously called ‘Dementia Precox’ ● Emphasizes the early onset and change in cognition in patients with the disorder ● Symptoms of hallucinations and delusions ● Long-term deteriorating course | |
| EUGENE BLEULER | ● Coined the term schizophrenia ● Greek word meaning "split mind" ● Schisms between thought, emotion and behavior in patients with the disorder ● Need not have a deteriorating course ● Can also have accessory or secondary symptoms | |
| EUGENE BLEULER ● Introduced the fundamental or primary symptoms: (Four As) | ○ Affect: ○ Ambivalence ○ Associations ○ Autism: | |
| Affect: | inappropriate affect | |
| Ambivalence: | indecision | |
| Associations: | looseness of association | |
| Autism: | peculiar behavior | |
| SCHIZOPHRENIA EPIDEMIOLOGY ● Lifetime prevalence: | 0.6-1.9% (approximately 1%) | |
| SCHIZOPHRENIA EPIDEMIOLOGY ● Annual incidence: | 0.5-5.0 per 10,000 persons | |
| SCHIZOPHRENIA EPIDEMIOLOGY | ● Often develops in early adulthood ● Equal prevalence in men and women ● Fertility rate is close to that of the general population | ● Higher mortality rate from accidents and natural causes ● Schizophrenia is more prevalent than other disorders |
| SCHIZOPHRENIA EPIDEMIOLOGY ● In the northern hemisphere, | - persons with schizophrenia more often born in January to April (winter and early spring) | |
| SCHIZOPHRENIA EPIDEMIOLOGY ● In the southern hemisphere, | - often born in July to September ○ Season specific risk factors such as viral infection or seasonal change in diet ○ Influenza, rubella | |
| SCHIZOPHRENIA EPIDEMIOLOGY ● More common | in the urban areas of industrialized nations | |
| SCHIZOPHRENIA EPIDEMIOLOGY ● Substance abuse is common | ○ Lifetime prevalence of drug abuse other than nicotine is more than 50% ○ Associated with poorer prognosis | |
| SCHIZOPHRENIA EPIDEMIOLOGY ● Cigarette smoking | ○ ~90% dependent on nicotine ○ Form of self-medication because it: ■ Reduces positive symptoms ■ Reduces neuroleptic induced parkinsonism | |
| SCHIZOPHRENIA ETIOLOGY: GENETIC FACTORS | ● Occur at an increased rate among biological relatives of patients with schizophrenia ● Individuals who are genetically vulnerable do not inevitably develop schizophrenia ● Paternal age >60 years | |
| SCHIZOPHRENIA ETIOLOGY: GENETIC FACTORS ● Genes linked to schizophrenia vulnerability | ○ 1q, 5q, 6p, 6q, 8p, 10p, 13q, 15q and 22q | |
| HERITABILITY OF SCHIZOPHRENIA ● The biological basis of schizophrenia is evident in heritability studies: | ○ Adoption studies ■ Schizophrenics adopted as children are likely to have schizophrenic biological relatives | |
| HERITABILITY OF SCHIZOPHRENIA ● Twin studies | ○ Concordance rates for schizophrenia are higher rate for identical than for fraternal twins | |
| HERITABILITY OF SCHIZOPHRENIA | ● No single gene identified for schizophrenia | |
| Prevalence of schizophrenia in specific population - General population | 1% | |
| Prevalence of schizophrenia in specific population - Non-twin siblings of a schizophrenic patient | 8% | |
| Prevalence of schizophrenia in specific population - Child with one parent with schizophrenia | 12% | |
| Prevalence of schizophrenia in specific population - Dizygotic twin of a schizophrenia patient | 12% | |
| Prevalence of schizophrenia in specific population - Child of two parents with schizophrenia | 40% | |
| Prevalence of schizophrenia in specific population - Monozygotic twin of a schizophrenic patient | 47% | |
| SCHIZOPHRENIA ETIOLOGY: BIOCHEMICAL FACTORS ● Most common: | Dopamine hypothesis | |
| dopamine receptor antagonists (DRAs) | Efficacy of typical antipsychotic medications (act as antagonists of the D receptors): | |
| psychotomimetic | Drugs that increase dopaminergic activity (e.g., cocaine, amphetamine) are: | |
| Dopaminergic hyperactivity | ■ Too much release of dopamine ■ Too many dopamine receptors ■ Hypersensitivity of the dopamine receptors | |
| 4 Dopaminergic pathways | ■ Nigrostriatal pathway ■ Mesocortical pathway ■ Mesolimbic pathway: positive symptoms ■ Tuberoinfundibular pathway: hyperprolactinemia secondary to antipsychotic medications | |
| Nigrostriatal pathway: | extrapyramidal symptoms secondary to antipsychotic medications | |
| Mesocortical pathway: | negative symptoms | |
| Mesolimbic pathway: | positive symptoms | |
| Tuberoinfundibular pathway: | hyperprolactinemia secondary to antipsychotic medications | |
| Serotonin excess | as cause of both positive and negative symptoms of schizophrenia | |
| Serotonin-dopamine antagonists (SDAs) | Effectiveness of atypical antipsychotics: | |
| GABA | ○ Loss of GABAergic neurons in the hippocampus of some patients with schizophrenia | |
| Areas of interest (Brain regions involved) ○ Limbic system | ■ Decrease in size of the amygdala, hippocampus, parahippocampal gyrus ■ Disorganization of neurons in the hippocampus | |
| Areas of interest (Brain regions involved) ○ Basal ganglia and cerebellum | ■ Control movement ■ Patients present with odd movements (e.g., awkward gait, facial grimacing, stereotypies) ■ Patients with movement disorders also present with psychosis ■ Increase D2 receptors in the striatum | |
| Areas of interest (Brain regions involved) ○ Prefrontal cortex | ■ Symptoms of schizophrenia mimics persons with prefrontal lobotomies or frontal lobe syndromes | |
| Areas of interest (Brain regions involved) ○ Thalamus | ■ Reduction of neurons in the medial dorsal nucleus, which have reciprocal connections with the prefrontal cortex | |
| Areas of interest (Brain regions involved) ○ Midbrain | ■ Origin of dopaminergic, serotonergic and noradrenergic neurons ● Ventral tegmental area, substantia nigra, raphe nuclei, locus coeruleus | |
| SCHIZOPHRENIA ETIOLOGY: NEUROPATHOLOGY ● Cerebral ventricles | ○ Lateral and third ventricular enlargement and some reduction in cortical volume ○ CT and MRI | |
| SCHIZOPHRENIA ETIOLOGY: NEUROPATHOLOGY ● Reduced symmetry | ○ Asymmetry in the frontal, temporal and occipital lobes ○ Disruption in brain latteralization during neurodevelopment ○ Twin b - had enlarged lateral ventricles and somewhat cortical atrophy | |
| SCHIZOPHRENIA ETIOLOGY: NEURAL CIRCUITRY ● Dorsolateral prefrontal circuitry/Mesocortical pathway | ○ Negative symptoms of schizophrenia | |
| SCHIZOPHRENIA ETIOLOGY: NEURAL CIRCUITRY ● Limbic loop pathway/mesolimbic pathway | ○ Positive symptoms of schizophrenia | |
| SCHIZOPHRENIA ETIOLOGY: NEURAL CIRCUITRY ● Dorsolateral Prefrontal Loop Pathway | ○ Dorsolateral Prefrontal Cortex sends projections to dorsolateral caudate nucleus ○ then sends to dorsomedial Globus Pallidus interna (GPi) or rostral substantia nigra (SNr) | ○ It may also send projections to Globus pallidus externa – an indirect pathway for it sends first to GPe then subthalamic nucleus back to GPi and SNr ○ Then from there it sends signals to thalamus so back to your cerebral cortex - this closes the loop |
Created by:
avemaria