Class notes Psychiatry

Schizophrenia
​
- Schizophrenia​ is characterized by a broad range of mental symptoms. It affects all
aspects of human psychology, thoughts, emotions and behavior
- Etiology​:
● Not known
● Stress
● Birth trauma
● Infection
● Autoimmune
● Dopamine theory:
○ Dopamine antagonists reduce symptoms. Drugs to block D2 receptors
○ Dop antagonist cause side effects similar to parkinson’s
○ L dopa produced schizo like symptoms in some
○ Amphetamine (dop agonists) cam make psychotic symptoms worse in
some
- More than 6 months
- 1 month of active symptoms
- Positive symptoms:
● Hallucinations
● Delusion
● Paranoia
● Thought disorganization
- Negative symptoms:
● Affective flattening
● Impoverished speech
● Ambivalence
● Anhedonia
- Affective symptoms:
● Dysphoria
● Suicidality
● Helplessness
- Neurocognitive symptoms:
● Distractibility
● Learning deficits
● Memory deficits
● Abstract thinking impairment
- Schizoaffective disorder:
● Schizophrenic plus depression or manic symptoms
● Delusions or hallucinations for more than 2 weeks in absence of depressive or
manic episode
● Of with mood disorders
- Substance induced psychotic disorder:
● Presence of one or both-
○ Delusions

, ○ Hallucinations
● Due to substance misuse
- Schizophreniform disorder:
● Less than 6 months
● Catatonia
- Brief psychotic disorder:
● Less than 1 month
● Antipsychotics
- Delusional disorder:
● One or more delusion
● 1 month +
● No odd behavior
- Antipsychotics​:
● Typical-
○ Haloperidol
○ Trifluoperazine
○ Chlorpromazine
○ Side effects:
■ EPS-
● Tardive dyskinesia
● Akathisia
● Pseudo parkinsonism
● Acute dystonia
■ Sedation
■ Q-T prolongation
■ Hyperprolactinemia
● Atypical-
○ Olanzapine
○ Risperidone (hyperprolactinemia)
○ Quetiapine (sedation)
○ Aripiprazole
○ Clozapine (resistant schizo)
○ Side effects:
■ Weight gain
■ Metabolic syndrome
- Non pharmacologic intervention:
● Family psychoeducation
● Psychotherapy
● CBT
● Personal therapy