Kaplan & Sadocks: Synopsis of
Psychiatry -- Chapter Seven 195
complete solutions.
Kaplan & Sadocks: Synopsis of
Psychiatry -- Chapter Seven 195
complete solutions.
Schizophrenia - ANSWER Although schizophrenia is discussed as if it is a single disease, it probably
comprises a group of disorders with heterogeneous etiologies, and
it includes patients whose clinical presentations, treatment response, and courses of illness vary. Signs
and symptoms are variable and
include changes in perception, emotion, cognition, thinking, and behavior.
Diagnosis, Signs, and Symptoms - ANSWER See Image
Typical Age of Schizophrenic onset? - ANSWER The disorder usually begins before age 25 years,
persiststhroughout life, and affects persons of all social classes.
The Four As of Schizophrenia - ANSWER Autism, Affect, Associations, Ambivalence
Reproductive Factors - ANSWER First-degree biological relatives of persons with schizophrenia
have a ten times greater risk for developing the disease than the general population.
Medical Illnesses: Schizophrenia - ANSWER Several studies have shown that up to 80
percent of all schizophrenia patients have significant concurrent medical illnesses and that up to 50
percent of these conditions may be undiagnosed.
Infection and Birth Season - ANSWER Season-specic risk factors, such as a virus or a seasonal change in
diet, may be operative. Another hypothesis is that persons
,Kaplan & Sadocks: Synopsis of
Psychiatry -- Chapter Seven 195
complete solutions.
with a genetic predisposition for schizophrenia have a decreased biological advantage to survive season-
specific insults.
Nicotine - ANSWER Up to 90 percent of schizophrenia patients may be dependent on nicotine. Apart
from smoking-associated mortality, nicotine
decreases the blood concentrations of some antipsychotics. There are suggestions that the increased
prevalence in smoking is due, at least in
part, to brain abnormalities in nicotinic receptors
Population Density - ANSWER The effect of
population density is consistent with the observation that the incidence of schizophrenia in children of
either one or two parents with
schizophrenia is twice as high in cities as in rural communities. These observations suggest that social
stressors in urban settings may aect
the development of schizophrenia in persons at risk.
Socioeconomic and Cultural Factors: Schizophrenia - ANSWER Because schizophrenia begins early in life;
causes significant and long-lasting impairments; makes heavy demands for
hospital care; and requires ongoing clinical care, rehabilitation, and support services, the financial cost
of the illness in the United States is
estimated to exceed that of all cancers combined. Patients with a diagnosis of schizophrenia are
reported to account for 15 to 45 percent of
homeless Americans.
Hospitalization - ANSWER The probability of readmission within 2 years after discharge from the first
hospitalization is about 40 to 60 percent. Patients with schizophrenia occupy about 50 percent of all
mental hospital beds and account for
about 16 percent of all psychiatric patients who receive any treatment.
ETIOLOGY
,Kaplan & Sadocks: Synopsis of
Psychiatry -- Chapter Seven 195
complete solutions.
Genetic Factors: Schizophrenia - ANSWER schizophrenia and schizophrenia-related disorders (e.g.,
schizotypal personality
disorder) occur at an increased rate among the biological relatives of patients with schizophrenia. The
likelihood of a person having
schizophrenia is correlated with the closeness of the relationship to an aected relative (e.g., rst- or
second-degree relative). In the case of
monozygotic twins who have identical genetic endowment, there is an approximately 50 percent
concordance rate for schizophrenia
Biochemical Factors: Dopamine Hypothesis. - ANSWER Excessive dopamine release in patients with
schizophrenia has been linked to the severity of positive psychotic symptoms. Position
emission tomography studies of dopamine receptors document an increase in D2 receptors in the
caudate nucleus of drug-free patients with
schizophrenia. There have also been reports of increased dopamine concentration in the amygdala,
decreased density of the dopamine
transporter, and increased numbers of dopamine type 4 receptors in the entorhinal cortex.
Serotonin - ANSWER Current hypotheses posit serotonin excess as a cause of both positive and negative
symptoms in schizophrenia. The robust serotonin antagonist activity of clozapine and other second-
generation antipsychotics coupled with the effectiveness of clozapine to decrease
positive symptoms in chronic patients has contributed to the validity of this proposition.
Norepinephrine - ANSWER Anhedonia—the impaired capacity for emotional gratification and the
decreased ability to experience pleasure—has
long been noted to be a prominent feature of schizophrenia. A selective neuronal degeneration within
the norepinephrine reward neural
system could account for this aspect of schizophrenic symptomatology. However, biochemical and
pharmacological data bearing on this
proposal are inconclusive.
, Kaplan & Sadocks: Synopsis of
Psychiatry -- Chapter Seven 195
complete solutions.
GABA - ANSWER The inhibitory amino acid neurotransmitter γ-aminobutyric acid (GABA) has been
implicated in the pathophysiology of
schizophrenia based on the finding that some patients with schizophrenia have a loss of GABAergic
neurons in the hippocampus. GABA has a regulatory effect on dopamine activity, and the loss of
inhibitory GABAergic neurons could lead to the hyperactivity of dopaminergic
neurons.
Neuropeptides - ANSWER Neuropeptides, such as substance P and neurotensin, are localized with the
catecholamine and indolamine
neurotransmitters and influence the action of these neurotransmitters. Alteration in neuropeptide
mechanisms could facilitate, inhibit, or
otherwise alter the pattern of firing these neuronal systems.
Glutamate - ANSWER Glutamate has been implicated because ingestion of phencyclidine, a glutamate
antagonist, produces an acute syndrome
similar to schizophrenia. The hypotheses proposed about glutamate include those of hyperactivity,
hypoactivity, and glutamate-induced
neurotoxicity.
Acetylcholine and Nicotine - ANSWER Postmortem studies in schizophrenia have demonstrated
decreased muscarinic and nicotinic receptors in the caudate-putamen, hippocampus, and selected
regions of the prefrontal cortex. These receptors play a role in the regulation of
neurotransmitter systems involved in cognition, which is impaired in schizophrenia.
Also: https://www-ncbi-nlm-nih-gov.ezp.waldenulibrary.org/pmc/articles/PMC3881431/?report=reader
Neuropathology - ANSWER In the 19th century, neuropathologists failed to nd a neuropathological basis
for schizophrenia, and thus they classied schizophrenia as a
functional disorder. By the end of the 20th century, however, researchers had made signicant strides in
revealing a potential
Psychiatry -- Chapter Seven 195
complete solutions.
Kaplan & Sadocks: Synopsis of
Psychiatry -- Chapter Seven 195
complete solutions.
Schizophrenia - ANSWER Although schizophrenia is discussed as if it is a single disease, it probably
comprises a group of disorders with heterogeneous etiologies, and
it includes patients whose clinical presentations, treatment response, and courses of illness vary. Signs
and symptoms are variable and
include changes in perception, emotion, cognition, thinking, and behavior.
Diagnosis, Signs, and Symptoms - ANSWER See Image
Typical Age of Schizophrenic onset? - ANSWER The disorder usually begins before age 25 years,
persiststhroughout life, and affects persons of all social classes.
The Four As of Schizophrenia - ANSWER Autism, Affect, Associations, Ambivalence
Reproductive Factors - ANSWER First-degree biological relatives of persons with schizophrenia
have a ten times greater risk for developing the disease than the general population.
Medical Illnesses: Schizophrenia - ANSWER Several studies have shown that up to 80
percent of all schizophrenia patients have significant concurrent medical illnesses and that up to 50
percent of these conditions may be undiagnosed.
Infection and Birth Season - ANSWER Season-specic risk factors, such as a virus or a seasonal change in
diet, may be operative. Another hypothesis is that persons
,Kaplan & Sadocks: Synopsis of
Psychiatry -- Chapter Seven 195
complete solutions.
with a genetic predisposition for schizophrenia have a decreased biological advantage to survive season-
specific insults.
Nicotine - ANSWER Up to 90 percent of schizophrenia patients may be dependent on nicotine. Apart
from smoking-associated mortality, nicotine
decreases the blood concentrations of some antipsychotics. There are suggestions that the increased
prevalence in smoking is due, at least in
part, to brain abnormalities in nicotinic receptors
Population Density - ANSWER The effect of
population density is consistent with the observation that the incidence of schizophrenia in children of
either one or two parents with
schizophrenia is twice as high in cities as in rural communities. These observations suggest that social
stressors in urban settings may aect
the development of schizophrenia in persons at risk.
Socioeconomic and Cultural Factors: Schizophrenia - ANSWER Because schizophrenia begins early in life;
causes significant and long-lasting impairments; makes heavy demands for
hospital care; and requires ongoing clinical care, rehabilitation, and support services, the financial cost
of the illness in the United States is
estimated to exceed that of all cancers combined. Patients with a diagnosis of schizophrenia are
reported to account for 15 to 45 percent of
homeless Americans.
Hospitalization - ANSWER The probability of readmission within 2 years after discharge from the first
hospitalization is about 40 to 60 percent. Patients with schizophrenia occupy about 50 percent of all
mental hospital beds and account for
about 16 percent of all psychiatric patients who receive any treatment.
ETIOLOGY
,Kaplan & Sadocks: Synopsis of
Psychiatry -- Chapter Seven 195
complete solutions.
Genetic Factors: Schizophrenia - ANSWER schizophrenia and schizophrenia-related disorders (e.g.,
schizotypal personality
disorder) occur at an increased rate among the biological relatives of patients with schizophrenia. The
likelihood of a person having
schizophrenia is correlated with the closeness of the relationship to an aected relative (e.g., rst- or
second-degree relative). In the case of
monozygotic twins who have identical genetic endowment, there is an approximately 50 percent
concordance rate for schizophrenia
Biochemical Factors: Dopamine Hypothesis. - ANSWER Excessive dopamine release in patients with
schizophrenia has been linked to the severity of positive psychotic symptoms. Position
emission tomography studies of dopamine receptors document an increase in D2 receptors in the
caudate nucleus of drug-free patients with
schizophrenia. There have also been reports of increased dopamine concentration in the amygdala,
decreased density of the dopamine
transporter, and increased numbers of dopamine type 4 receptors in the entorhinal cortex.
Serotonin - ANSWER Current hypotheses posit serotonin excess as a cause of both positive and negative
symptoms in schizophrenia. The robust serotonin antagonist activity of clozapine and other second-
generation antipsychotics coupled with the effectiveness of clozapine to decrease
positive symptoms in chronic patients has contributed to the validity of this proposition.
Norepinephrine - ANSWER Anhedonia—the impaired capacity for emotional gratification and the
decreased ability to experience pleasure—has
long been noted to be a prominent feature of schizophrenia. A selective neuronal degeneration within
the norepinephrine reward neural
system could account for this aspect of schizophrenic symptomatology. However, biochemical and
pharmacological data bearing on this
proposal are inconclusive.
, Kaplan & Sadocks: Synopsis of
Psychiatry -- Chapter Seven 195
complete solutions.
GABA - ANSWER The inhibitory amino acid neurotransmitter γ-aminobutyric acid (GABA) has been
implicated in the pathophysiology of
schizophrenia based on the finding that some patients with schizophrenia have a loss of GABAergic
neurons in the hippocampus. GABA has a regulatory effect on dopamine activity, and the loss of
inhibitory GABAergic neurons could lead to the hyperactivity of dopaminergic
neurons.
Neuropeptides - ANSWER Neuropeptides, such as substance P and neurotensin, are localized with the
catecholamine and indolamine
neurotransmitters and influence the action of these neurotransmitters. Alteration in neuropeptide
mechanisms could facilitate, inhibit, or
otherwise alter the pattern of firing these neuronal systems.
Glutamate - ANSWER Glutamate has been implicated because ingestion of phencyclidine, a glutamate
antagonist, produces an acute syndrome
similar to schizophrenia. The hypotheses proposed about glutamate include those of hyperactivity,
hypoactivity, and glutamate-induced
neurotoxicity.
Acetylcholine and Nicotine - ANSWER Postmortem studies in schizophrenia have demonstrated
decreased muscarinic and nicotinic receptors in the caudate-putamen, hippocampus, and selected
regions of the prefrontal cortex. These receptors play a role in the regulation of
neurotransmitter systems involved in cognition, which is impaired in schizophrenia.
Also: https://www-ncbi-nlm-nih-gov.ezp.waldenulibrary.org/pmc/articles/PMC3881431/?report=reader
Neuropathology - ANSWER In the 19th century, neuropathologists failed to nd a neuropathological basis
for schizophrenia, and thus they classied schizophrenia as a
functional disorder. By the end of the 20th century, however, researchers had made signicant strides in
revealing a potential
