Sadock Ch 7 Schizophrenia + Psych disorders + Study Guide, Complete Solution

Sadock Ch 7 Schizophrenia + Psych disorders + Study Guide, Complete Solution Bleuler's 4 A's Association Affect Ambivalence Autism Onset Schizophrenia men= 10-25 women= 25-35 (bimodel; 2nd peak at middle age) Schizophrenia in men: in women: men- more likely have negative sx women- have better social functioning; better outcome Schizophrenia pts more likely born in winter + early spring Nicotene decreases blood concentration of antipsychotics may decrease positive sx improves some cognitive impairments + parkinsonism dopamine hypothesis of schizophrenia idea that schizophrenia results from excess activity at dopamine synapses in certain brain areas -- (excess dopamine=linked to excess of positive sx) mesocortical +mesolimbic tracts = most often Serotonin Hypothesis of Schizophrenia serotonin excess causes pos + neg sx Norepinephrine selective neuronal degregation within the norepi reward neural system could account for anhedonia GABA Pts w. schizophrenia have a loss of GABAergic neurons in the hippocampus GABA has regulatory effect on dopamine activity; the loss of inhib GABAergic neurons could lead to HYPERACTIVITY of dopaminergic neurons. BRAIN CHANGES - Lateral and 3rd ventricular enlargement - Reduction in cortical volume - Reduction of gray matter volume - Reduced symmetry (temporal, frontal, occipital) - Decrease size of Limbic system (amygdala, hippocmp) - Hippocam smaller + fxnally abnormal - Functional deficits of prefrontal cortex - Volume shrinkage/ neuronal loss of Thalamus basal ganglia + cerebellum control...... lead to what sx? control of movement lead to Tardive Dyskinesia: awkward gait, facial grimacing, stereotypies What movement d/o's are most commonly assoc w schizophrenia? Involving the BASAL GANGLIA Huntingtons + Parkinsons Disease 5 subtypes of schizophrenia paranoid, disorganized, catatonic, undifferentiated, residual Paranoid Schizophrenia dominated by delusions of persecution, along with delusions of grandeur characterized by 1 or more delusions or freq auditory hallucinations Disorganized Schizophrenia marked regression to primitive/disinhibited/unorganized behavior. severely disturbed thought processes, frequent incoherence, disorganized behavior, and inappropriate affect. Disheveled; 'burst out in laughter' Catatonic Schizophrenia marked by striking motor disturbances, ranging from muscular rigidity to random motor activity; rapid alterations between excitement + stupor stupor, negativism, rigidity, excitement, posturing, mutism, waxy flex Catatonic Schizophrenia Classic feature = ? marked disturbance in motor function (may involve stupor, negativism, rigidity, excitement, posturing, mutism, waxy flex) Undifferentiated Schizophrenia mixture of sx does not meet diagnostic criteria for any 1 type Risidual Schizophrenia Continuing evidence of the schizophrenic disturbance in absence of a complete set of active sx. (emotional blunting, social w/d, eccentric behav, illogical thinking, mild looseness of assoc.) Early-Onset Schizophrenia childhood manifestation of sx insidious onset chronic unfavorable prognosis Late-Onset Schizophrenia after age 45 more frequently women predominance of paranoid sx do well on antipsychotics Deficit Schizophrenia =enduring idiopathic negative sx more severe illness course higher prev of abnorm invol. movements b4 meds start poorer social fxn insidious onset less long term recovery less likely to marry DECREASED RISK of MAJOR DEPRESSION + SUICIDE! Schizo pts perform poor on psychological testing such as =vigilance, memory, concept formation pathological involvement of frontotemporal cortex =attention, retention time, prob solving ability =motor ability (r/t brain assymmetry) Schizophrenia clinical features: ___ essential for diag. b/c all sx are in other d/o's history Premorbid Sx appear before prodromal phase quiet, passive, introverted few friends, avoid team sports, enjoy watching movies/TV/Music sudden onset of OCD Somatic starting may begin to have interest in philosophy, religion, abstract ideas Mental status exam- schizophrenia completely discheveled or obsessively groomed completely silent/immobile more so: poorly groomed, not bathed, dress too warm for weather Perceptual disturbances: Hallucinations: tactile, olfactory, gustatory = MD should Hallucinations The perception of a sensory process in the absence of an external source auditory - most common form Delusions A fixed false belief (resistant to change, even w. overwhelming contradictory evidence) bizarre or non-bizarre Bizarre delusions: Clearly implausible/have no possibility of being true (contradict the laws of physics) Content is not understandable Non-bizarre delusion: While not true is understandable and has the possibility of being true EX) The IRS is after the pt for not paying taxes Ideas/Delusions of Reference o Beliefs that random/neutral events are not random or neutral, but include the pt in a special way. o Common: Believing that occurrences on TV or Radio (certain words said/songs played) are meant to deliver a special message to the pt. POSITIVE SX hallucinations delusions disorganized thinking/thoughts behavior NEGATIVE SX blunted/flat affect anhedonia (inability to feel pleasure) apathy (lack of interest) inattentiveness lack of energy Disorganization: Disjointed, disconnected speech patterns reflect a disruption in the organization of pt's thoughts Most commonly observed forms of abnormal speech: tangentiality + circumstantiality More severe thought disorder: derailment, neologisms + word salad Tangential speech - Pt gets increasingly further off topic without appropriately answering a question. Circumstantial speech - Pt will eventually answer a question, but in a markedly roundabout manner. Derailment - Pt suddenly switches topic without any logic or segue. Neologisms - Creation of new, idiosyncratic words Word salad - Words are thrown together without any sensible meaning. Catatonia --Can present as: - Extreme negativism (motiveless motor resistance to instruction or attempts to move the person, or mutism) - Catatonic excitement (excessive, purposeless motor activity)