Schizophrenia

Question 1

What is Schizophrenia?

Answer 1

heterogeneous disorder - often impacting thought, behaviour, mood, perception, cognition

*IMPAIRING FUNCTION

often CHRONIC

Question 2

What gender is the majority?

Answer 2

Males

Question 3

What are ppl with SZP like?

Answer 3

• fearful
• withdrawn
• isolated
• poor impairment for relationships

Question 4

What are the 3 symptoms clusters

Answer 4

1. Positive
2. Negative
3. Cognitive

Question 5

What are the Positive Sx?

Answer 5

• Hallucinations (COMMON - may exp. 1 or more of AUDITORY (VOICES), visual, tactile, olfactory)
• Agitation
• Suicidal
• Delusions
• Anxiety

(elements of character personality that shouldn’t be there or are elevated)

Question 6

What are the Negative Sx?

Answer 6

• Lack of pleasure
• Complex step task is difficult
• Flat facial expression
• Anhedonia
• Amotivated
• Poverty of Speech
• Suicidal

Question 7

What are the Cognitive Sx?

Answer 7

• impairment of executive functions
  – attention
  – memory
  – may not completely resolve

RELATED to acute Sx & to PROLONGED NT IMBALANCE

Question 8

What are the most impactful clusters?

Answer 8

(-) & cognitive Sx

1st 5 years after Dx is critical

Question 9

What is the etiology?

Answer 9

GENETIC ~45% if both parents are +

BIOLOGIC - relative Dopamine imbalanced

etc.

Question 10

When is suicide rate the highest?

Answer 10

1st 5 years

Question 11

What do Antipsychotic drugs target, how do they work?

Answer 11

• Chlorpromazine - value in acute psychosis
  – blocks Dopamine

Question 12

1st Gen Antipsychotics?

Answer 12

ALL primarly target blockade of Dopamine, specifically D2 receptor

• potential for MOVEMENT DISORDERS

Question 13

What Dopamine (D2) receptors do you want to block?

Answer 13

• Mesolimbic –> Psychosis Relief
• Mesocortical –> “PR” & Restlessness

don’t want to block others b/c they can cause movement disorders or etc.

Question 14

Dopamine (1st target of antipsychotic drugs)

What type of NT is it?

What other NT systems does it interface with?

Why are we sure that Dopamine blockade is NOT the complete answer?

Answer 14

stimulatory NT

with GABAa

b/c no matter how good it was, ~25% had no response to it

Question 15

2nd Gen Antipsychotics?

Answer 15

• affinity for the Serotonin r. is key to reducing the movement disorders that are a risk with Dopamine blockade
• blockade of BOTH serotonin & dopamine receptors correlates with favourable antipsychotic effectiveness!
  – less risk for movement disorders

Question 16

FGA’s:

Answer 16

multiple receptors, antipsychotic effect based on D2 receptor blockade

Question 17

SGA’s:

Answer 17

blockade of BOTH 5HT2a & D2 receptors - less movement disorders but greater risk of metabolic effects

Question 18

Major goals of therapeutic plan:

Answer 18

• Prevent HARM
• Bring thoughts, BHVR under pt’s control
• Restore contact with reality
• Max functional recovery
• Prevent relapse
• *Eliminating hallucinations & delusions may not be realistic or possible

Question 19

Do Antipsychotics work fast?

Answer 19

no take 4-6-8 weeks

but longer pt is doing well, less vulnerable to relapse