Schizophrenia

Question 1

What are diagnostic criteria of schizophrenia?

Answer 1

• 2 or more characteristic sx for 6 months: delusions, a/vh, disorg speech, grossly disorg or catatonic behavior, negative sx
• social/occupational/interpersonal dysfunction
• not attributed to another condition or medication

Question 2

What characteristics of schizophrenia are associated with real-world outcomes?

Answer 2

• Cognitive disturbance and negative sx more though than positive sx
• Early detection and treatment initiation soon after onset
• social support, good premorbid adjustment, precipitating events, co-occurring mood disturbance, minimal residual sx

Question 3

What were the different variants of schizophrenia in prev. versions of dsm?

Answer 3

• paranoid
• disorganized
• catatonic
• undifferentiated
• residual

Question 4

How do neurodevelopmental models hypothesize development of schizophrenia?

Answer 4

• Heritable risk when genes underlie neurodevel. and brain maturation, along with others involved in signal transduction
• Disrupted signaling pathways in embryogenesis lead to faulty neurocircuitry during maturation
• environmental stressors + genetic vulnerability results in d/o

Question 5

What neuropathological abnormalities might be implicated in schizophrenia?

Answer 5

• reduced dendritic complexity
• lower spine and synapse density of cortical pyramidal neurons
• cortical and subcortical reductions in gray matter volume
• decreased gray matter integrity
• premorbid behavioral and neurological signs
• irregularities in amygdala, hippocampus, limbic sys, BG,

Question 6

What’s the estimated heritability of schizophrenia and rate of concurrent dx in twins?

Answer 6

• 80 to 85% overall
• Risk of developing schizophrenia increases in severity with the degree of genetic relationship
• Dizygotic twins, 10-19%
• Monozygotic twins, 40-50%

Question 7

What obstetric complications increase risk for schizophrenia?

Answer 7

• maternal infection during pregnancy
• malnutrition
• labor and delivery complications
• prematurity
• LBW

Question 8

What’s the typical age of onset of schizophrenia and gender trends?

Answer 8

• Late adolescence to young adulthood (15-35)
• early onset associated with poorer prognosis
• females have later illness onset, lower negative sx severity, greater affective sx, and better social, cognitive, premorbid functioning than men

Question 9

Common medical comorbid dxs with schizophrenia?

Answer 9

• cardiovascular disease
• obesity
• DM
• HTN
• hyperlipidemia

Question 10

What’s the rationale behind the dopamine hypothesis of schizophrenia?

Answer 10

• Excessive dopamine; neuroleptics block dopamine receptors can be effective in tx of schizophrenia
• Amphetamines can block reuptake; individuals taking amphetamines can display sxs of schizophrenia

Question 11

What are common premorbid features before dx of schizophrenia?

Answer 11

• Poorer social adjustment and intelligence

- Behavioral signs shyness, learning difficulties, withdrawn, clumsiness, depressed mood

Question 12

What are common features of prodromal stage in schizophrenia?

Answer 12

• Attenuated positive sxs or brief intermittent psychotic sxs
• Functional impairments
• Cognitive deficits in verbal memory, attn, emotion regulation, olfactory processing

Question 13

What are features of acute/first-episode psychosis in schizophrenia?

Answer 13

• full threshold psychotic sxs
• prominent cognitive impairments in memory, attn, EF
• Problems with social, academic, occupational functioning
• Psychotic sxs can last weeks to months if untreated and can fluctuate from exacerbation to relative stability or remission

Question 14

What are common features of schizophrenia not included in DSM criteria?

Answer 14

• Inappropriate affect, laughing
• disturbed sleep pattern
• dysphoric mood
• anxiety and phobias
• depersonalization
• derealization
• cognitive deficits
• lack of insight into d/o
• hostility and aggression

Question 15

What’s a residual phase in schizophrenia?

Answer 15

-Psychotic sxs are largely remitted but negative sxs may continue, odd beliefs, poor social functioning, persistent cognitive impairment

Question 16

What are expectations for neuropsych assessment in schizophrenia?

Answer 16

• Heterogeneous profiles and severity of impairment
• Intelligence: fluid more impacted than crystallized
• Attn: poor vigilance, slowed reactions, impaired selective attn
• Processing speed: reduced info processing speed
• Language: highly variable, poor initiation, generation, and speed of processing can impair list generation tasks
• Visuospatial: better preserved
• Memory: poor declarative memory
• EF: severe impairment
• Sensorimotor: deficits in gross and complex motor functions, poor odor identification predicts future schizophrenia
• Emotion: poor theory of mind, social perception/cognition

Question 17

Cognitive remediation strategies and outcome in schizophrenia?

Answer 17

• produce reliable improvements in multiple domains

- better outcomes when used with targeted strategy-based interventions for adaptive behaviors (skills training)

Question 18

Effects of antipsychotic medication in schizophrenia?

Answer 18

• First gen. act on D2-type dopamine receptors; once called neuroleptic drugs
• Second gen. also involve D2 but have more complex pharmacological profiles
• Help positive sxs more so than negative ones
• Adverse effects on cognition and motor function
• Extrapyramidal sxs, tardive dyskinesia, tardive dystonia

Question 19

Which dopamine pathway is thought to be involved in schizophrenia, particularly positive sx?

Answer 19

Mesolimbic

Question 20

Vocational rehab considerations in schizophrenia

Answer 20

• Individually based supportive interventions are preferred to traditional vocational rehab services
• greater effects for obtaining and maintaining stable employment