schizophrenia · development of schizophrenia genetic disposition – early environmental insults:...
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Schizophrenia
Psychiatry Clerkship Learning Block
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Goals: Review & Identify different aspects of Schizophrenia
Diagnose schizophrenia– Positive, negative and cognitive symptoms
Course of illness– Prodrome, active phase, residual phase
Epidemiology Genetics Costs of schizophrenia
– Financial & personal
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Readiness Assessment Test
1. What are the positive symptoms of Schizophrenia?
2. What are the negative symptoms of Schizophrenia?
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Readiness Assessment Test
3. What is the difference between a bizarre and non-bizarre delusion?
4. How is this information helpful in making the diagnosis of Schizophrenia?
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Readiness Assessment Test
5. What is the difference among hypnogogic & hypnopompic hallucinations, single voice hallucination, and multiple voices hallucinations?
6. How is this information helpful in making the diagnosis of Schizophrenia?
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Readiness Assessment Test
7. What are the cognitive deficits of schizophrenia?
8. What A Criteria symptoms do the cognitive deficits impact?
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Compare & Contrast:Positive, Negative, & Cognitive Symptoms
Positive symptoms– Often seen when illness is first diagnosed, but this point
is actually later in development of illness– May wax & wane c illness exacerbation & improvement– Correlated c hospitalization, but not functional
improvement– Respond well to anti-psychotics– May stabilize or improve later in life
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Summary:Positive, Negative, & Cognitive Symptoms
Negative symptoms– Occur early-prodrome – Tend to progress
especially in early years most during acute psychotic periods
– Moderately correlated c functional improvement– Fair/poor response to anti-psychotic medication
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Summary:Positive, Negative, & Cognitive Symptoms
Cognitive symptoms– Present from early age– Moderate progression c illness course– Most progression during episodes of acute psychosis– Highly correlated c functional impairment– Poor response to anti-psychotic treatment
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Readiness Assessment Test
9. What is the B Criteria of Schizophrenia?
10. What specifically is referred to in the B criteria?
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All Schizophrenia signs & symptoms effect pt’s social & occupational functioning
Adapted with permission from Michael F. Green, Ph.D.
Social/Occupational Dysfunction- work- interpersonal relationships- self care
Mood SymptomsCognitive Symptoms
Negative SymptomsPositive Symptoms
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Natural History of Schizophrenia
Good
Function
Poor
Age (y)5040302010
PremorbidProdromalProgressionStable Relapsing
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Natural History of Schizophrenia
0
10
20
30
40
50
60
Single Episode IntermittentCourse
Chronic Course
% of Patients
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Readiness Assessment Test
11. What is the downward drift hypothesis? And what does this have to do with the B Criteria?
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Readiness Assessment Test
12. What is the prodrome phase of Schizophrenia?
13. Is the presence of a prodrome a positive or negative prognostic sign?
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Readiness Assessment Test
14. What is the time duration criteria for diagnosing Schizophrenia?
Schizophreniform disorder?Brief Reactive psychosis?Psychosis nos?
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Readiness Assessment Test
15. What is the peak age of onset of Schizophrenia in males & females
16. Which sex is more likely to have Schizophrenia?
17. What is the lifetime prevalence of Schizophrenia?
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Readiness Assessment Test
18. In working up a patient for schizophrenia, what other diagnosis or groups of diagnoses need to be ruled out?
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Readiness Assessment Test
19. What is the baseline risk of having schizophreina?
Risk if your identical twin has schizophrenia?
Is schizophrenia caused by a single gene?
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Risks of developing Schizophrenia
Prenatal & Perinatal risks factors– In utero (especially 2nd trimester)
Viral infections Winter births Starvation Toxic exposure
– Perinatal anoxia– Advance paternal age
All bring about small ↑ in risk of Schizophrenia
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Development of Schizophrenia
Genetic disposition– Early environmental insults: Prenatal, perinatal,
Neurodevelopmental abnormalities– Later environmental insults: Subst abuse,
psychosocial stressors Further brain dysfunction
– Periods of psychosis Neurodegeneration
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Readiness Assessment Test
20. What is anosognosia? How does this effect the care of patients with Schizophrenia?
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Readiness Assessment Test
21. General population average lifespan is 78. What is the average lifespan for someone with schizophrenia?
Why is there a difference for schizophrenia?
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Financial Cost of Schizophrenia
2002 estimates, cost to US: 63 billion dollars– Cost more than cost of all cancers combined
– Illness begins early in life– Significant, long lasting impairment– Heavy demands for hospital care– Ongoing clinical care, rehab, support services – 75% can’t work, on disability