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Cheatography

Patho of Schizophrenia Cheat Sheet (DRAFT) by

This is a draft cheat sheet. It is a work in progress and is not finished yet.

PSYCHOSIS

A Sx of mental illness charac­terized by the loss of contact with reality
Manife­sta­tions
Halluc­ina­tions
 
Disorg­anized thoughts and speech
 
Emotions exhibited in an abnormal manner
────­────── Causes ──────­────
Funct­ional
Schizo­phrenia
 
Manic phase of bipolar disorders
 
Psychotic depression
Organic
Alzhei­mer's Disease
 
Other causes of dementia
 
Brain tumors
Drug Abuse
Cocaine
 
Amphet­amines
 
PCP ("angel dust")

STRUCTURAL ABNORM­ALITIES IN SZ

Decreased cortical thickness in the absence of glio­sis
Reduction in the volume of the frontal love, medial temporal lobe, thalamus, and hippoc­ampus ➩ increased ventri­cular size
Decreased blood flow and glucose metabolism in the frontal lobe and left temporal lobe
Abnormal (exce­ssive) synaptic pruning ➩ decreased umber of glutam­atergic dendritic spines in PFC
Risk is increased if a specific variant in a gene related to synaptic pruning ➩ Comp­lement Component 4 (C4)
Gliosis: the prolif­eration of glial cells ➩ occurs as a compen­satory change in the degene­rative diseases in the brain (typically later in life)

Synaptic Pruning: the process of synapse elimin­ation that occurs between age 2 and onset of puberty

C4: plays a role in the immune system and also in brain develo­pment

Neurot­ran­smi­tters

Multiple NT systems interact to cause the signs and sx of SZ
Functional abnorm­alities are related to altera­tions in:
Dopa­mine
 
Glut­amate
 
Sero­tonin

Positive Symptoms

Diso­rga­nized speech, thoughts, and beliefs
• May lose track of their ideas, meanings, and words (word salad)
• Thought processes are discon­nected (loose associ­ations)
• Ideas and images may become jumbled or linked together illogi­cally
• Words and meanings that should be linked may become diconn­ected
Diso­rga­nized Movement and Behavi­ors
• May use exagge­rated or repeated gestures
• May seem to be fidgeting, hypera­ctive, or preocc­upied with meanin­gless physical movements

Cogn­itive Symptoms

Impaired Attent­ion
• Trouble focusing or paying attention
Impaired Working Memory
• Ability to use inform­ation immedi­ately after learning it
Poor Executive Function
• Ability to understand inform­ation and use it to make decisions
Patients often have difficulty learning from their experi­ences and can repeatedly make the same mistakes in situations requiring judgment

Poor insight into the severity of their disorder; tend to d/c therapy
 

SCHIZO­PHRENIA (SZ)

Epid­emi­ology
Onset
Most common in young adults
 
Onset before adoles­cence or after 40 yr is extremely rare
 
Onset in males occurs earlier than females
Prevalence
Equal (male vs female)
 
In general, better outcomes in females
Suicide
~ 15%
Etiology
Unknown
 
Cause is multif­act­orial
Genetics
Signif­icant genetic component with a complex, non-Me­ndelian inheri­tance
 
Greatest risk factor ➩ positive family hx
 
Many genes involved ➩ pt's inherit several risk genes
 
➩ SNP's and CNVs
Enviro­nmental
Pt's more likely to experi­ence:
 
• premature birth
 
• low birth weight
 
• perinatal hypoxia
 
Maternal viral infxn during pregnancy (espe­cially during the 2nd trimes­ter)
Early Neurod­eve­lop­mental Defect
Brain vulner­ability by genetic predis­pos­ition
 
Combined with enviro­nmental factors or stressors
 
➩ Abnormal migration of neurons during CNS develo­pment
 
➩ Results in Abnormal neuronal connec­tivity and abnormal brain circuits
 
Schi­zop­hre­nia
SZ is more frequent in people born in cities and born between January and April (northern hemisp­here)

SNPs: single nucleotide polymo­rph­isms
CNVs: Specific copy number variat­ions

Dopami­nergic Pathways in the Brain

Nigr­ost­ria­tal
Originates in the substantia nigra
Projects to the striatum

Negative Symptoms

Alogia and Poverty of Speech
• May speak very little
• Speech may have little meaningful content
• May have long delays between words and sentences
Flat­tening or Blunting of Affect
• May have reduced emotional expression
• May not smile or frown in response to happy or sad events
• Voices may not change tone or pitch
• May not maintain eye contact or other kinds of emotional links with people
Anhe­donia and Avolit­ion
• May seem to lose interest in and energy for pleasu­rable activities and achiev­ements
• Lack of desire, drive, or motivation to pursue meaningful goals
Cata­tonia and Postur­ing
• May freeze into unusual body positions
• May stop moving entirely
• Sometimes hold rigid poses for hours and will ignore external stimuli
• May show stereo­typed repetitive movements
Lack of Motivation and Social Withdr­awal
• Contribute to poor-self care skills
• Diffic­ulties mainta­ining employment and living indepe­ndently