Schizophrenia: Symptoms and Hypotheses

a psychological disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression

-Loss of reality testing
-Loss of ego boundaries
-Characterized by positive symptoms

hallucinations, delusions, disorganized speech and thoughts

affective flattening, alogia, avolition, anhedonia, asociality

-Poor "executive functioning"
-Working memory deficiencies

onset between late adolescence and mid-30s (15-35)
Males-earlier onset

Environment breeds schizophrenia

schizophrenia causes its sufferers to fall from a higher to a lower socioeconomic level or to remain poor because they are unable to function effectively

Non-bizarre-plausible but not true
Bizarre -impossible

Fixed, beliefs that remains despite evidence to the contrary, and not in keeping with the person's social cultural background

persecution, reference, grandeur, control

auditory, visual, olfactory, gustatory,tactile

1) Mesolimbic (SCZ - increase in DA causes positive symptoms)
2) Mesocortical (SCZ - DA hypoactivity: negative & cognitive & affective symptoms)
3) Nigrostriatal (Drugs - EPS & TD drug side effects)
4) Tuberohypophyseal (Drugs - hyperprolactinemia side effects)

1st generation (typical)
-Dopamine antagonist
-Eg: Chlorpromazine, Haloperidol
-Improves +ve symptoms
-worsens -ve symptoms
-cause EPS
-cause hyperprolactinemia

2nd generation
-Dopamine and serotonin antagonist
-Clozapine, Risperidone
-Improves +ve and -ve symptoms
-LESS EPS and hyperprolactinemia

-Single
-Male
-Early and Gradual onset
-prominent negative symptoms
-Family history
-neurological signs
-Poor insight and compliance
-High expressed emotions in family
-Substance use

Declining function
Odd thinkingehaviour
Social withdrawal

Female more -decrease of hormone

Decreased( GABA, NAD, Serotonin, Glutamate, Dopamine)

Adrenal axes-hypersecretion of cortisol
Thyroid-hypersecretion of TRH
Growth hormone-depressed
Oestrogen -depressed

Smaller caudate nucleus and frontal lobes

-Histrionic personality
-Obsessive compulsive personality disorder

A 2 weeks duration of 5 or more of the follow

SIGECAPS
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor slowing
Suicidal Ideation

Full criteria are met for manic episode with some depressive features during the majority of the days of the current episode

In partial remission

no symptoms but less than 2 months duration , some symptoms are still present.
In full remission
No signs or symptoms are present during past 2 months

Full criteria are met for depressive episode with
3 or more manic/
the majority of the days of the current episode

loss of pleasure in nearly all activities even when something good happens along with symptoms like early morning wakening, increased depression in the morning, weight loss, excessive guilt, psychomotor retardation or agitation

-mood reactivity + 2<
1) weigh gain
2)Hypersomnia
3)Leaden paralysis
4)Interpersonal sensitivity

-Motor immobility
-Excessive motor activity
-Peculiar voluntary movement
-Extreme negativism/mutism
-Echolalia(talk nonsense)

4 weeks postpartum

-Absence of psychosis
-Short hospitalisation
-Good friendships, family
-Good social functioning
-Advanced age of onset
-No comorbid personality disorder

memory loss (retrograde, anterograde )and confusion
Mortality:due to arrhythmia

Mean :40 years (20-50)

High ideals not met in reality

Anger turned inwards

Depressive position of childhood

Learned helplessness

Explains depression using THIS: people's beliefs about themselves, their world, and their futures.

People suffering from depression often have irrationally negative beliefs about all three of these areas. Cognitive therapy aims to make these beliefs more positive.

mood disorder in one experiences both manic (at least 1 week)and depressed episodes

Extreme happiness from every activity
-Grandiose delusions
-Flight of ideas-Rapid, abrupt skipping from one thought to distantly related ideas.
-decreased need for sleep
- increased talkativenes
-distractibility
-increase in goal-directed activity
-excessive involvement in pleasurable activities that have negative consequences
-May experience psychotic (hallucinations, delusions, suicidal)

-at least 4 days
-no psychotic features
-same symptoms as mania but do not cause impairment/hospitalisation

Symptoms of both mania and depression within the same week .

A. Criteria have been met for at least one manic episode
B. Patients may have major depressive episode

-some may have experience chronic interpersonal/occupational difficulties

At least 1 hypomanic episode
At least 1 major depressive episode

Chronic (at least 2 years) mood disorder characterized by alternating hypomanic and depression levels that are not satisfy the criteria of hypomanic or major depressive episodes.

Symptom-free intervals must be less than 2 months a

bipolar features that includes disorders that do not meet criteria for any of the previously specified disorders.

diagnosis given when a person has four or more cycles of mood disorders (mania,mixed, hypomanic and depression within 1 year

5-50

Lithium-Mood stabilizers(anti-manic) ,atypical antipsychotics, anticonvulsants(Valproic acid, Lamotrigine, carbamezepine)

psychological disorders characterized by RESPONSE DOES NOT DIMINISH AFTER THREAT

Anxiety - Apprehension about future threat

Fear - response to an immediate threat

Excessive sympathetic nervous system activation
Globus hystericus

Specific phobias
Panic disorder and agoraphobia
Social anxiety disorder
Generalised anxiety disorder

Previously :
OCD
PTSF

irrational fears of specific objects or situations
Awareness that fear is excessive
Must be severe enough to cause distress with job/social life

- Specific phobias-unwarranted , excessive fear of certain object/situation
- Social phobias

-intense fear of negative evaluation in social situations
-adolescent onset
-can be generalised or specific
-some are diagnosed with avoidant personality disorder

Adolescence

Sudden, intense episode of apprehension, terror feelings of impending dooms
-accompanied by at least 4 other symptoms (laboured breathing ,sweating, nausea, dizziness, etc)
-usually include :
depersonalisation-Detached from your thoughts, feelings and body (some feel like they are watching their self from afar)
Derealization-feels like everything around them are not real

-Occur unexpectedly without warning
-must recrrennt

triggered by specific situations, more likely a phobia

-Avoidance of situations in which escape would be difficult or embarrassing
-Worsen prognosis

Involves chronic, excessive, uncontrollable worry (free-floating)
◦ Lasts at least 6 months
◦ Interferes with daily life
Usually begins in adolescence or earlier

a disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions)

Obsession cause anxiety
Compulsion relieve it

Before age 10 (usually men)
Late adolescence/early adulthood (usually women)
Chronic

Extreme response to severe stressor
Symptoms present for more than a month
Chronic

Re-experiencing the traumatic event
Avoidance of stimuli
Increased arousal

Exposure therapy (first line), teach to relax and try to understand/overcome the fear
Cognitive therapy

Panic Control Therapy
Cognitive Behavioral Therapy (CBT)

relaxation training
Cognitive behavioural methods-focus on present moment

Exposure plus ritual prevention
CBT-not engage in compulsion

benzos
Antidepressants

Clopiramine -OCD

Depression

20 years

12 months
-Using larger amounts or for longer time than intended
-Persistent desire or unsuccessful attempts to cut down or control use
-Great deal of time obtaining, using, or recovering
-Craving
-Fail to fulfill major roles (work, school, home)
-Persistent social or interpersonal problems caused by substance use
-Important social, occupational, recreational activities given up or reduced
-Use in physically hazardous situations
-Use despite physical or psychological problems caused by use
-Tolerance
-Withdrawal *(not documented after repeated use of PCP, inhalants, hallucinogens)*

Within 1 month of substance use

Endorphins-satisfies their craving which cause them to repeat it back

Focus on prevention of drug-related harm rather than prevention of drug use

Addiction is not an all or nothing approach
Any movement in the direction of reduced harm, no matter how small is positive in and of itself
Abstinence may not be for everybody

1) humane values
2) pragmatism
3) focus on harms
4) balancing costs and benefits
5) Priority of Immediate Goals

Taken orally
Very long half life

Dyscontrol
Salience
Compulsion to use
Physiological features

Nicotine binds to Ventral Tegmental Area at alpha4beta2 receptor which cause the release of dopamine at Nucleus accumbens->reward

Chronic exposure will cause activation and desensitisation and up regulation of alpha4beta2 nicotinic receptors

Well-defined with onset 12 hours after last cigarette

Fagestrom Test for Nicotine Dependence

Binds selectively to alpha4beta2 nicotinic receptor
Dual mechanism of action (Partial agonist-stimulates receptor to treat craving)(Antagonist-prevents nicotine from binding to the receptor)

-Antagonism of nicotine receptor and dopaminergic effect on reward mechanisms
Antidepressant
-Reduces post cessation weight gain
-reduces seizure

Antidepressant for smoking cessation

Nicotine patch

Long term patch+gum/nasal spray

10 g of ethanol/6 units of alcohol

3/ more over preceding 12 months
Stereotyped pattern of drink
Prominence of drinking seeking behaviour
Increase tolerance
Repeated withdrawal symptoms
Relief of withdrawal symptoms by further drinking
Subjective awareness of compulsion to drink
Reinstatement after abstinence

Epilepsy

Thiamine deficiency in Dry beri beri

Wernicke's syndrome: altered mental status, ataxia, ophtalmoplegia
Korsakoff's syndrome: anterograde amnesia, confabulations,chronic amnestic syndrome that follow wernicke's encephalopathy (Symptoms mimic alcoholic pellagra encephalopathy except APE need B3)
Treat with thiamine

is a progressive neurological disease characterized by corpus callosum demyelination and necrosis and subsequent atrophy.
Cause ataxia, dysarthria, epilepsy

Demyelination of pyramidal tracts within pons (quadriplegia, pseudobulbar palsy

Painless bilateral loss of vision dt retrobulbar neuritis (1-2weeks)
mostly smokers
Tx: Thiamine

Blindness
Methanol poisoning
Thiamine deficiency
Heavy tobacco smoking
B12 deficiency

•Auditory hallucinations
Occur 24 - 48 hours after heavy drinking

a psychotic condition typical of withdrawal in chronic alcoholics,
Has global confusion, hallucinations and tremor.
Marked autonomic hyperactivity

Psychiatric condition marked by morbid/pathological/delusional jealousy

Withdrawal-best oxazepam
Anticraving-Acomprostate/Naltrexone
Antiabuse-disulfiram
Thiamine

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