schizophrenia/psychotic disorders

diagnostic criteria for brief psychotic disorder

1+ symptoms (out of 4) for 1+ days but less than 1 month, with at least one being delusions, hallucinations, or disorganized speech (the other one that isn’t required is catatonia)

timeline for brief psychotic disorder

more than 1 day but less than 1 month

diagnostic criteria for schizophreniform

2+ symptoms (delusions, hallucinations, disorganized speech, catatonia, negative symptoms - must have 1 of the first 3) for more than 1 month but less than 6 months

timeline for schizophreniform

more than 1 month but less than 6 months

diagnostic criteria for schizophrenia

the presence of an active phase for 1+ months with 2+ symptoms, and at least 1 symptom is delusions, hallucinations, or disorganized speech (the other two are catatonia and negative symptoms)

must have continuous signs for the disorder for 6+ months, which may include prodromal and/or residual phases (2+ symptoms but attenuated form or negative symptoms only)

genetic factors in schizophrenia

not 1 single gene, but is polygenetic (like many psychiatric disorder). the greater the degree of genetic similarity, the higher the concordance rate (first-degree relatives)

heritability and concordance rates for schizophrenia

highly heritable, heritability rates from 70-80%

monozygotic 42-48% and dizygotic 4-11%

concordance rates higher when more genetically similar:

• parent of person w/disorder 6%

• sibling 9%

• child of 1 parent w/disorder 13%

• dizygotic (fraternal) 17%

• child of 1 parents w/disorder 46%

• monozygotic (identical) 48%

genes can be transmitted to offspring even though they don’t manifest symptoms

evidence for dopamine hypothesis

we know high dopamine = positive symptoms because amphetamines increase dopamine and produce schizophrenia-like symptoms

old and revised dopamine hypothesis

old: schizophrenia cause by dopamine overactivity

revised:

• high dopamine in subcortical regions = positive symptoms

• low dopamine in cortical regions (especially) PFC = negative symptoms

brain studies in schizophrenia regarding brain matter volume

reduced grey matter in PFC (including reduced activity in PFC causing negative and some positive symptoms), frontal and temporal lobe, hippocampus, amygdala, celebellum

increased volume in lateral and third ventricle

comoribity of schizophrenia

anxiety, OCD, tobacco use disorder (70-85% are tobacco uses and over 50% meet criteria for tobacco use disorder)

age of onset for schizophrenia

symptoms first appear late teens - early 30s. peak onset is mid-20s for males and late-20s for females

schizophrenia prognosis (and what improves it)

better prognosis in women, acute and late onset of symptoms, comorbid mood symptoms (especially depression), predominantly positive symptoms, precipitating factors, family history of mood disorder, and good premorbid adjustment

psychotic symptoms decrease with age but negative and cognitive symptoms persist

family involvement decreases relapse and increases med adherence

impact of family involvement in schizophrenia

family support decreases relapse and improves med compliance

families high in expressed emotion (criticism, hostility toward, emotional over-involvement) increase relapse

difference between western and non-western patients with schizophrenia

non-western developing countries = more likely to have an acute onset, shorter course, and higher rate of remission

immigrant paradox

new immigrants have better health outcomes (schizophrenia, alcohol use disorder, etc) than acculturated immigrants and US born natives of the same ethnicity

multimodal treatment of schizophrenia

typical treatment is antipsychotic + adjunctive meds for comorbid symptoms + psychosocial interventions

psychosocial interventions for schizophrenia

CBTp, ACT, assertive community treatment, cognitive remediation for schizophrenia, family psychoed, social skills training, illness self-management, supported employment services, NAVIGATE

meds for schizphrenia and which med is most effective

FGAs, SGAs, TGAs

the SGA clozapine is most effective for treatment-resistant schiz

treatment-resistant schizophrenia

no or suboptimal response to 2 antipsychotic medication trials with at least 6 weeks each at adequate dosage

most common cause of med noncompliance in schizophrenia

anosognosia (lack of awareness or insight of one’s disorder)

factors that increase med noncompliance in schizophrenia

anosognosia (lack of awareness or insight into illness), greater symptom severity, previous hospitalization, drug and alcohol use, younger age, male sex

early intervention for early stage or individual at high risk for schizophrenia

NAVIGATE (team-based, first-episode psychosis program with family education, resiliency training (CBTp), supported employment and education, meds)

resiliency training is based on CBTp and teaches skills to help understand precursors, triggers, effects of psychotic episodes, cog restructuring, strengthening positive feelings/thoughts/behaviors

diagnostic criteria for schizoaffective disorder

concurrent symptoms of schizophrenia and a major depressive or manic episode for most of the duration of the illness, but with presence of delusions or hallucinations for 2+ weeks without mood symptoms (which is what distinguishes it)

diagnostic criteria for delusional disorder

1+ delusions for 1+ months, overall functioning not markedly impaired except for effects of delusions

subtypes of delusional disorder

erotomanic (believes someone is in love w/them)

grandiose (great but unrecognized talent)

jealous (cheating partner)

persecutory (conspired against, spied on, poisoned, maliciously maligned)

somatic (involves bodily functions or sensations)

other specified schizophrenia spectrum and other psychotic disorders

indicates reason but don’t meet criteria (only auditory hallucinations, attenuated psychosis syndrome)

unspecified schizophrenia spectrum and other psychotic disorders

chooses not to specify why they don’t meet criteria (because not enough information)