L6 - developmental - schizophrenia

What are the DSM5 criteria of schizophrenia?

• A →two or more of the following symptoms lasting for at least 1 month; delusions, hallucinations, disorganized speech, disorganized behavior, affective flatening (no emotions)

• B→significnatly impairs functioning

• C→symptoms last 6 months

• D→ exclusion of bipolar or schizoaffective disorders.

• E→ cannot be attributed to medically induced symptoms or drug usage.

What is meant by positive symptoms in schizophrenia?

Feelings and behaviors that are previously not present, like a psychosis. This is a loss of reality, including delusions and hallucinations. One positive symptom must be included for diagnosis.

What is meant by negative emotions in schizophrenia?

Missing feelings that were previously present. Like loss of pleasure in previous interests, anhedonia, affective flattening, withdrawal.

What is the prevalence and comorbidity of schizophrenia?

Less than 1% of the population. Those with schizophrenia have higher death rates; high suicide rates, more smoking and higher risk of metabolic and heart diseases. Risk factors include; pre and perinatal events, older paternal age, early adverse events (migration and minority status especially), using drugs, male more prevalent due to possible estrogen protective factors. Also earlier onset in men.

What are possible mechanisms involved in schizophrenia?

Most consistent evidence suggest GABA dysfunction. Highly heritable disorder. Present already in early development, way before first episode. Less brain volume. Similar constructs affected (salience network and reward center) as depression.

What are considered as treatment and prevention for schizophrenia?

Approach prodormal patients before onset for those possibly at risk for developing the disorder. Medication should not be used prodormal, omega-3 supplements have shown effective. CBT and family therapy seems positive as well in preventing episode.

What are anti-psychotic medications and what do they target?

They block dopamine receptors. Side effects may incluse parkinsons (first gen meds), weight gain or even diabetes (second gens meds). Its used for acute reductiom of symptoms. Unfortunately high rates of relapse and low rates of remission/recovery. With the right environment, therapy and vocational functioning with treatment maybe sufficient for 2 years.

What demographic factors contribute to shizophrenia?

In utero stress and adverse childhood experiences, along with urban environment and migration/minority status are associated with chronically elevated cortisol levels which impact the brain. Substance abuse alters neurotransmitter levels which can worsen or contribute to symptoms.

Why is it more prevalent in men?

Estrogen may be considered as a protective factor due to its ability to modulate and prevents excessive dopamine signaling. Complement component (C)4 gene is involved in synaptic pruning. Genetic risk variants exists which causes excessive synaptic pruning. Greater impact of this is seen in men compared to women. Men often have earlier onset, more severe symptoms, and poorer treatment response.

In short, what could cause shizophrenia?

Genetic factors (highly heritable) interact with environmental factors which elevate chronic levels of cortisol that alters brain development (neurotransmitter levels and synaptic pruning)

What is the role of dopamine in schizophrenia?

Excessive dopamine activity in the brains mesolimbic reward pathway; ventral tegmental area along with nuclues accumbens, amygdala and hippocamous. This causes salience to be abnormally attributed to external stimuli and internal thoughts (e.g. hallucinations, delusions). May also stimulate auditory areas even when no auditory stimuli is present.

What is the role of GABA in schizophrenia?

Reduced GABA or inhibitory functioning in the prefrontal cortex associated with disorganized thinking and alterations to sensory processing.

What is the role of glutamate in schizophrenia?

Reduced gultamate functioning related to excitation of neurons in orefrontal cortex associated with reduced executive functioning (cognitive decline)

What is the prodromal stage and what to consider for treatment?

Individual may have some positive symptoms, but not at the levels that are clinically relevant thresholds. Omega-3 fatty acids bind to neuronal membranes and increase their fluidity and flexibility. It improves receptor binding and neuronal transmission. Also has anti-inflammatory properties which help with the elevated cortisol levels.

“You can visually tell when someone has schizophrenia”

Partially true

• When individuals go through an active psychosis, their positive symptoms may be visible through their behaviors. Some of the more negative symptoms may include improper hygiene/clothing which is physically visible.

• Affective flattening or improperly taking care of oneself is not only characterized by schizophrenia. Some can experience only mild symptom that are less visible. Sometimes unaware if they’re in a psychosis. Symptoms may also be well-controlled.

“As a consequence of the disorder, people with schizophrenia have multiple identities”

False, having multipke identities is not a symptoms in the disorder. The core identity in the same, in a psychosis they are experiencing hallucinations not split personalities. Symptoms may overlap with dissociative identity disorder, but they are different things and often mistaken for another.

“The positive symptoms may cause people with schizophrenia to commit dangerous acts”

Partially true

• Some may experience hallucinations of voices telling them to be violent.

• Large misconceptions often caused by misrepresentation and media biases. Often violent behavior caused by substance abuse of those with schizophrenia. Mostly violent to themselves, negative symptoms may cause them to want to commit suicide. Not all delusions are hallucinations are experienced by the individual as unpleasant. Are often actually victims of violence as they are a vulnerable target.