Psychotic Disorders -> Schizophrenia

teens, thirties, males, females, chronic, negative, positive

Schizophrenia

• Psychotic features emerge between late _______ to mid ___________

• Peak onset age → early-mid 20s for _______; late 20s for ________

• Typically, _________ life-long condition

• ____________ symptoms more closely related to prognosis than ___________ symptoms

thinking, mood, behavior, genetic, dopamine, acute, less

Schizophrenia

• Schizophrenia is manifested by a massive disruption of __________, ____, and overall ____________ as well as poor filtering of stimuli

• The cause is believed to be multifactorial

  • _________, environmental, and neurotransmitter (_________) pathophysiologic components

• No lab test to confirm diagnosis of schizophrenia

• Other psychotic disorders on this spectrum

  • Similar to schizophrenia in their _______ symptoms

  • Less pervasive influence long term

  • Allow higher levels of functioning

  • Acute psychotic episodes tend to be _____ disruptive of the person’s lifestyle

mesolimbic, mesocortical

Schizophrenia Pathophysiology

• Overactivity of the ___________ pathway causes positive symptoms

• ___________ pathway dysfunction causes negative and cognitive symptoms

1, delusions, hallucinations, speech, catatonic, negative, functioning, 6

Schizophrenia

A. 2+ of the following, each present for a significant portion of time during a _-month period (or less if successfully treated). At least one must be 1, 2, or 3

1. __________

2. ___________

3. Disorganized _______

4. Grossly disorganized or _____________ behavior

5. __________ symptoms (eg decreased emotional expression or avolition)

B. decreased level of ____________ (work, interpersonal, self-care)

C. Continuous signs of disturbance > _ months

cognitive, emotional, heterogeneous, prodromal, acute, residual, mood, full mood

Schizophrenia

• Characteristic symptoms involve a range of ___________, behavioral, and _____________ dysfunctions

• ______________ clinical syndrome with wide variety of manifestations

• Often presents with ___________ symptoms → _______ phase → _________ symptoms

• _____ symptoms and ____ _____ episodes are common

affect, dysphoric, sleep, eating, phobias, cognitive, anosognosia

Schizophrenia Associated Features

• Inappropriate ________

• ___________ mood

• Disturbed _____ pattern

• Lack of interest in _________ or food refusal

• Depersonalization, derealization, somatic concerns may occur

• Anxiety and __________ are common

• _________ deficits

• Sensory processing abnormalities

• Some may lack insight or awareness of disorder (_________)

• Hostility, aggression

hospitalization, typical, phenothiazines, atypical, clozapine, CBT, ECT

Schizophrenia Treatment

• _____________ sometimes necessary

• “__________” 1st Generation Antipsychotics

  • ____________, butyrophenones, thioxanthenes, dihydroindolenes, dibenzoxazepines, and benzisoxazoles

• “__________” 2nd generation antipsychotics

  • __________, risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, paliperidone, asenapine, iloperidone, lurasidone, and cariprazine

• Psychotherapy → ____

• ___ effective for schizophrenia and catatonia (in addition to meds)

anticholinergic, dry, blurred, retention, delayed, reflux, glaucoma

Antipsychotic Med ADRs (possible w/ 1st gen, more common w/ 2nd gen)

• ___________ ADRs → ___ mouth, _________ near vision, urinary _________, ________ gastric emptying, esophageal ________, ileus, delirium, and precipitation of acute ___________

autonomic, hypotension, sexual, retrograde, noncompliance

Antipsychotic Med ADRs (possible w/ 1st gen, more common w/ 2nd gen)

• Other ___________ effects → orthostatic ____________ and __________ dysfunction

  • Problems achieving erection, ejaculation (eg ____________ ejaculation) and orgasm in men and women

  • Delay in achieving orgasm is often a factor in medication ____________

EKG, QT, prolongation

Antipsychotic Med ADRs (possible w/ 1st gen, more common w/ 2nd gen)

• ___ changes → decreased T wave amplitude, appearance of prominent U waves, ST segment depression, __ interval ______________

extrapyramidal, akathisia, dystonias, spasms, parkinsonism, tardive dyskinesia, neuroleptic, catatonia, extrapyramidal, BP, hyperpyrexia, prolongation

1st Gen Antipsychotic ADRs

• __________ symptoms → __________, rigidity, bradykinesia, tremors

• Acute ___________ → bizarre muscle ________ of the head, neck, and tongue

• Drug-induced _____________ → indistinguishable from idiopathic parkinsonism

• _________ ___________ → abnormal involuntary stereotyped movements of the face, mouth, tongue, trunk, and limbs

• ___________ malignant syndrome (NMS) → __________-like state manifested by ____________ signs, __ changes, altered consciousness, and ________ (106+)

• Weight gain, QT _____________

• Photosensitivity, retinopathy, and hyperpigmentation

EPS, DM, gain, hypo, anticholinergic, myocarditis, QT, seizure

2nd Gen Antipsychotic ADRs

• Less incidence of ___

• Metabolic syndrome → new-onset __, hyperlipidemia, weight ____

• ____tension, sedation, _____________ symptoms

• Cardiovascular → __________, __ prolongation

• Lower __________ threshold

schizophrenia

Based on the vignette, what is the most likely diagnosis?

24 y/o F was brought to the ED by campus security after being found wandering the university library barefoot, muttering to herself and laughing intermittently. When approached, she became agitated and accused the librarian of "planting wires in the books" to monitor her thoughts.

During evaluation, she was alert but disorganized. Her speech was tangential, with frequent derailments and occasional neologisms. She wore multiple layers of mismatched clothing despite warm weather. When asked simple questions, she often responded with unrelated answers or giggled inappropriately.

She denied hallucinations but was preoccupied with the idea that government agents were using Wi-Fi to manipulate her dreams. Her family reports that she had been increasingly withdrawn over the past seven months and had stopped attending classes and social events.

admit to hospital, start antipsychotics, start CBT

Based on the vignette, what is the best approach to treatment?

32 y/o M was referred by his primary care doctor after expressing fears that his neighbors were plotting to poison him. He reported that they were "sending coded messages" through the radio and believed they had installed hidden cameras in his apartment.

He appeared neatly groomed and maintained a formal, guarded demeanor. His speech was coherent, but dominated by detailed descriptions of his persecutory beliefs. He denied substance use and had no insight into the irrationality of his fears. There were no signs of disorganized behavior or catatonia.

His brother shared that the patient had become suspicious and isolated over the past year, refusing to eat food he hadn’t prepared himself. He had no prior psychiatric history and had been working as an IT technician until he abruptly quit six months ago.