Schizophrenia Spectrum & Psychotic disorders

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Schizophrenia Spectrum & Psychotic disorders

1. What is the time period necessary for a person to be diagnosed w/ schizophrenia when displaying positive/negative sxs?
2. Six months
3. What are the 4 A's associated w/ the negative sxs?
4. Alogia, Avolition, Anhedonia, Asociality
5. Which dopaminergic tract is associated with prolactin changes?
6. Tuberoinfundibular

i

Serotonin System - 5HT Receptors

• present on DA axon and stimulation dec DA release
• 5HT2 r and dopamine r are colocalized
• All antipsychotics have BOTH DA/5HT r binding affinity
• Exception: Pimavanserin for PD psychosis
• NMDA - glutamate sys may be involved w/ psychosis and dec cog.

Tuberoinfundibular pathway

hyperprolactinemia

Nigrostriatal pathway

EPS + tardive dyskinesia

Non-dopamine neurotransmitter systems

NMDA subclass of glutamate receptors

Hypoglutamatergic disorder

Hypodopaminergic activity in mesocortical system

Negative symptoms

Hyperdopaminergic activity in mesolimbic system

Postive symptoms

Clinical Presentation

Cog sxs

-deficits in working memory, attention and in executive func. -def in abstract abilities -difficulty understanding interpersonal cues

Negative sxs

-diminished emotional expression (no emotions, eye contact, intonation of speech, movement of hand/head/face) -avolition: dec in motivated self-initiated purposeful activities -alogia: diminished speech output -anhedonia: dec ability to experience pleasure from pos stimuli -asociality: lack of interest in social interactions

Positive sxs

-delusions -hallucinations -disorganized speech/thinking -abnormal psychomotor behavior, incl. catatonia

Etiology/Patho/Sxs

Etiology: Molecular, genetic, and environmental factors

Pathophys: -Abn neuronal formation, apoptosis and neurodegeneration,leading to dysfunctional neural synaptic activity --> early cog impairment -anatomic abnormalities such as large brain ventricles, hippocampus changes, dec whole brain volume -neuro systen abnormalities -inflammation and immune function

Inflammation and Immune function:

• overactivation of the immune system --> prenatal infection/postnatal stress
• Overexpression of inflam cytokines --> alteration of brain structure/func
• Insulin resistance and metabolic disturbances

Sxs: -Imp attention/memory/lang -Positive/negative sxs (delusions, hallucinations)

DSM-5 Criteria

Schizophrenia

-Two or more symptoms present for 1 month, and at last 1/2/3 present. Criteria A. 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behavior 5. Negative symptoms Duration: cont. disturbance for at least 6 mo.

Schizophreniform Disorder

-Two or more symptoms present for 1 month and at least 1/2/3 present. Criteria A. 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behavior 5. Negative symptoms Duration: at least 1 month but <6 mo.

Delusional Disorder

-Criteria A for schizophrenia is NOT met. -Functioning not impaired -behavior NOT odd or bizarre -Duration: 1 month or longer

Brief Psychotic Disorder

Presence of at least one or more symptoms: -delusions -hallucinations -disorganized speech -grossly disorganized or catatonic behavior -duration: >1 day and <1 month