Schizophrenia

1
Schizophrenia

• Diagnosis and Treatment

2
Brain Differences
3
Grey Matter

• ScienceDaily (Jan. 19, 2009) A research study
  led by scientists from the Gregorio Marañón
  University Hospital in Madrid and the Network of
  Centres for Biomedical Research in Mental Health
  Networks (CIBERSAM) shows that adolescents
  experiencing a first outbreak of psychosis have
  lower levels of grey matter in their brains than
  healthy teenagers. Strangely, this change was
  seen in patients suffering from various
  psychoses, including bipolar illness and
  schizophrenia.

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Grey Matter

• The study, published recently in the Journal of
  the American Academy of Child and Adolescent
  Psychiatry, analysed a sample of 121 people aged
  between 7 and 18, inclusive. All the patients and
  controls were examined using magnetic resonance
  imaging in order to detect any possible changes
  in the structure of their brains.

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Clinical Studies

• However, it is important not to draw any causal
  link between alterations in this area of the
  brain and the appearance of these pathologies.
  Psychiatric illnesses need more complex
  diagnosis. What the research does show, however,
  is that the majority of people with schizophrenia
  and type 1 bipolar illness do suffer from this
  lack of grey matter and the majority of healthy
  people have normal levels of this substance.

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Clinical Symptoms

• Positive Symptoms
• Hallucinations
• Delusions
• Loose associations
• Neologisms

• Negative Symptoms
• Flat affect
• Apathy
• Mood changes
• Withdrawal
• Ambivalence
• Cognitive impairments

Disorganized Symptoms
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Diagnosis

• No diagnostic test.
• Clinical interview crucial.
• What are DSM-IV criteria for dx?

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Differential Diagnosis

• Prodromal issues
• Rule out other possibilities
• Mania in active phase?
• Depression with psychotic features?
• Drug induced?
• Extreme OCD?
• PTSD?

9
Development of Schizophrenia

• Risk Factors
• Early neurodevelopment
• Onset of illness
• Disrupted brain regions active later
• Hormonal contribution
• Disruption of Neural Circuits
• PFC, Thalamus, Temporal
• Grey Matter Differences
• medial prefrontal gyrus region of the brain,
  which controls processes such as cognition and
  the regulation of sensations

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Disrupted Neural Circuits

• PFC-Thalamus-Cerebellum
• DLPFC-Medial Temporal

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Outcome

• Symptom reduction varies.
• Social and occupational impairments persist.
• Suicide Rate

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Neurocognitive Deficits Functional Outcome

• Deficits
• Executive Functioning
• Vigilance (reduction in resources)
• Memory (loss of context)
• Social Cognition
• Functional Outcome
• Verbal memory closely related

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Interventions Medication

• Typical antipsychotics
• Haloperidol, Stelazine, Thorazine, Prolixin
• Side Effects akathisia, akinesia, tremor
• Dopamine Sertonin Receptor Antagonists
• Clozapine, Respiridol, Zyprexa, Seroquel, Geodon
• Works on - symptoms
• Serious side effect - agranulocytosis
• Importance of Early Treatment
• Medications and Compliance
• Video

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Typical Neuroleptics
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Atypical Neuroleptics
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Other Interventions

• Family Education
• Cognitive-Behavioral therapy
• Vocational and Self-care skills
• Social-skills training
• Cognitive remediation