Schizophrenia

1
Schizophrenia

• Diagnosis and Treatment

2
Clinical Symptoms

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

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

Disorganized Symptoms
3
Diagnosis

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

4
Differential Diagnosis

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

5
Development of Schizophrenia

• Risk Factors
• Early neurodevelopment
• Onset of illness
• Disrupted brain regions active later
• Hormonal contribution
• Disruption of Neural Circuits
• PFC, Thalamus, Temporal

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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

8
Neurocognitive Deficits Functional Outcome

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

9
Interventions Medication

• Typical antipsychotics
• Haloperidol, thioridazine, fluphenazine
• Side Effects akathisia, akinesia, tremor
• Atypical
• Importance of Early Treatment
• Medications and Compliance

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Other Interventions

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