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Psychosis and Schizophrenia. Clinical Quiz. List Symptoms of Schizophrenia. Presentation…. A peculiar young man presents at the request of his mother. He has worsening social difficulties, and has recently lost his job for his “weird” behaviour.
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Psychosis and Schizophrenia Clinical Quiz
Presentation… A peculiar young man presents at the request of his mother. He has worsening social difficulties, and has recently lost his job for his “weird” behaviour. You note he has disorganised speech, anhedonia and blunted affect. His mother reports he has been like this for 3-4 weeks, but he has had similar episodes in the last year, around the same time he started becoming “different”. • Does this case meet the criteria for schizophrenia? • Yes • No • Maybe (what else do you need to know..?)
DSM-IV Criteria for Schizophrenia • ≥2 of the following symptoms for ≥ 1 month (less if treated) • Delusions • Hallucinations • Disorganised Speech • Grossly disorganised or catatonic behaviour • Negative symptoms • Note that only one of the above is necessary if delusions are bizarre, or hallucinations are constant commentary or multiple voices • Social or occupational dysfunction • Continuous signs of the disturbance for ≥ 6 months • No schizoaffective or mood disorder explains the symptoms • No general medical condition or substance use explains the symptoms • If a pervasive developmental disorder (e.g. autism) is present, the diagnosis is only made with delusions or hallucinations ≥1 month
Schizophrenia has a characteristic feature of producing a “defect in selective attention”. What’s that? • Inability to distinguish between important/significant and non-important stimuli (e.g. clock ticking gains as much attention as friend’s voice)
Pathogenesis… Neurotransmitter most important in schizophrenia: Disease in which dopamine is naturally low: Dopamine precursor used to treat Parkinson’s: Side effects of treatment with L-Dopa: Biochemical effect of amphetamine: Behavioural syndrome of amphetamine: Next most important neurotransmitter for schizophrenia: Dopamine Parkinson’s L-Dopa Hallucinations Release of dopamine Indistinguishable from acute schizophrenic episode (positive symptoms) Glutamate
Neuroanatomy What two findings would you expect to see on MRI in a “classical” schizophrenia patient: • Hippocampus – reduced cortical thickness • Lateral Ventricle Third Ventricle – enlarged
Neuroanatomy The reduced cortical thickness of the medial temporal lobe is due to: • Marked neuronal loss • Decrease in neurone size • Loss of dendrites and axons • Decreased numbers of supporting cells Does this support a neurodevelopmental or neurodegenerative theory of schizophrenia?
“The well-established finding of decreased cortical volume in schizophrenia is not mirrored, as in most neurological disorders, by reports of marked neuronal loss. Some investigators have interpreted the lack of marked cell loss and the lack of an associated increase in the number of glial cells as evidence against a neurodegenerative and in favor of a neurodevelopmental abnormality.” Meltzer Herbert Y, Bobo William V, Heckers Stephan H, FatemiHossein S, "Chapter 16. Schizophrenia" (Chapter). Ebert MH, Loosen PT, Nurcombe B, Leckman JF: CURRENT Diagnosis & Treatment: Psychiatry, 2e: http://www.accessmedicine.com.ezproxy.library.uq.edu.au/content.aspx?aID=3284037
Stepping Stone Clubhouse What two criteria does a patient need to meet to become a member of the stepping stone clubhouse in Coorparoo? • Age 18+ • Diagnosed mental illness. (Membership is free) What four main services do they provide? • Education • Housing • Employment • Recreation and social activities http://www.steppingstoneclubhouse.org.au/
