Schizophrenia Spectrum & Psychotic disorders

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

DSM-5 Criteria

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

Delusional Disorder

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

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.

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.

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

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

Clinical Presentation

Positive sxs

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

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

Cog sxs

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

i

Serotonin System - 5HT Receptorspresent on DA axon and stimulation dec DA release5HT2 r and dopamine r are colocalized All antipsychotics have BOTH DA/5HT r binding affinity Exception: Pimavanserin for PD psychosisNMDA - glutamate sys may be involved w/ psychosis and dec cog.

Hyperdopaminergic activity in mesolimbic system

Postive symptoms

Hypodopaminergic activity in mesocortical system

Negative symptoms

Non-dopamine neurotransmitter systems

Hypoglutamatergic disorder

NMDA subclass of glutamate receptors

Nigrostriatal pathway

EPS + tardive dyskinesia

Tuberoinfundibular pathway

hyperprolactinemia