Schizophrenia and Psychosis

Identical twins - 46% concordance Non-identical twins - 14 % concordance

One parent - 5-6% One sibling - 10% One sibling and one parent - 17% Two parents - 46%

Neuregulin 1 (GABAergic, Glutamatergic neurotransmission) Dysbindin Catechol-o-methyltransferase (COMT) Disrupted-in-schizophrenia (DISC) Brain-derived neurotrophic factos (BDNF)

Affects 1% of world population Lifetime prevalence 0.5 - 1.5% (males = females) Men - mean onset age 15 - 25 Women - mean onset age 25 - 35 Rate of homelessness 4 - 16% 50% inpatient admissions, 25% inpatient beds DALYs 15-44

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Nigrostriatal pathway - VTA to caudate and putamen; rich in D1 and D2 receptors that cause Parkinson-like symptoms when blocked with anti-psychotics Mesocortial pathway - VTA to diffuse cortical connections; responsible for the negative symptoms of schizophrenia Mesolimbic pathway - VTA to amygdala and hippocampus; responsible for positive symptoms of schizophrenia Tuberoinfundibular pathway - hypothalamus to pituitary gland; causes increased prolactin

Thought content symptoms - impaired reality testing, delusions, hallucinations Thought process symptoms - loosening of associations, tangentiality, 'derailed'/disorganized speech, behavior and incongruous affect

Affective flattening Alogia - poverty of speech, content, blocking Avolition/apathy - impaired grooming, work, school performance Anhedonia/associality Attention - social inattentiveness

Most important to target specific symptoms! Patients with agitation, impulsivity, confusion respond in hours to weeks. Patients with auditory and visual hallucinations respond in weeks. Patients with delusions, social withdrawal, lack of motivation, flat affect, and impoverished speech may not respond at all.

Schizophrenia - greater than six months Schizophreniform disorder - one to six months Brief psychotic disorder - one day to less-than one month

Characteristic symptoms (2 or more) significantly persistent during a one-month period: 1. Delusions 2. Hallucinations 3. Disorganized speech (derailment/incoherent) 4. Grossly disorganized or catatonic behavior 5. Negative symptoms (flat, alogia, avolition)

Possessing wealth or great beauty or having special ability (ex. extrasensory perception); having influential friends; being an important figure

Believing that one is dead or dying; believing that one does not exist or that the world does not exist

Being persecuted by friends, neighbors, or spouse; being followed, monitored, or spied on by the government or other important organizations

Believing that one's organs have stopped functioning or are rotting away; believing that the nose or another body part is terribly misshapen or disfigured