Medical Archive

C7.1 Schizophrenia

History

Epidemiology

Schizo: ??, phrenia: ????
? ??? 1%. ??? ??? ? ?. Seasonality…?

Emil Kraepelin	behavior type? ?? ??? discription? ?? ‘????’? ?????
Eugen Bleuler	4A – fundermental Sx / Schizophrenia? ?? ??.
??	Polymorphic… genetic background? 50% (??? 10%) ??? ??? ??? ??
??	by stress? (stress-diathesis model) ??? ?? ??? ?? ??? ??? ??

Etiology

Genetic factors
Biochemical factors

Neurotransmitter	Dopamine	Serotonin	Glutamate	Nicotine	GABA
Change	Increase	Increase	Increase/decrease	Decrease	Decrease
Effects	Positive symptoms	Positive and negative symptoms	PCP (glutamate antagonist) leads to schizophrenia-like symptoms	Cognition	Leads to hyperactivity of dopaminergic neurons

Neuropathology

Brain Area	Ventricles	Symmetry	Limbic System	Prefrontal Cortex	Thalamus	Basal Ganglia and Cerebellum
Change	Increase	Decrease	Decrease	Decrease	Decrease	Increase/decrease

?? ??? frontal cortex? subcortex(limbic system)? ???? tract? ??
Frontal lobe? ??? ?? ??? ??? ????? ??? ??? ???. ? cortex? ?? ??? ??? ???? ? ??
Subcortex(limbic) – Frontal lobe circuit. Tract? ???? DA, SA? ??
???? ?? ?? ??? CNS? ??? pruning (????)? ????? ? stress? ?? ?? ?

Psychosocial and psychoanalytic theories

Diagnosis

DSM-V? ‘A criteria’

1	Delusion	??	??? ??, ??
2	Hallucination	??	????? ?? ??
3	Disorganized speech	??? ??	Derailment, loosening, ???? word salad
4	Disorganized behavior	??? ??	‘Bizzare’, catatonic (????)
5	Negative symptom	?? ??	Alogia, Anhedonia, Affect blunting

5? ? 2? ??? ?? 1?? ? ???? ?? ? psychotic. ? 6?? ??
Bizzare behavior? hallucination??? ?? X +Social function? ???? ??.

???(???)	Paranoid	??/??? ??. 30? ?? ?
???(???)	Hebephrenic	??? ??/??, ??/??? ??. ??? ?
???	Catatonic	???, ????/??, ??, ????. ??? ?? ? ?
????: 3??? ?? ?? ?	???: ??? ??/?? + ???? ? ?????

Thoeries about the family

1	Double bind	??? ???
2	Pseudomutual/hostile	???
3	Martial skew(??), martial schism(??)
4	Expressed emotion	?>?

Clinical features

Differential diagnosis

SLE, thyroiditis, metabolic/electrolyte disorders, CNS infection, and epilepsy

Treamtment

• Antipsychotic medication
• Family therapy
  • ???? ?????? ?? ??. ??? ?? ???? ??. Demonstrated efficacy in reducing the risk of relapse.
  • Patient and family are educated about the symptoms, course, and treatment of schizophrenia
• Cognitive-behavioral therapy
  • ???? (?? ??? ??? ???)
• Social skills training
• Assertive community treatment
• Supported employment

• ???? – Brain ???? ?? ??X ?? ?? IQ? ? ?????
• ???? – supportive psychotherapy? auxillary ego ??? ?? ??? ? ? ??.
• ???, ???? ECT? ???.

Prognosis

Good	??, ?? ??, ?? ??, ??, ????, ??? ??x, ??? ?? ?? ?, ?? ????/????, ????? ??
Bad	??? ??, ???, ?? ??, ??, ???

1/3? treatment resistant. 1/3? ??? ? ?? 1/3? ??? ? ???.

??? ??? ?? ???? ??.

1?? ??	?? ???? ??	?? ????, ???? A,B?, ?? ??? ??.
1~6??	????? ??	???? ECT ?? ?
6??~	?????

C7.2 Schizoaffective Disorder

To differentiate from a major mood disorder with psychotic features, patient must have > 2 weeks of psychotic symptoms without major mood episode.

• Schizophrenia + Major mood disorder (MDD/BPD-I)
• To differentiate from a major mood disorder with psychotic features, patients must have >2 weeks of psychotic symptoms without major mood episode.
• Mood episodes are prominent & recur throughout illness.

????/???? ?? > ???? ?? ?????.

C7.3 Schizophreniform Disorder

?1 months & <6 months, same symptoms as schizophrenia, functional decline not required.

C7.4 Delusional Disorder and Shared Psychotic Disorder

Epidemiology

Etiology

Diagnosis and clinical features

??? ?? 1?? ??.
??? ?? ??? ?? X, ??? ????? ???? ??
Schizo A criteria ?? ????. But ??? ??? ?? ????.

????: ????, ??, ??

Types

??(erotomanic)
??(grandiose)
??(jealous type)
??(persecutory) – m/c
??(somatic)
??(mixed)
???(unspecified)

???: ???? ??
????: ???? ?? ??
???: ??? ???

Shared psychotic disorder

???? ????? ??? ?? ??? ?? ???? ??. 
??, ?? ??. ??? ????, ????? ??? ????

Differential diagnosis

Paranoid personality disorder: lifelong pattern of pervasive distrust and suspicion of others, beginning in early adulthood. The paranoid beliefs are not of delusional intensity.

Course and prognosis

??????, ?? base. ????? ?? ???
?? ????? ???(schizo? ??)

Treatment

C7.5 Brief Psychotic Disorder, Other Psychotic Disorders, and Catatonia

Brief psychotic disorder

Symptoms of schizophrenia, but symptoms must last <1 month.

Psychotic disorder not otherwise specified

Autoscopic psychosis

Motility psychosis

Postpartum psychosis

• ?? ? 30? ?? ??? ??? ?? + ??? ??. 1,000?? 1~2?? ??.
• Risk factors
  • History of bipolar disorder or who are later diagnosed with bipolar disorder
• Management
  • ???? ??! (may harm the child and are also at high risk for suicide) ? Hospitalization
  • ??? ?? Lithium, ???? > ???? ??
• Cf) ?? ??: 50% ???? ??, 3~5? peak, 14? ?? ??? ??? ??.

Psychotic disorders due to a general medical condition and substanceor medication-induced psychotic disorder

• Glucocorticoid-induced psychosis
  • Typically during the first week of treatment, but can occur at any time.
  • ? haloperidol

Catatonic disorder

• Definition
• Epidemiology
• Etiology
• Diagnosis and clinical features
  • Symptoms
    • Immobility or excessive purposeless activity
    • Mutism, stupor
    • Negativism (resistance to instructions & movement)
    • Posturing (assuming positions against gravity)
    • Waxy flexibility (initial resistance, then maintenance of new posture)
    • Echolalia, echopraxia (mimicking speech & movements)
  • Relief of symptoms in response to a IV lorazepam challenge test
• Laboratory examination
• Differential diagnosis
  • Akinestic mutism
    • Caused by lesions in the frontal cortex
    • Not accompanied by echophenomena (eg, echolalia, echopraxia)
• Course and treatment
  • Benzodiazepines (lorazepam)
  • Electroconvulsive therapy