Schizophrenia Cheatsheet

Cheatsheet Content

### Overview - **Definition:** A chronic, severe mental disorder affecting how a person thinks, feels, and behaves. - **Prevalence:** Approximately 1% of the population worldwide. - **Onset:** Typically late adolescence to early adulthood (15-30 years old). - **Etiology:** Complex interaction of genetic, environmental, and neurobiological factors. ### Symptoms Symptoms are categorized into positive, negative, and cognitive. #### Positive Symptoms - **Hallucinations:** Sensory experiences not caused by external stimuli (e.g., auditory, visual, tactile). Auditory hallucinations (hearing voices) are most common. - **Delusions:** Fixed false beliefs, resistant to change even with conflicting evidence (e.g., paranoia, grandeur, somatic, control). - **Disorganized Thinking (Speech):** Difficulty organizing thoughts, leading to incoherent speech (e.g., tangentiality, word salad, loose associations). - **Grossly Disorganized or Abnormal Motor Behavior:** Catatonia (decreased reactivity to environment), inappropriate affect, unpredictable agitation. #### Negative Symptoms - **Affective Flattening (Blunted Affect):** Reduced emotional expression. - **Alogia:** Poverty of speech. - **Avolition:** Lack of motivation or goal-directed activity. - **Anhedonia:** Inability to experience pleasure. - **Asociality:** Lack of interest in social interactions. #### Cognitive Symptoms - Impaired executive function (e.g., planning, problem-solving). - Difficulty with attention and concentration. - Working memory deficits. ### Diagnosis (DSM-5 Criteria) - At least two of the following symptoms, present for a significant portion of time during a 1-month period (or less if successfully treated), with at least one being A, B, or C: A. Delusions B. Hallucinations C. Disorganized speech D. Grossly disorganized or catatonic behavior E. Negative symptoms - Level of functioning in major areas (e.g., work, relationships, self-care) is markedly below the level achieved prior to onset. - Continuous signs of the disturbance persist for at least 6 months, including at least 1 month of symptoms (or less if treated) and periods of prodromal or residual symptoms. - Other conditions (e.g., schizoaffective disorder, depressive or bipolar disorder with psychotic features, substance-induced psychosis) have been ruled out. ### Stages of Schizophrenia - **Prodromal Phase:** Subtle changes in behavior, thinking, and perception; social withdrawal, decline in functioning. Can last months to years. - **Active Phase:** Prominent positive symptoms (hallucinations, delusions, disorganized speech). - **Residual Phase:** Positive symptoms may decrease in intensity, but negative and cognitive symptoms often persist. ### Treatment - **Antipsychotic Medications:** Cornerstone of treatment. Reduce positive symptoms. - **First-generation (Typical):** Haloperidol, Chlorpromazine. Higher risk of extrapyramidal side effects. - **Second-generation (Atypical):** Risperidone, Olanzapine, Quetiapine, Aripiprazole, Clozapine. Broader efficacy, lower risk of EPS, but higher risk of metabolic side effects. Clozapine is reserved for treatment-resistant cases. - **Psychosocial Interventions:** - **Cognitive Behavioral Therapy (CBT):** Helps manage symptoms, improve coping skills. - **Family Psychoeducation:** Educates families about the illness, improves communication. - **Social Skills Training:** Enhances interpersonal skills. - **Supported Employment/Education:** Helps individuals achieve vocational goals. - **Assertive Community Treatment (ACT):** Intensive, integrated services for severe cases. ### Prognosis - Highly variable. Early intervention and consistent treatment improve outcomes. - Many individuals can achieve recovery or significant improvement with appropriate care. - Comorbidity with substance use disorders, depression, and anxiety is common. - Increased risk of suicide.