Schizophrenia Risk Factors and Statistics

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DSM-5-TR

• The document references "Schizophrenia Spectrum and Other Psychotic Disorders" as per DSM-5-TR

Psychotic Disorder Definition

• Delusions are fixed beliefs not changing with evidence that vary culturally. Example delusions include grandiose, persecutory, somatic, religious, or nihilistic delusions.
• Hallucinations are vivid perceptions that seem real but don't have an external cause, including hearing voices, seeing things, or experiencing smells or tastes.
• Disorganized thinking patterns include derailment (loose associations), neologisms (new words), tangentiality, and incoherence (word salad).
• Disorganized motor behavior involves bizarre or chaotic movements, stereotyped movements, or postures.

Major Disorders within DSM-5-TR (Schizophrenia Spectrum and Other Disorders)

• Schizotypal Personality Disorder: A personality disorder also including delusions.
• Delusional Disorder: Characterized by one or more delusions lasting at least one month without other psychotic symptoms.
• Brief Psychotic Disorder: Delusions, hallucinations, or disorganized thoughts/behaviors lasting less than a month and typically resolves without further episodes. Half of those with Brief Psychotic Disorder recover fully, but often recurrence and progression to schizophrenia is possible.
• Schizoaffective Disorder: A diagnosis when a person has a history of major depression or mania/hypomania symptoms in addition to schizophrenia.
• Substance/Medication-Induced Psychotic Disorder: A psychotic disorder induced by drugs or substances (e.g., cannabis, amphetamines, cocaine, hallucinogens, opiates).

What is Schizophrenia?

• A disorder of psychotic signs and symptoms.
• Affects approximately 1-2% of the global population across cultures.
• Accounts for about 12% of all psychiatric inpatients and 1 ¼ of all first admissions to U.S. mental hospitals.
• Considered very disabling, leading to higher suicide rates, especially concerning males without employment and a history of depression, with estimates sometimes doubling those found in the general population.
• Has been recognized for over 150 years, with Morel (1860) describing "dementia praecox." Kraepelin (1898) later expanded on this concept further defining and clarifying its unique symptoms. Bleuler (1911) later contributed to the concept of schizophrenia.

Typical Features of Schizophrenia

• Dramatic loss of previous functioning, that can be acute onset or gradual onset, predicting better or worse prognosis, respectively.
• Language and communication disturbances may include tangential or rambling speech, with private meanings different from the general population.
• Formal thought disorder manifests as alterations in thought boundaries(thought broadcasting, insertion, removal), hallucinations, and delusions.
• Emotional disturbances may be flat, paranoid or silly and often coupled with reduced spontaneity and social withdrawal with purposeless wandering
• Movement or motor abnormalities may be bizarre or stereotyped movements or postures.

Risk Factors: Who Becomes Schizophrenic?

• Family interaction or communication styles are not primary risk factors.
• Genetic relatedness is a significant risk factor, with higher rates seen in genetically related individuals (e.g., siblings, twins).
• Risk is present even if children are adopted early in life.
• Maternal factors like influenza during pregnancy are linked to higher risk.
• Seasonal patterns of birth (with winter births more frequent than summer births in some cases) may be correlated with infection and risk in various locations.

Genetic Relatedness and Schizophrenia

• This shows the percentage concordance of schizophrenia based on genetic relatedness. This means similar genetic makeup increases probability of schizophrenia.

Nongenetic Risk Factors in Schizophrenia

• Complications during birth, such as prolonged labor or forceps deliveries
• Maternal malnutrition or exposure to influenza virus, particularly during the sixth month of pregnancy is related to birth complications and higher risk.
• Seasonality of birth, as winter birth months may be correlated with infection at the time of birth
• Other maternal infectious agents are suspected, such as rubella (German measles).
• Toxoplasmosis is another factor that may lead to neurodevelopmental problems, carried by cats and found in feces.

Adolescent Cannabis Use and Later Schizophrenia

• A chart showing reported associations between adolescent cannabis use, number of occasions, and an increased risk of developing schizophrenia in later life.

Young Men at Highest Schizophrenia Risk From Cannabis Abuse

• A study highlighting the link between cannabis and schizophrenia risk, especially in young men.

Two Cases of Schizophrenia with Paranoid Features

• Images and brief description

Early Views and Structural damage in Schizophrenia

• Metabolic disorders
• Double binding mothers
• Structural brain damage from studies of brain scans (autopsy, CT, MRI)
• Cellular derangement: Gray matter loss and enlarged ventricles linked to the loss of neurons.

Disordered/Structural Brain Activity

• Disrupted Activity in PET and FMRI scans in frontal and temporal lobe areas and basal ganglia

Neurotransmitter Dysfunction

• Dopamine hypothesis: too much dopamine turnover in certain brain areas.
• Dopamine-serotonin interaction problems, insufficient serotonin in others.

Modern View of Schizophrenia

• Neurodevelopmental disorder, potentially related to fetal brain mis-wiring, possibly from viral infections.

Positive vs. Negative Symptom Predominant Schizophrenia

• This is a research classification, not in DSM-5-TR
• • Symptom includes later diagnoses, more female diagnosis, higher rates of childhood oddity, irritability, and aggressiveness and good response to classical antipsychotic meds.
• • Symptom includes earlier diagnoses, higher rates of males, childhood withdrawals, and poor response to classical antipsychotic meds.

Positive-Symptom Schizophrenia and Parkinson's Disease

• Drugs that increase dopamine can resemble schizophrenia symptoms.
• Some antipsychotics reduce dopamine turnover and have Parkinson's-like side effects.
• Other neurochemical systems are linked to schizophrenia rather than solely dopamine

Treatments for Schizophrenia

• Medication:
  • Acute goal is often sedation and chemical restraint in emergency room.
  • Long-term is normalization of behavior and cognition
  • Compliance with medication is low
• Individual and Family Psychotherapy:
  • Adjustments to life with illness, family and social support systems are incorporated.
  • Patients are educated on symptoms of their illness.

Medication for Schizophrenia

• Classical Antipsychotics: These are older drugs and are less commonly used now, some include Haldol and Thorazine.
• Second-generation Antipsychotics (Atypical): Tend to be used more frequently, targeting both positive and negative symptoms and some include Abilify, Clorazil, Geodon, Invega, Latuda, Rexulti, Risperdal, Seroquel, Vraylar, and Zyprexa. Clozaril is effective in treating treatment-resistant cases, but has severe side effects (neutropenia), which may require blood testing.

Cobenfy (New Medication):

• Targets brain muscarinic receptors for acetylcholine.
• Aims to treat both positive and negative symptoms.
• More expensive

Side Effects of Antipsychotic Medications

• Common effects: Drowsiness, sedation.
• Metabolic syndrome: Weight gain, increased blood lipids, type 2 diabetes, cardiovascular issues.
• Movement side effects (more common with first generation antipsychotics): Akathisia, pseudoparkinsonism, tardive dyskinesia.

Other Disorders where Antipsychotics are used

• Utilized often with patients who have major depression and psychosis, or with severe generalized anxiety
• Useful at times for patients with bipolar disorder, borderline personality disorder, and traumatic stress disorder

Is Schizophrenia a Violent Disorder?

• Schizophrenia itself is not strongly associated with violence
• Factors that correlate with violence for people with schizophrenia are: lack of medication compliance, presence of command hallucinations, drug abuse or substance abuse

Prognosis in Schizophrenia

• Older perspectives had variable outcomes.
• Current understanding considers that Bipolar disorder is more prevalent, hence worsening the prognosis, and is more frequent.
• Symptoms persist despite treatment in a large number of cases. Some individuals regain previous functioning to some extent.
• Current trends show lower rates of schizophrenia and the hope of better, less invasive prenatal and infant support, less traumatic births and wider distribution of influenza vaccines worldwide.

Hallucinations in Schizophrenia

• Auditory hallucinations are frequent; include malevolent voices.
• Command hallucinations order patients to take actions.
• Other hallucinations (visual, tactile, olfactory) sometimes indicate medical conditions such as seizure disorders.

Seasonality of Births & Schizophrenia

• Chart shows a potential correlation between birth month in the Northern Hemisphere and later schizophrenia diagnoses, suggesting possible influence through infection.

End of Document

This quiz explores various risk factors associated with the development of schizophrenia, including genetic and environmental influences. Test your knowledge on statistics related to parental impact, age, and other contributing elements that heighten the risk of this mental health condition.