2 symptoms for at least 1 month with signs of continuous disturbance for 6

2 symptoms for at least 1 month with signs of

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2 symptoms for at least 1 month, with signs of continuous disturbance for 6 months “Positive” symptoms 1. hallucinations (false perceptions) 2. Delusions (false beliefs) 3. Disorganized speech (derailment, incoherence, loose associations) 4. Disorganized behavior (e.g., disheveled appearance) “Negative” symptoms flat affect (lack of emotion) reduction in speech quality mental confusion lack of energy/initiative Diagnosis also requires significant decrease in functioning or failure to make expected gains Prevalence and Course Rare in children less than 12 age Increased prevalence in adolescence and early adulthood average age onset 20-25 COS: boys > girls, difference disappears in adolescence Gradual onset: ~ 95% show a clear history of disturbances prior to onset of psychosis speech language problems poor motor development movement abnormalities social skills deficits
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odd behavior (suspicion/paranoia) substance abuse childhood onset of schizophrenia indicates a more severe form of the disorder Chronic disorder with poor long-term prognosis Prevalence rates of adult schizophrenia similar across cultural groups and countries COS is distinct from transient psychotic symptoms Causes of COS Strong genetic contribution (80% heritability) Neurodevelopmental model Genetic vulnerability +prenatal insult defective neural circuitry, which is vulnerable to dysfunction under stress & developmental changes Exaggerated cortical gray matter loss during adolescence Pattern eventually mimics that seen in adult-onset cases temporal (attention and perception) and prefrontal lobe (organizing, planning, problem- solving) gray matter reductions. Family Influences exposure to a stressful family environment + genetic risk increases risk for developing COS Parents of children with COS are more critical parents of those with COS score higher on communication deviance = interpersonal signs of attentional and thought disturbance. Treatment of COS Primary treatment: anti-psychotic medications (dopamine antagonists – block dopamine transmission) reduce hallucinations and delusions
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negative symptoms often endure – predict poor quality of life adverse effects reduce adherence to treatment and require constant monitoring Weight gain Metabolic changes (cholesterol, prolactin) Sedation Neurological side effects Akathisia – inner restlessness inability to sit still Other long-term motor side effects (tremor, tardive dyskinesia) Treatment guidelines emphasize the use of antipsychotic medications combined with psychosocial treatments family intervention social skills training
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