Schizophrenia spectrum disorders: Pathology review

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Schizophrenia spectrum disorders: Pathology review

Psychological disorders

Psychological disorders

Psychological disorders


Schizophrenia spectrum disorders: Pathology review

USMLE® Step 1 questions

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USMLE® Step 1 style questions USMLE

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A 40-year-old woman and her 20-year-old son are brought to the physician by the woman’s sister. For the last two years, the mother has been accusing her neighbors of using black magic on her and her son to harm them. She has frequently gotten into verbal fights with them, and she has cut off all social contact with anyone in the neighborhood. She currently tries to avoid going outside her house to avoid contact with them. The son tells the physician that he recently started to understand that his neighbors will indeed harm them with black magic if they aren’t careful, and he has entered into verbal and physical altercations to protect himself and his mother “against their dark powers.” Over the past two months, he has spent most of his time in the house with his mother. In the office, the mother is poorly-groomed, irritable, and appears to be listening and responding to voices. The son is also irritable and becomes agitated when asked further questions. Which of the following is the most likely diagnosis?  


A 32 year old male named Bert is brought to the psychiatric clinic by his concerned mother, who thinks that Bert’s behavior has changed over the past 9 months. Upon further questioning, Bert’s mother reveals that he has been isolating himself, and stopped calling or visiting his family and friends. Bert says that he must stay at home because some aliens have been trying to control his mind. On physical examination, Bert appears disheveled, has poor eye contact with others, and shows little facial expression. You decide to order a toxicology screen, which comes back negative.

Some days later, you see a 25 year old female named Akuchi, who comes in for a psychiatric consultation. The first thing you notice is that she’s wearing a long coat and a sweater with a mini skirt and flips flops. Akuchi mentions that she has always had trouble fitting in and does not have any friends, even though she’d really like to. When you ask what she does during her free time, Akuchi tells you that she spends most of her time in her room, since she’s convinced that there are vampires hiding in her house, although she’s never seen or heard one. On physical examination, Akuchi’s speech seems peculiar, since she creates new versions of words and often doesn’t make sense.

Okay, based on the initial presentation, both Bert and Akuchi seem to have some form of schizophrenia spectrum disorder. These are a group of conditions, including schizophrenia, that are characterized by difficulty thinking clearly, making good decisions, distinguishing reality from imagination, and behaving appropriately, sometimes even to the point where they interfere with day-to-day activities like working, studying, eating, and sleeping. Now, the main risk factors for developing a schizophrenia spectrum disorder seem to include having a family history, experiencing a personal trauma, or heavy use of substances, and especially cannabis, during adolescence. And that’s actually high yield!

However, the underlying cause is poorly understood; for your exams, what you need to remember is that it’s related to altered levels of the neurotransmitter dopamine that affect two out of the four dopamine pathways in the brain: the mesocortical pathway, which helps regulate emotions, and the mesolimbic pathway, which controls motivation and desire. Bear in mind that these disorders don’t affect the two other dopamine pathways, meaning the nigrostriatal pathway, which contains motor neurons that bypass the medullary pyramids, to control involuntary movements and coordination; and the tuberoinfundibular pathway, which releases dopamine to limit the secretion of prolactin.


Schizophrenia spectrum disorders refer to a group of mental health conditions characterized by symptoms similar to those seen in schizophrenia, which are positive symptoms like hallucinations, delusions, disorganized speech, and disorganized behavior; negative symptoms such as alogia, affective flattening, avolition, and anhedonia; and cognitive ones - like decreased concentration, disorganized thinking, and poor memory. Schizophrenia is the most common of these disorders, with other conditions being schizotypal personality disorder, delusional disorder, and brief psychotic disorder. Schizophrenia spectrum disorders are typically treated using second-generation antipsychotic medication such as clozapine, but adjuvant therapies include social approaches, cognitive behavioral therapy, and electroconvulsive therapy.


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  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "Diagnostic and Statistical Manual of Mental Disorders" NA (1980)
  5. "Spectrum concepts in major mental disorders" Psychiatric Clinics of North America (2002)
  6. "Understanding Psychopathology" Current Directions in Psychological Science (2006)
  7. "Genetic Boundaries of the Schizophrenia Spectrum: Evidence From the Finnish Adoptive Family Study of Schizophrenia" American Journal of Psychiatry (2003)

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