1: Psychosis and schizophrenia

Question 1

What is a functional hallucination?

Answer 1

Hallucination e.g visual, auditory which only occurs in response to a specific cue e.g a noise or sight

Question 2

What is the definition of heritability?

Answer 2

Degree of variability in a trait that is caused by genetic differences in a population

Question 3

Which type of twins are most likely to both develop schizophrenia?

Answer 3

Monozygotic

from the same zygote

Question 4

Which drug is highly associated with schizophrenia?

Answer 4

Cannabis

Question 5

Does heroin have a hallucinogenic effect?

Answer 5

No

sedative, analgesic

neither does withdrawal

Question 6

What is the relationship between age, substance use and schizophrenia?

Answer 6

The younger you start on addictive drugs e.g cannabis, the more likely you are to be addicted AND develop schizophrenia

Question 7

What happens to the brain grossly in poorly managed schizophrenia?

Answer 7

Enlarged ventricles

Question 8

Why do the ventricles expand in diseases like Alzheimer’s and schizophrenia?

Answer 8

To fill space left by atrophied brain

Question 9

Which lobes atrophy in schizophrenia?

Answer 9

Frontal lobe

Temporal lobe

causing negative symptoms

Question 10

In schizophrenia, (grey / white) matter reduces in size.

Answer 10

grey matter

Question 11

In schizophrenia, grey matter is lost from the brain.

What causes this?

Answer 11

Reduced connections between neurons

NOT neuronal loss as in Alzheimer’s disease

Question 12

Which neurotransmitter is implicated in psychosis?

Answer 12

Dopamine

Question 13

Which addictive drug causes dopamine release in the brain and can worsen schizophrenia?

Answer 13

Amphetamine

Question 14

Which type of drug is used to treat schizophrenia?

Answer 14

Dopamine receptor antagonists

i.e antipsychotics

Question 15

Which dopaminergic pathways start at the

a) substantia nigra
b) VTA
c) pituitary gland?

What are they responsible for?

Answer 15

a) Extrapyramidal motor pathway

b) Mesolimbic pathway

c) Prolactin pathway

Movement, motivation/reward and PRL action respectively

Question 16

What effect do

a) amphetamine
b) dopamine antagonists

have on dopamine receptors?

Answer 16

a) Activation

b) Inhibition

Question 17

What symptoms of schizophrenia are caused by dopamine

a) hyperactivity
b) hypoactivity?

What does this mean for the effects of antipsychotic drugs?

Answer 17

a) Psychotic (positive) symptoms

b) Negative symptoms

Antipsychotics are dopamine antagonists, so they treat the hyperactive symptoms (psychosis) but NOT the hypoactive (negative) symptoms

Question 18

What areas of the brain are affected by schizophrenia?

Answer 18

Frontal lobe

Temporal lobes

Question 19

What are the two main groups of antipsychotic drugs?

Answer 19

Typical (1st generation)

Atypical (2nd generation)

Question 20

Which side effect do most 1st generation antipsychotics cause?

Answer 20

Extrapyramidal motor symptoms

Question 21

Which specific dopamine receptor is probably involved in schizophrenia?

Answer 21

D2

Question 22

Which class of antipsychotics are less likely to cause side effects?

Answer 22

2nd generation

Question 23

Which neurotransmitters are involved in schizophrenia?

Answer 23

DOPAMINE

Glutamate

Serotonin

Question 24

What is an example of extrapyramidal motor symptoms caused by antipsychotics?

Answer 24

Acute dystonia - painful spasms

Parkinsonism

Akathisia

Tardive dyskinesia

Question 25

Which muscles can be affected by acute dystonia after a patient takes antipsychotic drugs?

Answer 25

Neck

Back

Extraocular

Question 26

How is acute dystonia caused by antipsychotics treated?

Answer 26

Anticholinergics

e.g duloxetine

Question 27

What is Parkinsonism?

How is it managed?

Answer 27

Parkinsonian symptoms (i.e tremor, bradykinesia, rigidity, postural instability) with no underlying PD

Most commonly caused by drugs (e.g the dopamine antagonists given for schizophrenia)

Managed using anticholinergic drugs

Question 28

What is akathisia?

Answer 28

Severe restlessness

Question 29

How is akathisia managed?

Answer 29

Dose reduction of dopamine antagonist

Doesn’t respond to anticholinergics

Question 30

What is tardive dyskinesia?

Answer 30

Progressive onset of involuntary, repetitive movements

e.g grimacing, tongue rolling

Question 31

How is tardive dyskinesia managed?

Answer 31

Try dose reduction but sometimes that makes it worse

So you want to avoid tardive dyskinesia in the first place

Doesn’t respond to anticholinergics

Question 32

Which antipsychotic drug is advised after the failure of two previous 1st/2nd generation drugs?

Answer 32

Clozapine

Question 33

What is by far the most effective antipsychotic drug?

Answer 33

Clozapine

Question 34

Clozapine is the most effective antipsychotic drug.

Why isn’t it used first line?

Answer 34

Side effects

Question 35

What are the need to know side effects of clozapine?

Answer 35

Agranulocytosis

Myocarditis

Question 36

Clozapine can cause agranulocytosis. Which other drug, covered in 2nd year, can cause this disease?

Answer 36

Carbimazole (anti-thyroid drug)

Question 37

What are the first signs that a patient taking clozapine has agranulocytosis?

Answer 37

Sore throat

Fever

indicating an URTI that the patient will have major trouble fighting off

Question 38

How are clozapine patients monitored for agranulocytosis?

Answer 38

Blood tests (for low WCC)…

Weekly for 6 months

Then fortnightly for 6 months

Then monthly thereafter

Question 39

Apart from agranulocytosis, what is a side effect of clozapine?

Answer 39

Myocarditis

or all the other 2nd generation side effects: metabolic syndrome, increased appetite, sedation, muscarinic blockade…