35. Schizophrenia Flashcards

1
Q

Define

Schizophrenia

A

a chronic and severe mental disorder affecting 20 million people worldwide characterized by distortions in thinking, perception, emotions, language, sense of self and behaviour

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2
Q

Define

Positive symptoms

A

highly exaggerated ideas, perceptions, or actions that show the person can’t tell what’s real from what isn’t.

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3
Q

Define

Negative symptoms

A

refer to an absence or lack of normal mental function involving thinking, behavior, and perception

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4
Q

Define

Two-hit hypothesis

A

suggests that a prenatal genetic or environmental “first hit” disrupts some aspect of brain development, and establishes increased vulnerability to a second hit that may occur later in life. Neither insult by itself is sufficient to induce schizophrenia.

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5
Q

Define

Copy number variation (CNV)

A

a phenomenon in which sections of the genome are repeated and the number of repeats in the genome varies between individuals

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6
Q

Define

DISC 1

A

shown to participate in the regulation of cell proliferation, differentiation, migration, neuronal axon and dendrite outgrowth, mitochondrial transport, fission and/or fusion, and cell-to-cell adhesion. Several studies have shown that unregulated expression or altered protein structure of this protein may predispose individuals to the development of schizophrenia

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7
Q

Define

Neuroleptic

A

tending to reduce nervous tension by depressing nerve functions

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8
Q

Define

Atypical anti-psychotic

A

thought to be better in treating the negative symptoms of schizophrenia although differences may also be due to fewer adverse effects and/or better patient compliance. Members of this class include amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone and ziprasidone

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9
Q

Definition

a chronic and severe mental disorder affecting 20 million people worldwide characterized by distortions in thinking, perception, emotions, language, sense of self and behaviour

A

Schizophrenia

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10
Q

Definition

highly exaggerated ideas, perceptions, or actions that show the person can’t tell what’s real from what isn’t.

A

Positive symptoms

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11
Q

Definition

refer to an absence or lack of normal mental function involving thinking, behavior, and perception

A

Negative symptoms

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12
Q

Definition

suggests that a prenatal genetic or environmental “first hit” disrupts some aspect of brain development, and establishes increased vulnerability to a second hit that may occur later in life. Neither insult by itself is sufficient to induce schizophrenia.

A

Two-hit hypothesis

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13
Q

Definition

a phenomenon in which sections of the genome are repeated and the number of repeats in the genome varies between individuals

A

Copy number variation (CNV)

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14
Q

Definition

shown to participate in the regulation of cell proliferation, differentiation, migration, neuronal axon and dendrite outgrowth, mitochondrial transport, fission and/or fusion, and cell-to-cell adhesion. Several studies have shown that unregulated expression or altered protein structure of this protein may predispose individuals to the development of schizophrenia

A

DISC 1

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15
Q

Definition

tending to reduce nervous tension by depressing nerve functions

A

Neuroleptic

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16
Q

Definition

thought to be better in treating the negative symptoms of schizophrenia although differences may also be due to fewer adverse effects and/or better patient compliance. Members of this class include amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone and ziprasidone

A

Atypical anti-psychotic

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17
Q

Why is schozophrenia considered a syndrome?

A

No single defining symptom or sign, no known diagnostic laboratory test

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18
Q

What are the positive symptoms of schizophrenia?

A

Positive symptoms include paranoid delusions, hallucinations, thought disorder

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19
Q

What are the negative symptoms of schizophrenia?

A

Negative symptoms include diminished emotional expression and reaction, diminished participation in interpersonal relationships, loss of energy, drive and interests

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20
Q

Which neurotransmitter was initially believed to cause schizophrenia?

A

Dopamine

21
Q

What is the estimated prevalence of schizophrenia?

A

0.5-1%

22
Q

When is schizophrenia usually diagnosed?

A

Disorder usually diagnosed in young adults, peaking around 18-25 years of age

23
Q

What is seen in children with early-onset schizophrenia?

A

In children with early onset schizophrenia, there is excessive loss of gray matter and cortical thinning detected by neuroimaging

24
Q

Why do people with schizophrenia typically have a shorter lifespan?

A

Suicide is the major contributor early in the course of the disorder and cardiovascular disease in later years

25
Q

What is the gender difference in schizophrenia?

A

Slightly more frequent in males than in females (1.4:1 ratio) but the disorder is more severe in men

26
Q

What are the symptoms of schizophrenia?

A
  • Positive symptoms (fluctuates) – hallucinations, delusions, disorganised speech and behaviour
  • Negative symptoms (fluctuates) – decreased emotional range, loss of interest and motivation, inertia and apathy, poverty of speech, diminished participation in interpersonal relationships
  • Cognitive symptoms (stable) – deficits in working memory/attention/executive function, difficulty in understanding subtle interpersonal cues
  • Mood symptoms – depression is common, often cheerful/sad without reason
27
Q

How does the DSM diagnose schizophrenia?

A
  • Diagnostic & Statistical Manual of the American Psychiatry Association (DSM) (at least 2 of the following symptoms)
    • Delusions
    • Hallucinations
    • Disorganized speech
    • Catatonic behaviour
    • Negative symptoms
  • And at least 1 of the symptoms must be delusions/hallucinations/disorganized speech
  • Signs of disturbance must persist for at least 6 months and active symptoms must be experienced for at least 1 month and the problems must not be caused by other conditions
28
Q

Which protein networks are dysregulated in schizophrenia?

A

DISC1

Neureglin 1

SHANK3

Reelin

Kalirin 7

Neurexin 1

29
Q

What is the cause of the PFC and/or hippocampal asymchony seen in schizophrenia?

A

Disrupted E-I balance

Glutamate (NMDA)

GABA

30
Q

What is the nauropathology of schizophrenia?

A

Reductions in total grey and white matter and overall whole brain volume

Abnormalities in striatal connectivity to the prefrontal cortex linked to positive and negative symptoms

Executive dysfunction associated with abnormalities in dorsolateral prefrontal cortex, anterior cingulate cortex and inferior parietal lobe.

31
Q

What brain abnormalities have been linked to the positive and negative symptoms of schizophrenia?

A

Abnormalities in striatal connectivity to the PFC

32
Q

What brain abnormalities have been linked to the executive dysfunction in schizophrenia?

A

Abnormalities in dorsolateral prefrontal cortex, anterior cingulate cortex and inferior parietal lobe.

33
Q

Which prenatal/perinatal events are risk factors for schizophrenia?

A

Maternal malnutrition – increase incidence following famine

Maternal infections – increase incidence following influenza epidemic

Maternal adverse life events

Labour-delivery complications

34
Q

Which premorbid events are risk factors for schizophrenia?

A

social adversities - physical and sexual abuse, neglect, bullying

drug abuse - amphetamine, cocaine use

urban environment,

migrant status

35
Q

What is the heritability of schizophrenia?

A

64-81%

36
Q

Which candidate genes have been linked to schizophrenia?

A

DISC1

Neurexin

Dopamine D2R, Glutamate R components

37
Q

What is the best supported candidate gene of schizophrenia?

A

DISC1

38
Q

What is the role of DISC1?

A

neurodevelopmental roles in regulating neuronal migration, neurite outgrowth and neuronal maturation, adult roles in modulation of cytoskeletal function, synaptic transmission and plasticity

39
Q

What neuroleptic drugs are used to treat schizophrenia?

A
  • Chlorpromazine and haloperidol
  • DA2R antagonistic activity but not very selective
  • Can cause extrapyramidal motor disabilities such as rigidity and involuntary tremors
40
Q

What atypical antipsychotic drugs are used to treat schizophrenia?

A
  • Second generation antipsychotics
  • E.g. clozapine, risperidone, paliperidone
  • Exact mechanisms of action - unknown
  • Generally thought to also antagonise the DA2 receptors
  • Equally potent in blocking 5HT2A receptors
  • Decreased incidence of extrapyramidal side effects
41
Q

Which classes of drugs are used to treat schizophrenia?

A

Neuroleptics

Atypical antipsychotics

42
Q

What type of behavioural therapies are used in schizophrenia?

A

CBT

Supportive psychotherapy

43
Q

How is CBT used to treat schizophrenia?

A
  • Aim is to reduce the impact of positive symptoms
  • Generally comprising of 10 planned session with specially trained therapist over 6 month period
  • Explores patient’s own understanding of his/her symptoms
  • Should not be seen as a replacement for anti-psychotic medication but an addition
  • Not effective for all patients
44
Q

How is supportive psychotherapy used to treat schizophrenia?

A

Aim is to help patients deal with loss, disability and stigma of living with schizophrenia

45
Q

What types of animal models are used to study schizophrenia?

A

Pharmacological

Lesion

Genetic

46
Q

What do we look at in pharmacological models of schizophrenia?

A

NMDA R antagonist – PCP/ketamine, produce range of schizophrenic symptoms including hyperlocomotion, enhanced stereotype behaviour, cognitive and sensorimotor gating deficits, impaired social interactions

47
Q

What do we look at in lesion models of schizophrenia?

A

Neonatal lesion of the ventral hippocampus – hyperlocomotion, social and working memory deficits

48
Q

What do we look at in genetic models of schizophrenia?

A
  • DISC 1 mutant mice (N/C terminal truncation) – some but not all symptoms including increased aggression, social deficits, contextual associative learning and short term memory deficits
  • Neuregulin KO/knockdown – some but not all symptoms including hyperactivity, impairment of contextual associative learning, increased aggression, social deficits
  • NMDAR (NR1) knockdown
  • a7-Nicotinic R knockdown
  • Fisher344 rat
  • N-CAM-180 depletion