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PBL SEM 3 > CASE 8 - schizophrenia > Flashcards

CASE 8 - schizophrenia Flashcards

1
Q

what is residual Sz?

A

used when a person has a previous diagnosis of Sz but no longer has any prominent symptoms of this disorder; the symptoms have generally lessened in intensity. usually includes more -ve symptoms

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2
Q

what is the most common form of Sz?

A

paranoid. dominated by delusions and hallucinations (+ve symptoms)

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3
Q

what is the main psychoactive substance in cannabis?

A

delta-9-tetrahydrocannabinol (THC)

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4
Q

what does smoking cannabis lead to?

A
  • decreased BP
  • bloodshot eyes
  • feeling dizzy
  • increased appetite
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5
Q

what are the 2 types of cannabinoid receptors involved in the role of cannabis in psychosis?

A

CB1 and CB2 receptors

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6
Q

describe CB1 receptors

A

mediate most effects of cannabinoids on the CNS (also in the lungs, liver and kidneys). these are involved in physiological processes such as appetite, pain-sensation, mood and memory. these receptors are responsible for euphoric and anticonvulsant effects of cannabis

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7
Q

describe CB2 receptors

A

found in the periphery and are expressed mainly in the immune system and in haematopoietic cells

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8
Q

what are cannabinoid receptors activated by?

A

> plant cannabinoids (produced by cannabis plant) — THC — through the production of an endocannabinoid (a ligand known as anadamide)

> endocannabinoids (produced by humans)

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9
Q

mode of action of THC

A
  • increases the release of DA in the brain
  • this causes stimulation of the D2 DA receptors in the striatum
  • this causes an increase in the formation and release of a ligand called anandamide
  • anandamide activates cannabinoid receptors
  • this leads to euphoria
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10
Q

what does THC disrupt?

A

coordination and balance by binding to CB1 receptors in the cerebellum and basal ganglia

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11
Q

what are endocannabinoids?

A
  • substances produced in the brain
  • used in retrograde signalling between neurones, to temporarily reduce the amount of conventional neurotransmitter released
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12
Q

endocannabinoid production is dependent on what? where are they produced?

A
  • Ca++ dependent
  • produced in post-synaptic GABA neurons
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13
Q

mode of action of endocannabinoids — euphoria

A
  • GABA is released into the synaptic cleft and binds to the ‘endocannabinoid source’ (where endocannabinoids are produced)
  • this leads to the production of endocannabinoids
  • they are released from the depolarised post-synaptic GABA neuron and bind to CB1 receptors in the pre-synaptic GABA neuron and cause a reduction in GABA release
  • this causes a decrease in the inhibitory effects in the brain, thus leading to euphoria

aka “endocannabinoid-mediated depolarisation-induced suppression of inhibition”

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14
Q

MoA of endocannabinoids — anticonvulsive

A
  • cannabinoids are thought to have regulatory role in the striatum in terms of glutamatergic signals from the corticostriatal fibres
  • intense firing of corticostriatal neurons leads to release of Glu which causes an influx of Ca++ ions in the post-synaptic membrane
  • constant Glu release causes Ca++ ions to build up in the post-synaptic membrane
  • this accumulation causes Ca++ ions to synthesise endocannabinoids in the medium striatal spiny neurons
  • these stimulate CB1 receptors on the pre-synaptic corticostriatal fibres lading to a decreased release of Glu
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15
Q

what appearance of RBCs is suggestive of alcohol abuse?

A

macrocytic

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16
Q

alcohol and Sz

A
  • over half of people with Sz have a co-morbid drug or alcohol abuse problem
  • people with Sz who abuse alcohol experience more frequent relapses of their psychotic symptoms
  • dangerous predictor of suicide and violence
  • often used as self-medication to help cope with the distressing symptoms or side effects of medications
  • increases non-compliance with meds, inability to think clearly, unemployment, depression, worsening hallucinations and delusions
17
Q

_______ DA release in _______ striatum during acute psychotic episodes — positively correlated with ______ symptoms — correlated with ______ treatment response to antipsychotic drugs

inadequate DA in _______ — associated with deficits in cognitive function and working memory

decreased DA in _______ striatum — negative symptoms

A

excessive DA release in associative striatum during acute psychotic episodes — positively correlated with positive symptoms — correlated with good treatment response to antipsychotic drugs

inadequate DA in frotnal cortex — associated with deficits in cognitive function and working memory

decreased DA in ventral striatum — negative symptoms

18
Q

what are some organic causes of psychosis?

A
  • temporal lobe epilepsy
  • space occupying lesion (MS)
  • limbic encephalitis
  • B12 deficiency
  • hyperthyroidism
  • HIV infection
  • dementia
  • hypoglycaemia
19
Q

CBT for psychosis

A

CBT works by helping you examine how you think about a situation, how you act based on your thoughts, and how your thinking and behavior together affect how you feel. If your thoughts and actions are making you feel bad — or making it difficult for you to function — the goal of therapy is to change them and thus alieviate distress and dysfunction.
In the case of CBTp, the therapist’s goal is not to get the patient to question the reality of delusions or hallucinations, but to reduce the damage they can do.

20
Q

dosage of antipsychotics

A

2mg a day (can be divided into 2 doses)

reduce to 0.5mg if over 65 yo, taken twice a day, due to worse renal function

START SLOW AND LOW

21
Q
A

section 2 can only be used if the patient has a confirmed mental health disorder

22
Q

reduced DA function in the prefrontal cortex is associated with which schizophrenia symptoms?

  • apathy
  • auditory hallucinations
  • impaired working memory
  • bizarre delusions
  • all of the above
A

impaired working memory

23
Q

what is the risk of Sz in a person with a first degree relative with the disorder?

  • 0.5%
  • 1%
  • 5%
  • 10%
  • 50%
A

10%

24
Q

which of the following drugs is a second-generation antipsychotic commonly used to treat Sz?

  • chlorpromazine
  • risperidone
  • loxapine
  • haloperidol
  • clozapine
A

risperidone

25
Q

section 2 of the MHA requires an AMHP, and 2 doctors, one of which must be approved by what section?

A

section 12 approved

26
Q

early intervention services are designed to provide treatment and support for who?

A

young people experiencing a first episode of psychosis

27
Q

what is wavy flexibility a form of?

A

catatonia

28
Q

what project from the VTA?

A

mesolimbic and mesocortical pathways

29
Q

what pathway is responsible for cognitive control, motivation and emotional response?

A

mesocortical pathway

30
Q

which pathway is responsible for the -ve symptoms of Sz?

A

mesocortical

31
Q

where are atypical antipsychotics also antagonists?

A

5HT2A

32
Q

typical APs have a higher risk of what side effect?

A

neurological

33
Q

which AP is used in treatment resistant Sz?

A

clozapine

PBL SEM 3 (49 decks)

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