Exam 4 - Schizophrenia

Question 1

Schizophrenia

Answer 1

• profound disruption of basic psychological processes; distorted perception of reality; altered/blunted emotion; disturbances in thought/motivation/behavior
• 2 major symptoms for 1 month, w/ signs for at least 6 months

Question 2

Gender differences

Answer 2

• peak onset for F and M from 16-25
• more women experience their first episode >36 (hormonal changes like menopause)

Question 3

Diagnostic criteria - positive symptoms

Answer 3

• delusions: unreasonable beliefs/ideations, held despite being proven wrong
• hallucinations: visual, mostly auditory sensations
• something that schizo pts have that we do not

Question 4

Diagnostic criteria - negative symptoms

Answer 4

• disorganized speech: incoherent, word salad
• disorganized or catatonic behavior: lack of goal oriented behavior, unnatural behavior, catatonia
• blunted affect: lack of emotional response, lack of motivation
• these symptoms usually indicate a poorer prognosis

Question 5

How were pts with schizo treated in the 1950s?

Answer 5

• majority were institutionalized
• most widely used treatment was a frontal lobotomy
• electroconvulsive therapy, lobotomy, restrainment

Question 6

Heredity

Answer 6

• closer the genetic relationship, the higher the chance
• 48% chance in identical twins

Question 7

Developmental errors associated w/ schizo

Answer 7

• higher occurrence of perinatal complications
• exposure to viral infections while in womb
• genetic vulnerability

Question 8

Dopamine theory

Answer 8

higher levels of dopamine in pts with schizo

Question 9

Structural brain abnormalities associated w/ schizo

Answer 9

• positive symptoms usually due to NT imbalances
• negative symptoms usually due to structural abnormalities like:
  
  • enlargement of ventricles
  • cerebral atrophy
  • reduced volume in basal ganglia, temporal lobe, limbic areas
  • disorganized neural structure

Question 10

Functional abnormalities

Answer 10

• hypofrontality
• decreased blood flow in frontal cortex while performing cognitive tasks requiring planing and strategy

Question 11

Effectiveness of treatment - law of thirds

Answer 11

1. significant time hospitalized, failure to respond to medication
2. respond well to medication
3. improvement in symptoms, relapses and hospitalization, need assistance

Question 12

Phenothiazines

Answer 12

• antipsychotics like thorizene
• antagonists of D2 receptors, and partial affinity for other dopamine receptor subtypes

Question 13

What is the initial reaction to phenothiazines?

Answer 13

• increase in dopamine synthesis, and release of autoreceptors that are more sensitive to dopamine

Question 14

Side effects of phenothiazines

Answer 14

• blockage of norepi receptors: dry mouth, low BP, tachycardia
• block muscarinic receptors: dyr mouth and eyes, dilated pupils, blurred vision, decreased sweating, memory impairment
• block D2 receptor: parkinsons symptoms, tardive dyskinesia

Question 15

Tardive dyskinesia

Answer 15

motor tics

Question 16

Nonphernothiazine antipsychotics

Answer 16

• haloperidol
• similar to phenothiazines, but not in structure

Question 17

New generation (atypical) antipsychotics

Answer 17

• clozapine
• antagonize D1 and serotonin receptors
• help positive and negative symptoms

Question 18

Pharmacodynamics of clozapine

Answer 18

• weakly competes with dopamine receptors - less incidence of tardive dyskinesia
• do not cause extrapyramidal side effects

Question 19

Side effects of clozapine

Answer 19

• sedation, hyperglycemia
• most serious and rare side effect is agranulocytosis (deficiency of WBCs)

Question 20

Risperidone

Answer 20

treatment of schizo in children and adolescents aged 10-18

Question 21

Pharmacodynamics of risperidone

Answer 21

• blocks both D2 and serotonin 5-HT2a receptors
• competes w/ noradrenergic receptors

Question 22

Amisulpride

Answer 22

• more effective in treating depression with psychotic symptoms
• not associated with hyperglycemia

Question 23

Pharmacodynamics if amisulpride

Answer 23

• potent blocker of D2 and D3 receptors
• at low doses it does act on presynaptic autoreceptors
• does not block 5-HT2a receptors

Question 24

Schizo pts have depressed numbers of ______ receptors in the ________ and ______________. What does this mean?

Answer 24

• NMDA
• thalamus
• hippocampus
• drugs that enhance glutamate activity might be more effective in treating negative symptoms and cognitive impairments than dopamine antagonist

Question 25

Preclinical models of schizophrenia

Answer 25

• reaction to high doses of stimulants like amphet and cocaine
• in animals, high doses of amphet produces amphetamine induced stereotypy (sniffing, licking, gnawing)
• apomorphine administration in rodents causes hyperactivity
• failure to filter sensory stimuli they receive (sensory overload)

Question 26

PCP induced psychosis

Answer 26

• preclinical model of schizo
• resembles acute episode of schizo
• disorientation, profound cognitive impairments, motor symptoms, paranoid delusions

Question 27

Prepulse inhibition of startle in schizo

Answer 27

pts with schizo have trouble tracking with their eyes
- especially prominent in chilren

Question 28

How effective if pharmacological treatment of schizo?

Answer 28

• 75% respond well
• no cure, but early detection and pharmacological treatment may slow or suspend progression