Lecture 24

Question 1

What are positive symptoms of schizophrenia?

Answer 1

Delusions, hallucinations, disordered thought and speech

Question 2

What are negative symptoms of schizophrenia?

Answer 2

Flat effect, alogia, anhedonia, asociaity, avolition

Question 3

What is alogia?

Answer 3

Lack of additional, unprompted content in normal speech

Question 4

What is anhedonia?

Answer 4

Inability to feel pleasure in normally pleasurable activity

Question 5

What is avolition?

Answer 5

The decrease in the motivation to initiate and perform self-directed purposeful activities

Question 6

What is schizophrenia usually associated with?

Answer 6

Depression, substance abuse, suicide and life expectancy reduced by 10-12 years

Question 7

What is the pathology of schizophrenia?

Answer 7

Increased levels of dopamine in the mesolimbic pathway

Question 8

What is the incidence of schizophrenia?

Answer 8

0.6% of population worldwide!

Can start at any age, peak onset early twenties

Question 9

What are the causes of schizophrenia?

Answer 9

Genetics: 50% concordance in monozygotic twins (DISC1)
Environment: 50% concordance in monozygotic twins
Developmental: infection in utero, poor diet, asphyxia
Social factors: environment, stress relationships
Drug abuse: e.g. cannabis, cocaine, (cause or effect?)
Dopamine hypothesis (excessive D2R stimulation)
Reduced NMDAR function

Question 10

What do mice with reduced NMDAR function exhibit?

Answer 10

Excessive motor activity
Stereotypy (continuously pacing around etc)
Deficits in social and sexual interactions (Excape behavior is exaggerated in mutated mice)
Symptoms that are ameliorated by typical and atypical antypsychotics

Question 11

What consists of the mesolimbic pathway?

Answer 11

Substantia nigra stimulates the striatum

Ventral tegmental area stimulates the frontal lobe

Question 12

What are treatments for schizophrenia?

Answer 12

Antipsychotics (typical and atypical) more effective in treating positive symptoms
Intense psychotherapy, social support
Recovery and improvement in symptoms in over 50%

Question 13

What are symptoms of depression?

Answer 13

Lowered mood
Anhedonia
Avolition
Altered appetite
Hyposomnia/Hypersomnia
Worthlessness and guilt
Reduced ability to concentrate
Recurrent thoughts of death
Reduced life span
3-7% risk of suicide

Question 14

What is the pathology of depression?

Answer 14

Reduced hippocampal volume
Vascular lesions
Reduced BDNF

Question 15

What is the incidence of depression?

Answer 15

3% Japan, 18% USA - average 10%
May not reflect actual people with depression but attitudes toward depression
Women are twice as affected as men
Massive cost to society

Question 16

What is defined as a stroke?

Answer 16

Neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours

Question 17

How is a stroke different from a transient ischaemic attack?

Answer 17

Transient ischemic attack has stroke-like symptoms but resolve within 24 hours

• Brain function ceases 60-90 seconds of an ischaemic event
• irreversible brain damage if ischaemic event > 3 hours duration
• neurological deficit related to site and extent of damage

Question 18

What are two main types of stroke?

Answer 18

Ischaemic and Haemorrhagic

Question 19

What are types if ischaemic strokes?

Answer 19

Embolus (wandering clot)
Thrombus (locally-formed clot)
Systemic hypoperfusion (e.g. heart)
Venous thrombosis

Question 20

What is the definition of a haemorrhagic stroke?

Answer 20

Entry of blood into CNS via rupture of blood vessel/sinus or an aneurysm

Question 21

What are types of haematomas in the brain?

Answer 21

Epidural
Subdural
Subarachnoid
Intracerebral

Question 22

What is an epidural haematoma?

Answer 22

Traumatic damage to a meningeal artery of dural venous sinus (e.g. blow to the head)

Question 23

What is a subdural haematoma?

Answer 23

Caused by rapid movement of head causing tearing of the cerebral vein as it enters a dural venous sinus

Question 24

What is a subarachnoid haematoma?

Answer 24

Is caused by damage (e.g. aneurysm) to a cerebral artery or into the subarachnoid space

Question 25

What is an intracerebral haematoma?

Answer 25

Cause by damage of a blood vessel within the brain

Question 26

What is the incidence of stroke?

Answer 26

10% of deaths worldwide
2nd leading cause of death (1st heart disease, 3rd cancer)
95% occur in people over 45 years of age

Question 27

What are risk factors for stroke?

Answer 27

High blood pressure
 - disputable
 - why it is a risk factor is unknown
High cholesterol
Diet 
Physical inactivity
Drugs of abuse (alcohol, cigarettes, cocaine, amphetamine)

Question 28

What are treatments for stroke?

Answer 28

Preventative
 - Antocoagulants; carotid angioplasty
 - Endarterectomy; diet/lifestyle
Acute ischemic
 - thrombolysis (tissue plasminogen activators (within 3 hours); thrombectomy, angioplasty, stenting)
Acute haemorrhagic
 - surgery
Chronic post stroke
 - control of hypertension; aspirin; physical and occupational therapy

Question 29

What are symptoms of Alzheimer’s?

Answer 29

Short-term memory loss
Progressive apathy, confusion, irritability, mood swings, long-term memory loss, withdrawal, loss of bodily functions, death within 7 years of diagnosis

Question 30

What is the pathology of Alzheimer’s?

Answer 30

Profound loss of neurons
Plaques (amyloid)
Neurofibrillary tangles (hyperphosphorylated tau)

Question 31

What is the incidence of Alzheimer’s?

Answer 31

1.5-2%

Worldwide cost: 160 billion USD per year

Question 32

What are causes of Alzheimer’s?

Answer 32

Age: 10% over 65, 50% over 85
Genetics but predominantly for early onset e.g. ApoE4 gene variant
Trauma e.g. stroke
High blood pressure/hypercholesteremia (but statins ineffective)
Environemental factors e.g. food Aluminium, supplements in coffee drinks

Question 33

What are treatments for Alzheimer’s?

Answer 33

Treating symptoms:
Acetyl cholinesterase inhibitors, NMDAR antagonists e.g. memantine
Against risk:
NSAIDs and caffeine intellectual stimulation, diet and exercise