Lectures 2 & 3-Schizophrenia

Question 1

What is schitzophrenia? Are there genetic, social, or stress components? Does it get better?

Answer 1

Schizo-phrenia =“Split mind-” irrational divergence between behavior and thought content

Chronic, debilitating illness associated with deterioration in mental function and behavior

Clearly involves a gene by environment interaction

Not caused by any known social or environmental factor

Exacerbated by social stress

Schizophrenia does not get better, the term “Downward drift” represents the social loses that occur with progression of disease.

Question 2

Describe and define the main symptom of Schizophrenia?

Answer 2

Psychosis

Psychosis consists of hallucinations, delusions, and abnormalities in thought process/organization

Question 3

Define the term Illusion (symptom of psychosis)

Answer 3

Misperception of real external stimuli

Question 4

Define the term Hallucination (symptom of psychosis)

Answer 4

Sensory perceptions not generated by external stimuli

Question 5

Define the term Idea of reference (symptom of psychosis)

Answer 5

False conviction that one is subject of attention by other people (Crowds, TV, Radio, Internet). Feeling as though people are referring to you in their conversations…

Question 6

Define the term Delusion (symptom of psychosis)

Answer 6

False beliefs not correctable by logic or reason, not based on simple ignorance, and not shared by culture; delusions of persecution most common

Question 7

Define the term Loss of ego boundaries (symptom of psychosis)

Answer 7

Not knowing where one’s mind and body end and those of others begin

Question 8

Define the term Alogia (symptom of psychosis)

Answer 8

Lack of informative content in speech, lacking/poverty of speech
ex. “Patient is mute or speaks few words.”

Question 9

Define the term Echolalia (Clanging) (symptom of psychosis)

Answer 9

Repeating Statements of Others/Associating words by their sounds, not by their meaning
ex. “I’m very sure I’ve got the cure and I’m not pure.”

Question 10

Define the term thought blocking (symptom of psychosis)

Answer 10

Abrupt halt in the train of thinking, often because of hallucinations
Ex. I have to take my……….

Question 11

Define the term Neologisms (symptom of psychosis)

Answer 11

Inventing new words

Ex. Patient states he is ‘fatigloo’ which means he is tired

Question 12

Define the term Circumstantiality (symptom of psychosis)

Answer 12

In responding to questions, one presents unnecessary and voluminous details ultimately arriving at an answer to the question posed

Question 13

Define the term Tangentiality (symptom of psychosis)

Answer 13

Beginning a response in a logical fashion but then getting further and further away from the point and fail to answer the question initially posed (can understand topic transition)

Question 14

Define the term Loose associations (symptom of psychosis)

Answer 14

Loss of logical meaning between words or thoughts; when asked a question, illogically jumps from one subject to another

Question 15

In contrast to delirium or substance abuse, patients with schizophrenia do not have clouding of ______.

Attention and memory capacity typically ______, when not psychotic.

Schizophrenics are alert and oriented, do _____ fluctuate in/out of consciousness/stupor

Answer 15

consciousness; intact; not

Question 16

In schizophrenia, you have ____ or more of the following symptoms for a significant portion of time during a 1-month period (or less if successfully treated):

Delusions

Hallucinations

Grossly disorganized or catatonic behavior

Negative symptoms (flat affect, alogia, or avolition)

Disorganized speech (frequent derailment or incoherence)

Answer 16

2

Question 17

For diagnosing schizophrenia, ____ or more major areas of functioning (ie. work, interpersonal relations, or self care) are markedly below level achieved prior to onset.

Answer 17

one

Question 18

For diagnosing schizophrenia, continuous signs of the disturbance persist for at least ___ months. This ___-month period must include at least ___ month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active phase symptoms) and may include periods of prodromal (symptomatic of the onset) or residual symptoms.

Answer 18

6; 6; 1

Question 19

In schyzophrenia positive symptoms are ____ to us and negative symptoms are ______ from us.

Answer 19

added; subtracted

Question 20

List some positive symptoms. Do positive symptoms respond better to typical or atypical antipsychotics?

Answer 20

Delusions

Hallucinations

Agitation

Talkativeness

Thought Disorder

Positive symptoms Respond well to most traditional and atypical antipsychotic agents

Question 21

List some negative symptoms. Do negative symptoms respond better to typical or atypical antipsychotics?

Answer 21

Lack of motivation

Social withdrawal

Flattened affect/emotion

Cognitive disturbances

Poor grooming

Poor/impoverished speech

Negative symptoms Respond better to atypical than to traditional antipsychotic agents

Question 22

What are the 3 phases of schizophrenia?

Answer 22

1. Prodromal: prior to first psychotic break
2. Psychotic/Active: loss of touch with reality-positive symptoms
3. Residual: period between psychotic episodes, in touch with reality, but doesn’t behave normally-
   Negative symptoms

Question 23

Schizophrenia occurs ____ in men and women, but age of onset is lower in ____

Answer 23

equally; mens

Question 24

The greater the number of days on D2 receptor antagonists, the greater the risk of what disease?

Answer 24

TD-Tardive Dyskinesia

Question 25

______ infection and exposure to _____ during development have been implicated in the etiology of schizophrenia

Answer 25

Viral; drugs

Question 26

What are the 3 main neurological abnormalities in Schyzophrenia?

Answer 26

Abnormalities of the frontal lobes: Decreased use of glucose in prefrontal cortex = hypofrontality

Lateral and third ventricle enlargement

Abnormal cerebral symmetry (loss of asymmetry)
Asymmetry is normal

Question 27

What is the dopamine hypothesis of Schyzophrenia?

Answer 27

excessive dopaminergic (DA) activity in mesolimbic tract.

Question 28

In Schyzophrenia (& othe diseases) psychosis comes from too much DA in the ______ system (middle), and not enough in the ______ lobes.

In Schyzophrenia there is excess dopaminergic activity via excessive # of DA _____, excessive _____ of dopamine or ______ of receptors to DA.

Answer 28

mesolimbic; frontal; receptors; concentration; hypersensitivity

Question 29

Positive symptoms in schizophrenia come from _____ DA & negative symptoms come from _____ DA.

Answer 29

high; low

Question 30

What is the Glutamate hypothesis of Schizophrenia?

Answer 30

The NMDA (excitatory) Glutamate receptors (NMDARs) are hypoactive and fire to little in Schizophrenia. NMDARs may sit on GABA (inhibitory) interneurons that spit our inhibitory GABA at high quantities, if NMDA receptor is defective this leads to decreased GABA and elevated DA.

Question 31

If someone gets a virus and makes antibodies vs the ______ receptor that sit on GABA, and destroy ______ receptors, they get Schizophrenia.

Answer 31

NMDA; NMDA

Question 32

Describe how you get positive symptoms in Schyzophrenia.

Answer 32

GLUGABAGLUDA:

is the normal circuit and DA output is low. When the GLU NMDA receptor on the GABA interneuron is damaged, there is increased GLU & thus increased DA.

where GLU = +, GABA = -, & DA gives positive symtoms of schyzophrenia

Question 33

Describe how you get negative symptoms in Schyzophrenia.

Answer 33

GLUGABAGLU-GABA-DA:

The first GABA interneuron is inactive so mad GLU hits the GABA receptor in the midbrain. The hyperactive GABA receptor then acts on the ventral tegmental area and releases a LOW amount of DA to the forebrain. Usually, a HIGH amount of DA hits the forebrain. Negative symtoms = loss of affect.

where GLU = +, GABA = -, & DA gives positive symtoms of schyzophrenia

Question 34

______ pathway = negative symptoms

Positive symtoms = _____ pathway

Answer 34

Mesocortical; mesolymbic

Question 35

Psychotic disorder caused by a general _____ condition: B12/Folate deficiency, temporal lobe epilepsy, cortico-steroid induced, can give symtoms simmilar to Schyzophrenia.

Answer 35

medical

Question 36

Manic phase of _____ disorder can give symtoms simmilar to Schyzophrenia.

Answer 36

bipolar

Question 37

_______-induced psychotic disorder: Cocaine, crystal meth, ritalin/adderall(stimulants, ketamine, PCP, LSD, bath salts can give symtoms simmilar to Schyzophrenia.

Answer 37

Substance

Question 38

_____ psychotic disorder (1-29 days of schizophrenia symptoms) can give symtoms simmilar to Schyzophrenia.

Answer 38

Brief

Question 39

Schizophreniform disorder __-___ months of symptoms) can give symtoms simmilar to Schyzophrenia.

Answer 39

1 - 6

Question 40

______ disorder (schizophrenia + mania and/or depression) can give symtoms simmilar to Schyzophrenia.

Answer 40

Schizoaffective

It has psychotic + mood symptoms

Question 41

_____ disorder (delusions, but no other schizophrenia symptoms) can give symtoms simmilar to Schyzophrenia.

Answer 41

Delusional

Question 42

______ psychotic disorder (one person is delusional and a second person develops same delusion) can give symtoms simmilar to Schyzophrenia (Charles Manson’s family).

Answer 42

Shared

Question 43

_____ generation antipsychotics side effects = weight gain (used first to avoid neuromuscular issues)

_____ generation antipsychotics side effects = neuromuscular issues (give to fat people)

Answer 43

Second; First

Question 44

Since compliance rate of Schyzophrenia drugs are low due to side effects, long acting injectable _____ forms of antipsychotic meds are used for noncompliant patients who do not take their pills. Name the ____ drugs.

Answer 44

depot; depot

Haloperidol decanoate, fluphenazine decanoate, (typical)

Risperidone, Paliperidone, and aripiprazole (atypical)

Question 45

All effective antipsychotics block _____ receptors in the mesolimbic DA path & is often a ____ long treatment

Answer 45

D2; life

Question 46

Traditional high- and low-potency (D2 receptor affinity) typical first generation antipsychotics (Prior to 1995) ____ (high potency), _____ (low potency), respectively

High potency/affinity drugs are _____ at binding and sticking to D2 receptors and may cause _____ side effects in the nigrostriatal and tuberoinfundibular pathway (see above)

Answer 46

haloperidol; chlorpromazine; better; more

Question 47

Atypical ____ generation antipsychotics also block _____ receptors (after 1995): Clozapine, risperidone, paliperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, asenapine, iloperidone, lurasidone

They are first line agents due to fewer negative neurological effects such as parkinsonism or tardive dyskinesia because the _____ blockade allows dopamine to more freely flow in the nigrostriatal path

Answer 47

second; 5HT2a; 5HT2a

Question 48

There is a lot of post-psychotic ______ and suicides in Schyzophrenia (there are “______” hallucinations that tell you to kill yourself).

Answer 48

depression; command

Question 49

A 24-year-old male presents with auditory hallucinations. He says he hears 3 distinct voices. He perceives voices coming from the television when it is turned off. He states this started 7 months ago. He feels that his family is plotting against him and he is being spied on. What is the most likely diagnosis ?

A. Brief psychotic disorder

B. Schizophreniform disorder

C. Schizophrenia

Answer 49

C. Schizophrenia

Since greater than 6 months

Question 50

A 57 year old male has had schizophrenia with continuous symptoms for 30 years despite treatment. Which brain morphometric finding is most likely increased in size?

A. Ventricles

B. Hippocampus

C. Cortical Gray Matter

Answer 50

A. Ventricles