Mood Disorders

Question 1

Schizophrenia

Answer 1

defined in 1911 by Eugene Bleuler; schizo – to split/cleave; cognition from emotion, thought disorders – emotion & though process do not match up

Question 2

Schizophrenia Symptoms (5)

Answer 2

➢ Hallucinations – experiencing sensory information when no processing of APs of sensory information actually occurring in brain

➢ Delusions – interaction w/environment that are being taken way out of context from the real life situation

➢ Attention problems/loss of attention ➢ Inability to plan

➢ Social behavior can become inappropriate quickly

Question 3

Schizophrenia Etiology (6)

Answer 3

➢ Poorly Described

➢ with genetic components

➢ Usually teen/early adult onset

➢ Men = Women ➢ Neurodevelopment is impaired in utero & anomaly is not noticed until the poorly developed lesion is needed later in life; have a fairly normal looking & functioning brain/nervous system → problems later

➢ Brain changes

Question 4

What are the genetic Components of Schizophrenia?

Answer 4

1. High concordance in monozygotic twins (30-50% concordance); decreases to approx. 1% in non-identical twins (not causality, just association)
2. Multiple genes involved w/variable penetrance; penetrance determined by environmental cues/triggers o Perinatal nutrition o Deficiencies o Virus maybe?

Question 5

What are the Brain changes of Schizophrenia? (6)

Answer 5

1. Enlargement of ventricular system (3rd & lateral)
2. Change/widening of sulci (not unique to schizophrenia, but is present)
3. Loss of temporal lobe & thalamus (particularly the area that includes the amygdala & hippocampus; these play a role in emotion & learning)
4. Reelin – extracellular matrix protein involved w/axonal migration in utero & synaptic function in adults (helps proteins to where they need to go when developing the nervous system) o this is decreased in schizophrenia o concentration of this protein in interneurons that contain GABA (main inhibitory NT of brain; GABAnergic transmission a player in this dz?)
5. Dorsolateral prefrontal cortex problems

o Involved w/working memory

o Goal directed activities – can’t maintain focus

o Cannot function normally

6. NT alterations

o Dopamine hypothesis – DA transmission plays some role in this dz

o D2 receptor antagonists are anti-psychotic meds for tx (Chlorpromazine)

o Cocaine & amphetamines in high doses can induce schizophrenia through dopaminergic neurotransmission

Question 6

What are Positive Symptoms of Schizophrenia? (3)

Answer 6

o hallucinations o Disorganized speech/behavior

o Inappropriate gestures – unable to interact socially in a normal way

Question 7

What are Negative Symptoms of Schizophrenia? (4)

Answer 7

o Symptoms that describe “something that is missing” from the personality that should be there → unable to feel emotion in an appropriate way; quieter symptoms

o Affective flattening – absence of emotion, facial expressions, & body language

o Anhedonia – unable to experience pleasure, rage, & basic emotions; unable to experience pleasure from activities that are normally enjoyable

o Incoherent

Question 8

Schizophrenia Diagnosis

Answer 8

• 6 months + of positive &/or negative symptoms • Severe symptoms will probably will be reinforced by feedback from family members or other healthcare providers

Question 9

Schizophrenia Treatment

Answer 9

• Chlorpromazine (FGA);
• SGAs

Question 10

Chlorpromazine

Answer 10

somewhat successful, but produces undesirable side effects → causes EPS & likely induce Parkinsonism; 1/3 or pts does not have any effect

Question 11

SGAs

Answer 11

Used more often now and have a broader spectrum of activity

Question 12

Neuroleptics

Answer 12

Clasp on to neuron to regulate it – turn off specific diseased neurons

Question 13

Clozapine (DA & Serotonin receptor antagonist):

Answer 13

Mechanism of action unknown for this dz; main problem w/this med is that it causes a change in metabolism → significant wt. gain