Neuro Schizophrenia

Question 1

What are the symptoms of schizophrenia

Question 2

What are the risk factors that contribute to schizophrenia

Question 3

What are the key underlying neurobiology of schizophrenia

Question 4

What are the current treatments for schizophrenia

Question 5

Which sex has a greater risk

Answer 5

Males have a greater risk, and more severe symptoms

Question 6

What are the 3 primary symptom groups of schizophrenia

Answer 6

Positive, Negative, Cognitive

Question 7

What are Positive symptoms of schizophrenia

Answer 7

Hallucinations, disorganised behaviour, delusions and a loss of insight

Question 8

What are Cognitive symptoms of schizophrenia

Answer 8

working memory, attention, executive function, goal-directed behaviour and cognitive flexibility

Question 9

What are Negative symptoms of schizophrenia

Answer 9

Flattening of affect, amotivation, social withdrawal

Question 10

How is schizophrenia diagnosed

Answer 10

Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):

1. delusions
2. hallucinations
3. disorganized speech (e.g., frequent derailment or incoherence)
4. grossly disorganized or catatonic behavior
5. Negative symptoms (i.e., diminished emotional expression or avolition).

Question 11

What occurs to ventricles of patients with schizophrenia

Answer 11

Increased ventricles

The fluid spaces in the brain are larger in people with schizophrenia
This suggests altered brain development
- there are no signs of pathological degeneration i.e., gliosis

However, no morphological changes are useful for diagnosis.
- Too much overlap with healthy individuals to be diagnostic

Question 12

What are some of the minutiae morphological changes

Answer 12

• Thinning of the cortex (but increased density)
• Smaller cells bodies
• Decreases in neurites
• Shorter dendrites
• Decreased presynaptic terminals

Question 13

What is the difference between psychotic and antipsychotic agents

Answer 13

Psychotic agents:
Drugs that increase dopamine release

Antipsychotics:
Drugs that block dopamine signalling

Question 14

Explain Antipsychotics

Answer 14

The affinity for the D2 receptor is
highly correlated with clinical dose.
All antipsychotics block/antagonise
the D2 receptor

Question 15

What occurs in the Nigrostriatal pathways when there is too much or too little dopamine

Answer 15

• too much dopamine in schizophrenia
• too little dopamine in Parkinson’s disease

Question 16

Explain the The striatum, decision-making and reward learning

Answer 16

Critical for reward learning, anticipation and high-effort choices
- Reduced activation during reward anticipation
- Reduced activation during reward learning
- Reduced activation during high effort choices

Question 17

What are the arguments for glutamate

Answer 17

Drugs that antagonise the NMDA receptor (ketamine, PCP) induce positive and cognitive symptoms.
- A broader profile of symptoms than dopamine stimulants.
- Amphetamines tend to only induce positive symptoms.
Treatment-refractory subjects do not appear to have a dopamine dysfunction.
- Clozapine is the most effective antipsychotic medication.
- Has much lower D2 receptor antagonism than most other antipsychotics.
- Acts on multiple neurotransmitters and affects multiple brain areas
- Evidence for primary cortical glutamate abnormalities (not subcortical dopamine)

Question 18

What factors cause schizophrenia

Answer 18

No one factor causes schizophrenia, but rather a combination of genetics and environmental factors.

Question 19

What are the treatment options focused on

Answer 19

Treatment options are focussed on dopamine, but this may not be the case in those with treatment-refractory psychosis