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PSYCHIATRY > Neurobiology of Psychosis > Flashcards

Neurobiology of Psychosis Flashcards

1
Q

What is the largest risk factor for schizophrenia?

A

Genetics

- high concordance in monozygotic twins or in children where both parents are affected

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2
Q

What perinatal factors may predisposee to schizophrenia?

A
  • 2nd trimester viral illness
  • early spring births (due to high rates of illness at this time)
  • pre-eclampsia
  • foetal hypoxia
  • emergency Caesarian section
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3
Q

What type of infection as a child is shown to predispose to schizophrenia?

A

childhood viral CNS infection

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4
Q

Use of what substances increase the risk of developing psychosis?

A

Amphetamines
Cocaine
Cannabis

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5
Q

Opiates can cause psychosis. TRUE/FALSE?

A

FALSE

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6
Q

What signs on CT show poor prognosis in schizophrenia?

A

Reduced frontal lobe volume
Reduced frontal lobe grey matter
Enlarged lateral ventricle volume

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7
Q

Why is grey matter seen to be reduced in schizophrenia patients?

A

No neuronal loss

just decreased Arborisation (branching)

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8
Q

Patients with perinatal or childhood environmental risk factors can often identify behavioural, motor and intellectual impairment from early age. TRUE/FALSE?

A

TRUE

usually from school age

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9
Q

What is the mainstay of treatment in schizophrenia?

A

Dopamine antagonists

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10
Q

What pathways of the brain involve dopamine

A

Mesolimbic (reward)
Nigrostriatal
Tuberoinfundibular (prolactin)

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11
Q

What genes are altered in schizophrenia and what is their main impaired function?

A

Neuregulin
Dysbindin
DISC-1

=> cause impaired branching/ growth of neurones

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12
Q

Give examples of Typical antipsychotics?

A

Chlorpromazine

Haloperidol

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13
Q

What receptor does haloperidol mainly act on, and what side effects does this cause

A

D2

=> extra-pyramidal (parkinsons) side effects

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14
Q

What are the reasons for scond generation antipsychotic being branded as “atypical”?

A
  • Less likely to induce Extra-Pyramidal side-effects
  • High 5-HT2A to D2 ratio
  • Better efficacy against negative symptoms
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15
Q

Give examples of atypical antipsychotics

A

Olanzapine
risperidone
quetiapine

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16
Q

What is an acute dystonic reaction to antipsychotics?

A
  • occurs after single dose or within 24 hrs

- spasm of particular muscle/ group of muscles

17
Q

How is an acute dystonic reaction treated?

A

Stop anti-psychotic OR give anti-cholinergic

18
Q

What is akathisia?

A
  • Internal restlessness
  • patients complains of feeling need to constantly move
  • may notice them fidgeting, wriggling or pacing
19
Q

What is Tardive dyskinesia?

A

Late onset repetitive mouth movements (involuntary)

e.g grimacing, sticking tongue out, lip smacking

20
Q

Blocking dopamine receptors causes hyperprolactinaemia. What symptoms can this cause?

A

Females
amenorrhoea
galactorrhoea
bone density problems

Males
Gynaecomastia
sexual dysfunction

21
Q

What are the side effects of blocking 5HT2 receptors?

A

Weight gain
sedation
metabolic syndrome

22
Q

What are the main symptoms of metabolic syndrome?

A

Increased abdominal circumference
High BP
High Cholesterol
High Blood Glucose

23
Q

Some anti-psychotics act on alpha-adrenoceptors. What side effects could this cause?

A

Postural hypotension

24
Q

Some anti-psychotics have an anti-muscarinic effect, what does this cause?

A 
Blurred vision
Dry mouth
Constipation
Urinary retention
Sedation and confusion
25
Q

WHat should be considered when choosing an anti-psychotic?

A
  • little difference in efficacy (except clozapine)
  • past use? what has worked?
  • pre-existing comorbidities?
  • patient concerns? side effects?
26
Q

What is a depot?

A

Long acting IM injection
can be used for antipsychotics
- used if patients detained and lacking capacity but need tx
OR
- if patients do not wish to comply with daily medication

27
Q

When is clozapine normally used?

A

Treatment resistant cases of schizophrenia

3rd line

28
Q

What are the potential side effects of clozapine?

A

Myocarditis
Paralytic ileus
Agranulocytosis

29
Q

How should a patients bloods be monitored when started on clozapine?

A

Once a week for 6 months
Every 2 weeks for 6 months
Every 4 weeks thereafter

IF STOPPED - 1 month post stopping drug

PSYCHIATRY (35 decks)

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