Neuropsychiatry

Question 1

What is neuropsychiatry?

Answer 1

Neuropsychiatry is a field of medicine in which neurology, and by
extension neuroscience, is necessary or at least helpful in the
understanding and management of mental and behavioral illness.

Question 2

Which fields does neuropsychiatry combine?

Answer 2

psychiatry, neurology, and neuropsychology.

Question 3

There are 5 patient types within neuropsychiatry, explain the Behavioral Neurology model and the Neurology as a ‘meme’

Answer 3

Type 1: Behavioral Neurology model
Neuropathology is both a necessary and sufficient cause of neuropsychiatric disease

Type 2: Neurology as a ‘meme’
Neuropathology is probably not necessary and certainly not sufficient for symptom formation.

Question 4

There are 5 patient types within neuropsychiatry, explain the Interactive model and the Neuropsychiatry of Pain and the Autonomic Nervous System

Answer 4

Type 3: Interactive model
Neuropathology is necessary, but not a sufficient cause of symptoms and not sufficient to understand/manage psychopathology.

Type 4: Neuropsychiatry of Pain and the Autonomic Nervous System
Neuropathology originates within the peripheral nervous system (PNS) & the autonomic nervous system (ANS) and is related to
somatoform and visceral symptoms

Question 5

There are 5 patient types within neuropsychiatry, explain the Neuropsychiatry of Psychotropic Drug Use

Answer 5

Type 5: Neuropsychiatry of Psychotropic Drug Use
Psychopathology and side effects are mediated via psychotropic drugs, requiring careful differential diagnosis and management to
distinguish between medication effects and disease symptoms.

Question 6

How can the different patient types coincide?

Answer 6

A singular patient (i.e. epileptic) can be seen as having multiple types (Neuropathology alone is enough for some seizures, but for other seizures neuropathology is not, a mix for other seizures and drugs can be a useful treatment) - type 1, 2, 3 and five respectively

Question 7

What is a disorder/disease for which neurpsychiatry is very useful?

Answer 7

Schizophrenia

Question 8

What are 7 psychotic disorders in the DSM V?

Answer 8

• Schizophrenia
• Delusional Disorder
• Brief Psychotic Disorder
• Schizophreniform Disorder
• Schizoaffective Disorder
• Substance/Medication-Induced Psychotic Disorder
• Psychotic Disorder Due to Another Medical
  Condition

Question 9

DSM V definition of schizophrenia?

Answer 9

A. Two+ of the following, significant proportion of time during 1-month (at least one is 1, 2, or 3):
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behaviour
5. Negative symptoms (e.g. reduced emotional expression / avolition)

B. Reduced functioning in one or more major areas
C. Continuous signs of disturbance for at least 6 months
D. Other diagnoses ruled out (e.g. depressive disorder)
E. Not due to effects of substance or other medical condition
F. If history of autism, then delusions/hallucinations must be present

Question 10

What is a problem with biomarkers and schizo?

Answer 10

It is heterogeneous and overlaps with other conditions

Question 11

Why does the Research Domain Criteria (RDoC) maybe pose a better picture for, i.e., schizo than the DSM V?

Answer 11

Because of heterogenity, RDoC may better describe a more complete picture because of it’s complexity

Question 12

What is the basis of the Dopamine hypothesis of schizophrenia?

Answer 12

Based on studies showing effects of dopamine receptor agonists (activates) & antagonists (blocks)

Question 13

What effect do antipsychotics (antagonists) usually have? What is a side-effect?

Answer 13

Partly blocks dopamine receptors, but a side-effect is that it blocks all dopamine receptors

Question 14

Explain the dopamine hypothesis of schizo

Answer 14

Environmental/genetic predisoposal > dysregulated firing/release of dopamine > Abnormal sense of novelty and obnormal assignment of salience to stimuli and representations > cognitive scheme (delusions) to explain abnormal salient experience > antipsychotics block dopamine which dampens salience

Question 15

Limitations/critique for domapine hypothesis of schizo

Answer 15

1. Mainly related to positive symptoms (hallucinations, delusions, …) (negative meaning abscene of response, etc.)
2. Not in all patients (treatment non-responders)
3. Does not explain the efficacy of some medications
   (clozapine)
4. Simplistic view of reality

Question 16

The glutamate hypothesis is another theory about schizo, why is this viable?

Answer 16

NMDA receptor (glutamate receptor) antagonism can
induce psychotic symptoms, including cognitive and negative symptoms, also most abundant, excitatory neurotransmitter in the brain

Glutamate genes involved in schizophrenia, neuroimaging studies and excessive glutamate possible accounting for synaptic loss in schizophrenia (SIRS) give further evidence for this theory

Question 17

Explain glutamate hypothesis of schizo

Answer 17

NMDAR dysfunction > lower glutamate transferral > lowers GABA > promoting DA transmission > positive symptoms
AND
NMDAR dysfunction > lower glutamate transferral > negative symptoms

Also possible involvement of promotion of serotonin to both types of symptoms

Question 18

There are negative and positive symptoms in schizo, whaddup?

Answer 18

Positive: Hallucinations, delusions, etc.
Negative: inactivity, catatonic, avolition, autistic behaviour)

Question 19

What does cognition look like in schizo and with what cognitive domains?

Answer 19

General cognitive impairment; information processing speed, attention and vigilance, WM, learning and memory, executive and social cognition

Also: theory of mind and emotional processes (autism overlap)

Question 20

Cognitive styles associated with schizo?

Answer 20

Jumping to conclusions, Bias against disconfirmatory evidence (needing more evidence to refute own belief) and Source monitoring bias (false source attribution)

Question 21

Overlaps between schizo and autism symptoms?

Answer 21

Difficulties with language or speech, social withdrawal, flattened affect and rigid interest

Question 22

What is a difficulty with diagnosing schizo (not heterogenity or overlap)?

Answer 22

Poorly validated measurement instruments

Question 23

DSM-5 solution to autism-schizo overlap?

Answer 23

F diagnostic criteria; If history of autism, then delusions/hallucinations must be present

Question 24

What are non-DSM (better?) solutions to autism-schizo overlap?

Answer 24

Take into account developmental history and semi-structured interview to assess psychotic symptoms

Question 25

What is a problem with autism and schizo patients (ASD+P)?

Answer 25

Poor response to antipsychotics and no increase in dopamine