PBL 6

Question 1

What does olazapine mean

Answer 1

an antipsychotic drug that is used to treat schizophrenia.

Question 2

what is the definition of schizophrenia

Answer 2

major mental illness that affects how one thinks, feels and perceives.
- it can significantly impair functioning and has both acute and chronic effects on cognition

Question 3

what is the hallmark symptom of schizophrenia

Answer 3

o Psychosis is the hallmark symptom.

 i.e. experiencing auditory hallucinations (voices)/delusions (fixed false beliefs).

Question 4

when does the onset of scizophrenia usually occur

Answer 4

• Onset: usually adolescence/early adult life.

o Onset can be insidious/acute (possibly after emotional event).

Question 5

How do you classify schizophrenia

Answer 5

These types were:
• Paranoid (prominent hallucinations/delusions).
• Disorganized (behaviour without purpose).
• Catatonic (unusual movements between being very active/still).
• Undifferentiated (have signs of different types and doesn’t fit into one).
• Residual (history of psychosis but only negative symptoms).

• these have since been removed as they are not helpful in treatment

Question 6

how do you diagnose schizophrenia

Answer 6

you have to have at least two of the following
 Delusions
• Of control, influence or passivity.
• Persistent delusions of any other kind (i.e. superhuman powers/abilities).

 Hallucinations: voices commentating.
• Persistent hallucinations in any modality.

 Disturbance in Thought/Speech
• Echo, insertion or withdrawal.
• Breaks in train of thought resulting in incoherent/irrelevant speech.

 Catatonic Behaviour
• Variety of abnormal motor postures.
o Mutism, stupor.

 Negative Symptoms
• Marked apathy, low self-esteem, introversion, personal neglect.

or you can have one very clear symptom of delusion, hallucination, disorganised speech

2. these symptoms have to be ongoing for 6 months or nearly present for most of the time during a period of 1 or more month
3. have to have exclusion of mood disorder, substance misuse

Question 7

what are the three types of symptoms of schizophrenia`

Answer 7

• positive
• negative
• cognitive

Question 8

describe what the they types of systems are and give examples

Answer 8

• Positive Symptoms: hallucinations, delusions, agitation, disorganized thinking (psychotic symptoms).
• Negative Symptoms: introversion, apathy, low self-esteem, personal neglect (decreased emotions).
• Cognititive Symptoms: poor memory, attention deficit, executive dysfunction (making decisions).

Question 9

what symptoms has a major outcome on schizophrenia

Answer 9

(!) Cognitive deficits have a major impact on the outcome of schizophrenia and social reinsertion of patients.
• As few as 10% of patients with schizophrenia work full time/20% can work part time.

Question 10

how can you test for a cognitive dysfunction

Answer 10

Frontal Cortical Dysfunction Testing: Wisconsin Card Sorting Test.

Question 11

what does the patient in this case present with

Answer 11

• Auditory Hallucinations: 2nd person command auditory hallucinations.
• Delusions: paranoid persecutory delusional beliefs.
• Isolated/social withdrawal and self-absorbed: significant change in aspects of her personal behaviour.

Question 12

describe the epidemiology of schizophrenia

Answer 12

• Most common type of psychotic disorder (general population occurrence around 1%).
• Constant prevalence throughout the world with no difference between males vs females
o Although onset is earlier in males.

Question 13

describe the pathophysiology of schizophrenia

Answer 13

• Associated with decreased synaptic spines/decreased dendritic complexity in the cortex.
o Creates abnormalities in formation/maturation of brain circuits

Question 14

what provides evidence that there is a genetic factor for schizophrenia

Answer 14

there is a concordance rate in monozygotic twins of 50%

Question 15

what is the biggest risk factor for developing schziophrenia

Answer 15

having a close relative with psychosis and schizophrenia

Question 16

what genes have been associated with schizophrenia

Answer 16

o Dysbindin: may affect D2 receptors levels/glutamate and GABA transmission
o Neuregulin: neuroplasticity.
o DISC 1: neurodevelopment and signalling in Corticolimbic areas.
o DAOA: glutamatergic transmission
o COMT: dopaminergic transmission.
o BDNF: neurotrophic factor
o RGS4: G-protein coupled receptor signalling.

Question 17

what environmental factors can lead to schizophrenia development

Answer 17

• Events that occur during gestation may be critical. Higher risk if:
o Born in winters.
o After viral epidemics.

• Other risk factors include:
o Excessive cannabis use in adolescence.

Question 18

describe the structural and functional changes that are seen in schizophrenia

Answer 18

• Increased rate of gray matter loss
o Larger ventricles and smaller mesial temporal lobes.

• Event-related potentials (ERPs) (increased reactions to stimulation).

• Hypofrontality (decreased frontal activation)
o Leads to excessive striatal dopamine release (explains psychotic symptoms).

• Overall brain volume loss
• Altered brain connectivity

Question 19

what is treatment for schizophrenia based upon

Answer 19

Treatment is based on the “dopamine theory of schizophrenia”.
• Believed to be an imbalance between dopaminergic projections.
o Hyperactivity in the mesolimbic pathway.
o Hypoactivity in the mesocortical pathway.

Question 20

what is the major pharmacological target of all drugs used to treat schizophrenia

Answer 20

Dopamine D2 receptors are major pharmacological target of all drugs used to treat schizophrenia:
- acts as antagonists.

Question 21

name two types of drugs used to treat schizophrenia

Answer 21

• Typical Neuroleptics/First Generation Antipsychotics

- Atypical Neuroleptics/Second Generation Antipsychotics

Question 22

name examples of the typical antipsychotics

Answer 22

• Chlorpromazine
• Thioridazine
• Fluphenazine
• Haloperidol
• Flupenthixol.

Question 23

describe how typical antipsychotics work

Answer 23

• Block dopamine receptors as well as acting as antagonists at other receptors (e.g. muscarinic cholinergic, histamine H1 and alpha2-adrenergic receptors).
• Lack of selectivity of action

Question 24

what was the first neuroleptic drug

Answer 24

• Chlorpromazine was the first neuroleptic drug.

Question 25

what factor of typical antipsychotics can help schizophrenia in the community

Answer 25

• Some drugs can be given as depot slow release preparation (makes chronic SD manageable in community).
o Also, useful in non-compliance.

Question 26

name the adverse effects of typical antipsychotics

Answer 26

•	More extrapyramidal effects vs atypical (normally reversible) *
o	Tardive dyskinesia
o	Dystonia
o	Parkinsonism
o	Bradykinesia
o	Tremor

• Weight gain
• Postural hypotension
• Blurred vision
• Dry mouth (muscarinic)
• Hypothermia
• QT interval prolongation
• Sudden death
• Hyperprolactinaemia

Question 27

Define and describe the symptoms of extrapyramidal side effects

Answer 27

• Dystonia: continuous spasms and muscle contractions
• Akathisia (restlessness)
• Parkinsonism (rigidity)
• Bradykinesia (slowness of movement

Question 28

name some examples of atypical antipsychotics

Answer 28

• Risperidone
• Olanzapine
• Clozapine
• Quetiapine
• Paliperidone
• Aripiprazole

Question 29

describe the mechanism of action of atypical antipsychotics

Answer 29

• Acts as antagonists at D2 receptors as well as antagonists 5-HT2 receptors

Question 30

what Is the atypical antipsychotics clozapine used for

Answer 30

• Clozapine is used in patients that are drug resistant (30% of SD patients do not respond to treatment).

Question 31

describe the adverse effects of atypical antipsychotics

Answer 31

• Less prone to give extrapyramidal effects.
• Improve negative effects/cognitive dysfunction
• Significant weight gain
• Dyslipidaemia
• T2D (insulin resistance)
• Metabolic disturbance
• Neutropenia (clozapine)

Question 32

describe what is meant by tardive dyskinesia

Answer 32

• Involuntary movements of (lips, jaw, face, constant chewing etc…).
• Associated with typical antipsychotics, taken for longer than a few months/years (irreversible).

Question 33

what is neuroleptic malignant syndrome

Answer 33

•	Rare but potentially lethal complication.
•	It is a medical emergency
•	Characterized by:
o	Hyperpyrexia (high fever)
o	Tremor
o	Confusion
o	Autonomic instability.

Question 34

what are the guidelines for taking the medication

Answer 34

• Whatever the choice of neuroleptic, treatment must be continued for several months/reviewed regularly by a psychiatrist.
• Patients who relapse after cessation of treatment require long-term medication.
o Minimum of 2 to 5 years.

Question 35

what are the non pharmologcial approaches for treating schizophrenia

Answer 35

• Cognititive behavioral theraphy

* Family theraphy.

Question 36

name a new approach for treating schizophrenia

Answer 36

• Schizophrenia is associated with decreased glutamatergic transmission.
o Possible to potentiate activity of NMDA receptor.

Question 37

what does the prognosis depend upon

Answer 37

• Balance between positive and negative symptoms
• Complicating Factors (i.e. development of drug addiction, circumstances involving repeated high level of stress, lack of supporting structures etc…).

Question 38

describe the risk of suicide in schizophrenia

Answer 38

risk of suicide will not disappear during the disease.
• May be made worse by presence of depression.
• 10-15% of schizophrenic patients die by suicide.