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Semester 3: Mind and Movement > PBL Topic 3 Case 8 > Flashcards

PBL Topic 3 Case 8 Flashcards

1
Q

Outline the epidemiology of schizophrenia

A
  • Affects 1% of population
  • More common in makes
  • Onset is usually between 16 and 25
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2
Q

Identify 3 genes implicated in the pathogenesis of schizophrenia

A
  • Neuregulin (synaptic development and plasticity)
  • Dysbindin (NMDA tethering)
  • DISC-1 (Receptor trafficking)
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3
Q

Outline 2 environmental factors implicated in the pathogenesis of schizophrenia

A
  • Maternal virus infections during pregnancy
  • Cannabis consumption in adolescence and early adulthood
  • Childhood sexual abuse
  • Urban living
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4
Q

Which dopaminergic pathway is implicated in positive symptoms?

A
  • Nigrostriatal pathway
  • From substantia nigra pars compacta
  • To association striatum
  • Excess dopamine acting on D2 receptors
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5
Q

Which dopaminergic pathway is implicated in negative symptoms?

A
  • Mesocortical pathway
  • From ventral tegmental area of midbrain
  • To prefrontal cortex
  • Lack of dopamine acting on D1 receptors
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6
Q

Outline the role of glutamate in the pathogenesis of schizophrenia

A
  • NMDA hypofunction reduces activity in mesocortical pathway and increased activity in mesolimbic pathway
  • Reduce dopamine acting on inhibitory D1 receptors and increase dopamine acting on excitatory D2 receptors
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7
Q

What is the cause of neurodegeneration in schizophrenia?

A
  • Glutamate induced excitotoxicity
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8
Q

Outline 5 positive symptoms of schizophrenia

A
  • Paranoid delusions
  • Hallucinations
  • Thought disorder
  • Disorganised behaviour
  • Catatonia (immobility, purposeless motor activity)
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9
Q

Outline 4 negative symptoms of schizophrenia

A
  • Withdrawal from social contact
  • Flattening of emotional responses
  • Anhedonia
  • Reluctance to perform everyday tasks
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10
Q

What percentage of schizophrenia cases lead to suicidal attempts and successful suicide attempts respectively?

A
  • 50%

- 10%

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11
Q

What is selective attention and how is it impaired in schizophrenia?

A
  • Ability to focus on important information

- Schizophrenic patients fail to discriminate between significant and irrelevant stimuli

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12
Q

Outline 4 differential diagnoses of schizophrenia

A
  • Organic mental disorders e.g. partial complex epilepsy
  • Affective disorders e.g. mania
  • Drug psychosis e.g. amphetamine psychosis
  • Personality disorders e.g. schizotypal
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13
Q

Identify two first general antipsychotic drugs

A
  • Chlorpromazine

- Haloperidol

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14
Q

Identify two atypical antipsychotic drugs

A
  • Risperidone

- Clozapine

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15
Q

Explain how antipsychotics act on dopamine receptors and which type of symptom they reduce

A
  • Antagonism of D2 receptors in nigrostriatal pathway, resulting in increased firing in nigrostriatal pathway
  • Reduces positive symptoms
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16
Q

What side effects occur as a result of D2 antagonism and why do they occur?

A
  • Systemic antipsychotics do not discriminate between D2 receptors in distinct brain regions
  • Unwanted motor affects due to block of D2 receptors in nigrostriatal pathway (dorsal striatum)
  • Enhanced prolactin secretion due to block of D2 receptors in tuberohypophyseal pathway
  • Reduced pleasure due to block of D2 receptors in mesolimbic pathway
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17
Q

Why are 5-HT2a receptor antagonists important in the control of extrapyramidal side effects of antipsychotics?

A
  • 5-HT2a receptors cause inhibition of dopaminergic nigrostriatal neurons
  • Antagonism of these receptors enhances dopamine release into striatum
  • So blocks unwanted motor affects of D2 blockage
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18
Q

Why are muscarinic acetylcholine receptor antagonists important in the control of extrapyramidal side effects of antipsychotics?

A
  • D2 blockage in striatum results in enhanced ACh release on muscarinic receptors
  • Which further inhibits D2 receptors??
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19
Q

What is acute dystonia?

A
  • Reversible extrapyramidal motor side-effect of antipsychotics
  • Beginning within the first few weeks
  • Characterised by fixed upward gaze, torticollis (involuntary spasm of neck muscles) and restlessness
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20
Q

What is tardive dyskinesia?

A
  • Irreversible extrapyramidal motor side-effect of antipsychotics
  • Beginning after months or years in a fifth of patients
  • Characterised by athetosis (writhing movements of the face, neck and limbs), chorea
  • Resembles effects of levodopa in Parkinson’s
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21
Q

What are the effects of enhanced prolactin concentration?

A
  • Dopamine acts on D2 receptors in tuberohypophyseal pathway to inhibit prolactin secretion
  • Blockage of receptors results in breast swelling, and lactation
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22
Q

What are the effects of blockage of histamine receptors by antipsychotics?

A
  • Drowsiness

- Sedation

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23
Q

What are the effects of blockage of muscarinic receptors by antipsychotics?

A
  • Blurred vision
  • Increased intraocular pressure
  • Dry mouth
  • Dry eyes
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24
Q

What are the effects of blockage of alpha adrenoreceptors receptors by antipsychotics?

A
  • Orthostatic hypotension
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25
Q

What are the effects of blockage of 5-HT receptors by antipsychotics?

A
  • Weight gain

- Increased risk of diabetes and cardiovascular disease

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26
Q

What is antipsychotic malignant syndrome?

A
  • Muscle rigidity and rapid rise in body temperature
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27
Q

What does psychological treatment of schizophrenia involve?

A
  • Reassurance and support
  • CBT to reduce intensity of delusions
  • Psychotherapy is contraindicated
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28
Q

What does social treatment of schizophrenia involve?

A
  • Attention paid to patient’s environment and social functioning
  • Family education on optimal amount of emotional and social stimulation
  • Sheltered employment
  • Assertive outreach mental health teams for poor adherence to medication
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29
Q

Outline the prognosis for schizophrenia

A
  • 25% have good outcome
  • 33% develop chronic schizophrenia
  • Most will not work or live independently
  • 1 in 10 take their own lives
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30
Q

What is the role of the early intervention service?

A
  • Address needs of patients during period of untreated psychosis (between first episode and receiving of effective treatment)
  • To improve symptom severity, admission rates, relapse rates and prognosis
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31
Q

What is the role of the care-coordinator in the EIS and who typically carries out this role?

A
  • Ensure everyone is working together to identify patients needs
  • Community psychiatric nurse/occupational therapist/social worker
32
Q

What is the role of Approved Mental Health Practitioners in the EIS?

A
  • Make decisions about whether a person should be admitted to hospital for assessment or treatment
33
Q

What is the role of the psychiatrists in the EIS?

A
  • Specialise in diagnosis and treatment
34
Q

What is the active principle of cannabis?

A
  • Cannabinoids

- The most abundent of which is delta 9 tetrahydrocannabinol (THC)

35
Q

What is cannabidiol?

A
  • Precursor of THC
36
Q

What is cannabinol?

A
  • Breakdown product from THC
37
Q

What is meant by a psychotomimetic effect?

A
  • Produces hallucinations and delusions
38
Q

How do the effects of cannabis differ to ethanol?

A
  • Cannabis does not produce reckless and aggressive behaviour
39
Q

Outline subjective effects of cannabis

A
  • Relaxation
  • Wellbeing
  • Sharpened sensory awareness
  • Time passes extremely slowly
40
Q

Outline six adverse central effects of cannabis

A
  • Impairment of short-term memory and simple learning tasks
  • Impairment of motor co-ordination
  • Catalepsy
  • Hypothermia
  • Analgesia
  • Increased appetite
41
Q

Outline five peripheral adverse effects of cannabis

A
  • Tachycardia
  • Vasodilation (scleral and conjunctival vessels producing bloodshot eyes)
  • Reduction in intraocular pressure
  • Bronchodilation
42
Q

What is the time frame of the effects of cannabis?

A
  • Takes 1 hour to develop

- Lasts between 2 and 3 hours

43
Q

Outline the distribution of CB1 receptors and how these relate to their central effects

A
  • Hippocampus (impaired memory)
  • Cerebellum (impaired co-ordination)
  • Hypothalamus (increased appetite and hypothermia)
  • Substantia nigra (impaired motor control)
44
Q

Where are CB2 receptors located?

A
  • Lymphoid tissue including
  • Spleen, tonsils, thymus,
  • Lymphocytes, monocytes, mast cells, microglia
45
Q

Describe CB1 receptors

A
  • G protein coupled receptors located presynaptically
  • Activation of inward-rectifying potassium channels causing hyperpolarisation
  • Also influences gene expression by acting on mitogen activating protein kinase
46
Q

What are endocannabinoids?

A
  • Endogenous ligands for CB receptors
  • Made on demand (eicosanoid)
  • Their role is retrograde mediations passing information from postsynaptic neurons
47
Q

Identify two endocannabinoids

A
  • Anandamide

- 2-AG

48
Q

What is the role of fatty acid amide hydrolase (FAAH)?

A
  • Inactivated anandamide

- Converting it to arachidonic acid and ethanolamine

49
Q

Identify a stimuli that causes release of endocannabinoids

A
  • Increased intracellular Ca2+
50
Q

What is meant by depolarisation induced suppression of inhibition (DSI)?

A
  • Depolarisation of hippocampal pyramidal cells
  • Causing suppression of GABA mediated inhibition input to these cells
  • Implying a retrograde flow of information by activation of CB receptors
  • Inhibited by CB1 antagonists e.g. rimonabant
51
Q

How does NMDA hypofunction cause positive symptoms?

A
  • NMDA hypofunction on GABAergic neurons
  • Resulting in disinhibition of glutamatergic neurons in the PcSN
  • Increased dopamine release from PcSN acting on D2 receptors in associative striatum
52
Q

How does NMDA hypofunction cause negative symptoms?

A
  • NMDA hypofunction on GABAergic neurons
  • Resulting in disinhibition of glutamatergic neurons on GABA neurons
  • Inhibiting ventral tegmental area
  • Reduce D1 in mesocortical pathway
53
Q

Outline the diagnostic criteria for schizophrenia

A
  • At least 1 symptom for at least 1 month:
  • Hallucination
  • Delusions
  • Withdrawal
54
Q

How long should antipsychotics be taken to be maximally effective?

A
  • 2-4 weeks
55
Q

In patients with a first psychotic episode, how long should antipsychotic treatment be continued for in order to prevent relapse

A
  • 1-2 years
56
Q

What is the dose of risperidone?

A
  • Orally up to 4 mg
57
Q

Explain the relationship between FAAH and pain threshold?

A
  • Endocannabinoids have analgesic and anxiolytic properties
  • Capable of reducing anxiety and increased pain threshold
  • FAAH inhibition increases endocannabinoids concentration
58
Q

What is rimonabant and what are its clinical effects?

A
  • CB1 receptor antagonist
  • Increased weight loss
  • Reduced tobacco dependence and drug addiction
59
Q

What percentage block of D2 receptors is required for therapeutic effects of antipsychotics?

A

-65% to 80%

60
Q

What is meant by sectioning?

A
  • Person is kept in hospital under Mental Health Act 1983
61
Q

Identify three criteria for sectioning

A
  • Patients needs assessment and treatment
  • Patients health would otherwise deteriorate
  • Their own safety or safety of others is impaired
62
Q

Outline Section 2 of the MHA

A
  • Patient can be detained if they have a mental disorder that poses risks to their own safety or safety of others
  • And they need to be detained for a short time for assessment (up to 28 days)
63
Q

Outline Section 3 of the MHA

A
  • Patient can be detained if they have a mental disorder that poses risks to their own safety or safety of others
  • Treatment can only be given in hospital
  • Can be detained for up to 6 months
64
Q

Who is able to extent or renew sectioning under Section 3?

A
  • Responsible clinician
65
Q

For how many months can Section 3 be extended:

[A] The first time

[B] The second time

[C] The third time

A
  • [A] 6 months
  • [B] 6 months
  • [C] 12 months
66
Q

Who is responsible for discharging the patient?

A
  • Responsible clinician
67
Q

What is the role of the Approved Mental Health Professional?

A
  • Co-ordination of assessment and admission to hospital
68
Q

Aside from the AMHP, identify two other roles involved in assessment and admission

A
  • Registered GP, ideally one who knows the patient

- Section 12 approved doctor e.g. psychiatrist

69
Q

What right’s does the nearest relative have?

A
  • They can tell the AMHP their concerns which may lead to sectioning
  • They should be consulted if the AMHP wants to section the patient
  • They have the right to object to sectioning
70
Q

What is the role of the independent mental health advocate?

A
  • Help patient express patients views if they refuse sectioning
71
Q

What is escorted leave and who grants permission?

A
  • Patient can leave ward for good reason
  • Permission clinician
  • Hospital is not under legal obligation to do this
72
Q

Can patients be given treatment against their will?

A
  • Yes
73
Q

What happens when a patient refuses sectioning?

A
  • AMHP can use reasonable force or can involve the police
74
Q

What is meant by recovery?

A
  • A way of living a satisfying, hopeful and contributing life even with the limitations caused by illness
75
Q

What is a Wood Shedding Model or recovery?

A
  • Following an initial improvement, the individual’s condition may ‘plateau’ for long periods
  • And then suddenly improve in a discontinuous manner.
76
Q

Identify internal and external conditions of recovery

A
  • Internal: Hope

- External: Human rights

Semester 3: Mind and Movement (21 decks)

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