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Part 3 – PM3B COPY T > (PM3B) Psychosis & Schizophrenia > Flashcards

(PM3B) Psychosis & Schizophrenia Flashcards

1
Q

What is psychosis?

A

Syndrome (a set of symptoms)
- Delusions/ hallucination/ disorganised speech or behaviour/ distortion of reality

Can be associated with Alzheimer’s disease, depression, cognitive disorders + mania

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2
Q

Define syndrome.

A

A set of symptoms

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3
Q

What is the principle symptom of schizophrenia?

A

Psychosis

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4
Q

What is split personality a symptom of?

A

NOT schizophrenia

Multiple personality disorder

Very rare

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5
Q

Describe the aetiology of schizophrenia.

A

Onset – adolescence/ early adulthood

~1% lifetime risk

Higher incidence in lower socioeconomic groups

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6
Q

What role do genetics play in schizophrenia?

A

No single gene responsible (multiple which can increase risk)

Tends to be genetic

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7
Q

How is it known that schizophrenia is partly inherited?

A

Studies on identical twins

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8
Q

If identical twins are raised separately and one of them develops schizophrenia, what is the likelihood the other isolated twin will also develop this?

A

50%

1 in 2

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9
Q

If fraternal twins are raised separately and one of them develops schizophrenia, what is the likelihood the other isolated twin will also develop this?

A

12.5%

1 in 8

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10
Q

What neuropathological changes can be observed?

A

(1) Enlarged ventricles
(2) Reduced temporal lobe volume – post-mortem
(3) Reduce cerebral blood flow -> reduced frontal function
(4) Non-progressive

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11
Q

Which area(s) of the brain is/ are responsible for aggressive symptoms of schizophrenia?

A

(1) Orbitofrontal cortex

(2) Amygdala

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12
Q

Which area(s) of the brain is/ are responsible for affective symptoms of schizophrenia?

A

Ventromedial prefrontal cortex

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13
Q

Which area(s) of the brain is/ are responsible for positive symptoms of schizophrenia?

A

Mesolimbic pathway

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14
Q

Which area(s) of the brain is/ are responsible for negative symptoms of schizophrenia?

A

(1) Mesocortical
(2) Prefrontal cortex
(3) Nucleus accumbens (rewards circuits)

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15
Q

Which area(s) of the brain is/ are responsible for cognitive symptoms of schizophrenia?

A

Dorsolateral prefrontal cortex

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16
Q

What are some positive symptoms of schizophrenia?

A

(1) Delusions

(2) Hallucinations

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17
Q

What are some negative symptoms of schizophrenia?

A

(1) Apathy
(2) Anhedonia – inability to feel pleasure in normally pleasurable activities
(3) Cognitive blunting
(4) Neuroleptic dysphoria – unpleasant changes of thinking

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18
Q

What are some inherited genetic factors of schizophrenia?

A

(1) Increased risk in families when 1 member is affected

(2) Susceptibility with certain genes – e.g. neuregelin 1

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19
Q

What is the significance of the neuregelin 1 gene?

A

Increases susceptibility of schizophrenia development

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20
Q

What are some environmental factors which may increase the susceptibility of developing schizophrenia?

A

(1) Birth complications
(2) Viral infection
(3) Immigration
(4) Drug misuse
(5) Inner cities

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21
Q

With regard to schizophrenia, what is the neurodevelopmental model?

A

Poor environment/ genetic factors

Lead to changes in brain development

Contribute to risk

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22
Q

What is the dopamine hypothesis?

A

Role of onset of schizophrenia

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23
Q

How is dopamine produced?

A

In dopaminergic neurones

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24
Q

What does dopamine bind to?

A

Dopamine receptors

D1-D5

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25
What is the role of COMT in the synaptic cleft?
Breakdown of dopamine
26
What is the function of dopamine autoreceptors (D2)?
Is a presynaptic autoreceptor Prevents the release of further dopamine Negative feedback mechanism
27
Where can dopamine autoreceptors (D2) be found?
(1) Presynaptic membrane | (2) Somatodendritic
28
What is the mesolimbic pathway?
Reward/ dopaminergic pathway Begins with ventral tegmental area (VTA) + ends with nucleus accumbens
29
In schizophrenia, what is the effect of the mesolimbic pathway?
Dopamine pathways are hyperactive Release too much dopamine Leads to positive symptoms
30
In schizophrenia, what is the effect of the mesocortical dopaminergic pathway?
Hypoactivity Releasing too little dopamine Selective neural degeneration of mesocortical dopaminergic production Leads to negative symptoms
31
What is the cause of positive symptoms in schizophrenia?
Mesolimbic dopamine pathway Dopamine (reward) pathway Too much dopamine
32
What is the cause of negative symptoms in schizophrenia?
Mesocortical dopamine pathway Dopamine (reward) pathway Too little dopamine
33
With regard to schizophrenia, what is the glutamine hypothesis?
A novel hypothesis Based the first psychopharmacological agents on it Revision of glutamatergic transmission
34
What are some of the key glutamatergic pathways in the brain?
(1) Cortico-brainstem glutamatergic projection (2) Cortico-striatal glutamatergic pathway (3) Thalami-cortical glutamatergic pathway (4) Ventral hippocampus to nucleus accumbens (5) Cortico-thalamic glutamatergic pathway (6) Cortico-cortical glutamatergic pathway (7) Intracortical with GABAergic coordination
35
What is PCP?
Phencyclinide Drug that induces psychosis
36
What are the effects of ketamine or PCP binding to NMDA-R?
Prevention of glutamate-mediated excitation Hypofunction of this receptor is a possible mechanism for schizophrenia pathogenesis
37
What types of symptoms can NMDA-R inhibition (hypofunction) lead to?
Both positive + negative Depending on whether those NMDA-R receptors are in excitatory or inhibitory neurones
38
What is the serotonin hypothesis?
Increased cortical seratoninergic tone Leads to reduced dopamine secretion downstream
39
What is the another term for the negative symptoms of schizophrenia?
Inhibited/ withdrawn
40
What is another term for the positive symptoms of schizophrenia?
Disinhibited
41
How are symptoms of schizophrenia diagnosed?
Purely psychiatric No biomarkers/ clinical signs
42
What may some observations of schizophrenia symptoms be?
(1) Reduced speech (2) Poor grooming (3) Limited eye-contact
43
What may some consultations regarding schizophrenia highlight?
(1) Reduced emotional responsiveness (2) Reduced interest (3) Reduced social drive
44
How may symptoms of schizophrenia change with time?
Progressively more negative symptoms compared to positive symptoms
45
When do the positive symptoms of schizophrenia begin?
Acute phase of schizophrenia
46
What is the prodromal phase of schizophrenia?
Beginning of initial symptoms Some negative symptoms present No positive symptoms present
47
What type of schizophrenia symptoms are predominantly present in the chronic phase?
Negative symptoms (increasing) Positive symptoms less common + decreasing
48
What are some prognostic signs for an isolated episode of schizophrenia?
(1) No family history (2) Stable personality (prior to episode) (3) Acute onset (4) Emotional responses preserved (5) Early diagnosis + treatment
49
What are some prognostic signs for a chronic (persistent) schizophrenia diagnosis?
(1) Family history (2) Disturbed personality (prior to episode) (3) Inability to form relationships (4) Poor social adjustment (5) Insidious onset (gradual + subtle) (6) Loss of initiative/ drive (7) Delayed diagnosis + treatment
50
What does delayed diagnosis and treatment of a schizophrenic episode increase likelihood of?
Persistent/ chronic schizophrenia
51
What are the key aims of treatment in schizophrenia?
(1) Control acute attacks (2) Resolution of social/ domestic factors (3) Rehabilitate the patient (4) Begin long-term maintenance therapy (if required)
52
What are some examples of D2 antagonists?
(1) Antipsychotics - Haloperidol - Chlorpromazine
53
What is the role of D2 antagonists in schizophrenia?
Treatment of positive symptoms
54
How do D2 antagonists work in reducing positive symptoms of schizophrenia?
Reduce mesolimbic hyperactivity
55
What is a downside of D2 antagonists for schizophrenia treatment?
Although they reduce positive symptoms Can increase negative symptoms - Reduces mesocortical dopaminergic tone
56
What are extrapyramidal symptoms of schizophrenia?
Most common category of side effects Associated with antipsychotic use Manifestation of movement disorders
57
What is acute dystonia?
Neck/ spine spasm Neck/ jaw/ larynx rigidity Oculogyric crisis – spasmodic movement of the eyeballs
58
What is pseudo-parkinsonism?
Dyskinesia Dystonia Rigidity/ tremor/ bradykinesia
59
What is akathisia?
Psychomotor restlessness Agitation Inability to sit still
60
What is tardive dyskinesia?
Abnormal face/ mouth/ jaw movement Lipsmacking/ grimacing/ tongue protrusion Body writhing
61
What is prolactinaemia?
Side effect of schizophrenia Due to blocking of D2 receptors on prolactin producing cells Leads to increased production of prolactin
62
What can happen to the patient before the optimal level (plateau) of antipsychotic effect has been reached?
(1) Extrapyramidal effects | (2) Prolactinaemia
63
What are some common side effects of blockage of M1 receptors?
(1) Dry mouth | (2) Increased risk of mouth ulcers
64
What effect does reducing the mesolimbic dopamine pathway hyperactivity have on schizophrenia?
Reduces positive symptoms Better control with fewer extrapyramidal side effects
65
What effect, on schizophrenia, does blockage of serotonin (5HT2A) receptors in the cortex have?
(1) Increased dopamine secretion downstream (2) Reduces extrapyramidal symptoms (3) Reduces prolactinaemia prevalence
66
What is the purpose of blockage of serotonin (5HT2A) receptors, with regard to schizophrenia?
Reduces effective antipsychotic threshold To reduce prevalence of extrapyramidal symptoms + prolactinaemia
67
Which drugs bind to the 5HT1B receptor?
(1) Olanzapine (2) Clozapine (3) Asenapine
68
What are some side effects of D2 antagonists specifically?
(1) Weight gain (2) Diabetes (3) Increased smoking – as with schizophrenia (4) Metabolic syndrome
69
What is metabolic syndrome?
Combination of diabetes, high blood pressure (hypertension) and obesity
70
What general types of antipsychotics are there?
(1) 1st generation – typical | (2) 2nd generation – atypical
71
What type of antipsychotic are D2 receptor antagonists, 5HT antagonists and dopamine partial agonists?
Atypical 2nd generation
72
Following an acute attack of schizophrenia, what is the treatment?
12-24 months follow-up treatment ~75% relapse
73
Is schizophrenia the same as psychosis?
No Psychosis is a symptom of schizophrenia Schizophrenia is NOT psychosis
74
What association is there between cannabis use and schizophrenia or psychosis?
No association with schizophrenia Association with psychosis (acute episodes)

Part 3 – PM3B COPY T (33 decks)

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