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MOHD4: Exam 5 > Psychosis and Antipsychotics > Flashcards

Psychosis and Antipsychotics Flashcards

1
Q

22q11 deletions

A

alter expression of genes via decrease of DGCR8 protein expression

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2
Q

Which of these illnessess does not have psychosis??

Brain tumors
Dementias
Endocrine disorders
Depression
Seizures
Infections
Substance intoxication/withdrawal
Delirium
A

Depression

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3
Q

Region hyperactivated in hallucinations

A

secondary auditory association cortex

located in superior temporal gyrus

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4
Q

Hallucinations result from increased activity from _______ and decreased activity from ________

A

Increased from emotional regulation/attention,

Decreased from monitoring/volitional functions

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5
Q

Structures involved in delusions

A

fronto-striatal circuits, parietal cortices, amygdala, cerebellum

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6
Q 
Symptoms include: 
Delusions
Hallucinations
Disorganized speech
Disorganized/catatonic behavior
Negative symptoms (flat, alogia, avolition)
A

Schizophrenia
(at least two symptoms,
at least 1 from the first three
for most of at least 1 month)

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7
Q

Genetics involved in schizophrenia

A 
KCNH2
DTNBP1
NRG1
DISC1
RGS4
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8
Q 
Structural abnormalities in schizophrenia include:
Enlarged ventricles
Reduced total brain volume
Enlarged occipital lobes
Smaller frontal/temp/par lobes
A

All but enlarged occipital lobe

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9
Q 
Which of these cells are altered in schizophrenia pathology?
Pyramidal
Chandelier
Neurons
Oligodendrocytes
Astrocytes
A

All but astrocytes

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10
Q

Which neurotransmitters have dysfunction in schizophrenia?

A

DA, glut, GABA, 5-HT, ACh

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11
Q

What is the increased risk if a sibling has schizophrenia?

A

9% if sibling only,

16% if one parent + sibling

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12
Q

What is the heritability estimate of schizophrenia?

A

80%

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13
Q

What is the increased risk of schizophrenia in offspring?

A

13% if one parent,

46% if both parents

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14
Q

What are examples of common variants in schizophrenia?

A

SNPs
Tandem repeats

Account for ~30% of risk variance
8300+ variants
100 different genes

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15
Q

What are examples of rare varients in schizophrenia?

A

mutations
Unique CNVs (100+ w/ schiz ass’n)
- 22q11 via DGCR8 decrease
- DISC1 translocation (1/11)

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16
Q

Target of antipsychotic drugs

A

D2 receptor

D2 side effects:
• Extrapyramidal symptoms: Nigrostriatal pathway, parkinsonism, dystonia, akathisia, tardive dyskinesia after chronic use
• Worse negative/cognitive symptoms: mesocortical pathway
• Hyperprolactinemia, galactorrhea, amenorrhea, gynecomastia (esp risperidone)

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17
Q

Increases catecholamine via receptor blockade in the presence of MAO inhibition

A

Chlopromazine

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18
Q

Classifications of antipsychotics

A

Chemical
First/Second generation
High/low potency

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19
Q

Included in chemical class of phenothiazines

A
  • Aliphatic: chlorpromazine
  • Piperidine: thioridazine
  • Piperazine: fluphenazine, perphenazine
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20
Q

First generation antipsychotics

A

chlorpromazine, haloperidol, fluphenazine, perphenazine, thioridazine, trifluoperazine

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21
Q

Additional effects of second-generation antipsychotics

A

5-HT2a antagonism, D2 receptor affinity

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22
Q

Low potency antipsychotics have ______ side effects related to D2 blockage, _______ side effects related to non-DA receptors

A

Decreased

Increased

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23
Q

Non-DA side effects of antipsychotics

A 
Anticholinergic
Antihistamine
Alpha-1 adrenergic
QTc prolongation
Increased BP, lipids, blood sugar
Neuroleptic malignant syndrome
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24
Q

Side effects include agranulocytosis, seizure (high dose), constipation, sialorrhea, myocarditis, orthostatic hypotension + tachycardia

A

Clozapine

25
Q

Shown to be more efficacious than other antipsychotics

A

Clozapine

26
Q

Longest time to d/c in CATIE study

A

olanzapine

27
Q

FDA approved uses of antipsychotics

A 
schizophrenia
schizoaffective disorder
bipolar disorder
major depressive disorder
Tourette's syndrome
28
Q

Moderate potency antipsychotics

A

perphenazine, loxapine

29
Q

High potency antipsychotics

A

haloperidol, fluphenazine

30
Q

Low potency antipsychotics

A

chlorpromazine

31
Q

Catatonia

A

decreased reactivity to environment (negativism, rigid posturing, mutism, stupor)

32
Q

Which major NT systems involved in psychosis?

A

DA, glut, GABA, 5-HT

33
Q

Basal magnocellular corticopedal pathway involves…

A

GABA and ACh pathways

34
Q

Acute fluctuating disturbance in attention, awareness, cognition

A

Delirium

35
Q

Monitoring/volitional structures decreased during auditory hallucinations:

A

dlPFC, Cerebellum, DACingulate cortex

36
Q

Emotional regulation and attention structures upregulated during auditory hallucinations:

A

OFC, VACingulate cortex, subcortical structures

37
Q

Hyperactive in auditory hallucinations

A

Secondary auditory association cortex

38
Q

Delusion of passivity means

A

someone/somthing external is controlling you

39
Q

Thought broadcasting means

A

Others can hear your thoughts

40
Q

Misinterpreting messages from the external world

A

Reference

41
Q

Thought withdrawal means

A

Thoughts are being taken from your mind

42
Q

Circuits involved in delusions

A

Salience/reference
Agency/others
Fear/paranoia

43
Q

Abberrations in how brain circuits specify hierarchia predictions, how they compute and response

A

Delusions

44
Q

the state or quality by which it stands out relative to its neighbors

A

Saliance

45
Q

Symptom domains in Schizophrenia include

A 
Delusions
Hallucinations
Disorganized speech
Disorganized or catatonic behavior
Negative symptoms (affect, alogia, avolition)

+ Common cognitive deficits

46
Q

Structures commonly involved in all delusions

A

prefrontal cortex, midbrain

Other structures: fronto-striatal circuits, parietal cortices, amygdala, cerebellum, anterior cingulate, medial PFC

47
Q

Alterations in glut affect GABA signalling, increase in glut in PFC, overinhibition of DA.

A

True –> too little DA results in negative symptoms

48
Q

Alterations in glut affect GABA signalling, hyperactivity in NAcc and increase in DA.

A

True –> positive symptoms in schizophrenia

49
Q

Hereditibility in schizophrenia

A

up to 80%. Some environmental involvement.

50
Q

22q11 deletion

A

alters expression of multiple genes of DGCR8 (microRNA processing complex –> impact other areas of the genome)

51
Q

DISC1 (disruption of schizophrenia 1)

A

translocation between 1/11 gene, disrupts gene, produces altered protein, interaction with many pathways (Wint, Dynein, Endopeptidate, Inflammatory, Immune) –> neurodevelopment

Found in Family in Scotland, produces other mental disorders

52
Q

Schiz with shorter time period

A

schizophreniform disorder

53
Q

Schiz with low mood

A

schizoaffective disorder

54
Q

Schizophrenia is a chronic illness

A

True

55
Q

Potency is inverse to efficacy.

A

False - potency has NO relationship to efficacy.

56
Q

Likely to cause hyperprolactinemia, galactorrhea, amenorrhea, gynecomastia

A

Risperidone

+ other D2 blockades

57
Q

Antihistamine effects:

A

Weight gain

EPS clonazapine, olanzapine

58
Q

Clozapine scary SE

A

agranulocytosis (+ seizures, constipation, myocarditis, orthostatic hypotension, tachycardia)

Use only for treatment resistant schizophrenia

MOHD4: Exam 5 (23 decks)

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