Psychosis and Schizophrenia

Question 1

What is psychosis?

Answer 1

Altered perception of reality. the person has difficulty distinguishing reality from what is not real

Question 2

What is the most common cause of psychosis?

Answer 2

Schizophrenia.

the most important symptoms of psychosis are hallucinations and delusions

a serious mental health condition that affects how people think, feel and behave.

Question 3

List some other conditions that can cause psychosis.

Answer 3

• Bipolar disorder
• Severe depression
• Drug or alcohol abuse

Question 4

What are hallucinations?

Answer 4

Sensory experiences in the absence of external stimuli. A perception of having seen, heard, touched, tasted or smelled something that wasn’t actually there.

Question 5

What are delusions?

Answer 5

Unsubstantiated(not supported or proven by evidence) beliefs.

Question 6

What percentage of people diagnosed with schizophrenia experience hallucinations?

Answer 6

Over 60%.

Question 7

What is the most common type of hallucination?

Answer 7

Auditory hallucinations, so for example hearing voices…etc

very real to people

Question 8

symptoms of schozphrenia are characterised into 2 , name them

Answer 8

positive and negative

symptoms could be cognitive as well, meaning they impair the mental capacity or abilities of the subject

Question 9

What are positive symptoms in schizophrenia?

Answer 9

they are Active, noticeable behaviours not present in normal or healthy subjects.

Question 10

What are negative symptoms in schizophrenia?

Answer 10

refers to the Absence or lessening of normal behaviours that are present in a healthy subject.

Question 11

List some positive symptoms of schizophrenia.

Answer 11

• Delusions
• Hallucinations
• Distortion of language
• Disorganised speech + behaviour
• Catatonic behaviour
• Agitation

Question 12

List some negative symptoms of schizophrenia.

Answer 12

• Blunted affect
• Emotional + social withdrawal
• Avolition (lack of desire)
• Alogia (lack of speech)
• Anhedonia (loss of joy)
• Poor rapport, passivity
• Stereotyped thinking

Question 13

What is paranoia?

Answer 13

Irrational belief or perception that others wish to cause harm. may be associated with delusions or auditory
hallucinations related to a theme that somebody is persecuting or
harassing them

this and inappropriate effect(the extent to which a person’s emotional expressiveness fails to correspond to the content of what is being discussed) are some other features of schizophrenia.

Question 14

What characterizes disorganized schizophrenia?

Answer 14

Disorganized speech, behaviour, and flat or inappropriate affect.

Question 15

What is catatonic schizophrenia?

Answer 15

Motoric immobility or excessive activity, extreme negativism, peculiar movements.

Catatonic behavior is a set of symptoms that affect a person’s ability to move, speak, and respond to their environment. It’s a rare psychomotor disorder that can last from hours to years.

Question 16

What is the typical onset age range for schizophrenia?

Answer 16

18-24 years.

Question 17

What percentage of schizophrenia patients attempt suicide?

Answer 17

25-50%.

Question 18

True or False: Psychosis is more prevalent in urban areas than rural areas.

Answer 18

True.

due to a combination of social stressors associated with city life, including high population density, social fragmentation, socioeconomic deprivation, limited access to green spaces, increased noise pollution, and exposure to environmental pollutants, which can all contribute to increased psychological stress and potentially trigger psychotic symptoms in individuals with a genetic predisposition to psychosis.

Question 19

What are some environmental factors that can increase the risk of developing psychosis?

Answer 19

• Stressful life events
• Drug abuse
• Viral infections

Question 20

What is the neurodevelopmental hypothesis regarding schizophrenia?

Answer 20

The disease is due to a malfunction in the development of the brain.

Question 21

What is the neurodegenerative hypothesis regarding schizophrenia?

Answer 21

Ongoing neurodegenerative processes with loss of neuronal function during the course of the disease.

from google: The neurodegenerative hypothesis of schizophrenia proposes that the symptoms of schizophrenia, particularly in chronic cases, are at least partially caused by a progressive degeneration of brain tissue, similar to other neurodegenerative diseases, rather than solely arising from abnormal brain development during early life (neurodevelopmental hypothesis); essentially suggesting that the brain continues to deteriorate over time in individuals with schizophrenia, leading to worsening symptoms

Question 22

List some prenatal risk factors for schizophrenia.

Answer 22

• Maternal rubella
• Genital/reproductive infection
• Folic acid deficiency
• Iron depletion
• Maternal deprivation

Question 23

What is the main neurotransmitter traditionally linked to psychosis?

Answer 23

Dopamine.

Question 24

What are the two main types of antipsychotic drugs?

Answer 24

• 1st generation (typical antipsychotics)
• 2nd generation (atypical antipsychotics)

Question 25

How do 1st generation antipsychotics primarily work?

Answer 25

By blocking dopamine D2 receptors in the CNS.

Question 26

What is a common side effect of D2 receptor blockade in antipsychotic treatment?

Answer 26

Extrapyramidal symptoms (EPS). Extrapyramidal side effects (EPS) are movement disorders that can be caused by certain drugs, particularly antipsychotics

Question 27

What percentage of neurons in the striatum are large cholinergic interneurons?

Answer 27

2-3%.

Question 28

What is the role of anticholinergic agents in treating motor side effects of antipsychotics?

Answer 28

They alleviate motor side effects.

Question 29

What is galactorrhea?

Answer 29

Spontaneous breast milk production.

Question 30

Fill in the blank: The average treatment lag from onset of symptoms to onset of treatment in epilepsy is _______.

Answer 30

one year.

Question 31

What are common side effects of antipsychotic medications?

Answer 31

Dry mouth, blurred vision, constipation, cognitive impairment, weight gain, drowsiness, sedation, sexual/fertility dysfunction ## Footnote Many patients discontinue treatments due to these side effects.

Question 32

What is the action of 5-HT2A receptors in schizophrenia?

Answer 32

5-HT2A receptors are dopamine brakes, regulating dopamine release ## Footnote 5-HT1A acts as a dopamine accelerator. High dopamine levels can contribute to positive symptoms in schizophrenia, like hallucinations and delusions

Question 33

True or False: Atypical antipsychotics primarily act on dopamine D2 receptors.

Answer 33

True ## Footnote They also have relatively high affinity for 5-HT2A receptors.

Question 34

What distinguishes atypical antipsychotics from typical antipsychotics?

Answer 34

Atypical antipsychotics antagonize both 5-HT2A and D2 receptors, with improved efficacy in treating negative and cognitive symptoms ## Footnote They also have a low propensity to cause acute extrapyramidal side effects. Typical antipsychotics primarily work on dopamine receptors alone

Question 35

Fill in the blank: A common side effect of typical antipsychotics is _______.

Answer 35

extrapyramidal symptoms (EPS)

Question 36

What is the role of glutamate in schizophrenia?

Answer 36

Glutamate dysfunction may relate to altered migration, synaptic organization, and cell survival ## Footnote Both underactivation and overactivation can lead to significant neurological issues. Research suggests that NMDA receptor (a glutamate receptor) hypofunction could contribute to various schizophrenia symptoms including positive (hallucinations, delusions), **negative (flat affect, alogia)**, and cognitive impairments. Note that glutamate dysfunction is more likely to cause negative symptoms , based on the “glutamate hypothesis”.

Question 37

What is a significant finding regarding NMDA receptors in schizophrenia?

Answer 37

Deficits in NMDA receptor function are associated with dopamine dysregulation ## Footnote NMDA receptor antagonists can induce schizophrenia-like symptoms.

Question 38

What is the hypo-glutamatergic hypothesis?

Answer 38

It suggests that NMDA receptor hypoactivation leads to neurotoxicity and cognitive disruption ## Footnote This affects GABAergic, serotonergic, and noradrenergic neurons.

Question 39

What should be monitored when prescribing clozapine?

Answer 39

Agranulocytosis (severe leukopenia) ## Footnote Clozapine is indicated for suicidality in schizophrenia.

Question 40

What is the therapeutic effect occupancy level for D2 receptors with antipsychotic drugs?

Answer 40

About 80% occupancy ## Footnote 60-80% for second generation antipsychotics This suggests that secondary effects may be more important than direct D2 receptor block. Occupancy level refers to the percentage of receptors that a drug binds to at a given time. In the case of D2 receptor occupancy with antipsychotic drugs, it represents how many of the brain’s dopamine D2 receptors are occupied (blocked) by the drug

Question 41

What are potential non-pharmacological treatments for schizophrenia?

Answer 41

Cognitive behavioral therapy, electroconvulsive therapy ## Footnote Cognitive behavioral therapy is suitable for all patients, while electroconvulsive therapy is controversial. Electroconvulsive therapy (ECT) is a psychiatric treatment that uses electric pulses to cause a brief seizure in the brain

Question 42

What are the pharmacological guidelines for starting antipsychotic treatment?

Answer 42

Start low and titrate up, change medication after 4-6 weeks, avoid loading doses ## Footnote Combination therapies should not be initiated except when changing medications. a loading dose is an initial higher dose of a drug that may be given at the beginning of a course of treatment before dropping down to a lower maintenance dose. A loading dose is most useful for drugs that are eliminated from the body relatively slowly. Loading doses achieve therapeutic levels quicker

Question 43

What is the impact of 5-HT1A receptor partial agonism in second-generation antipsychotics?

Answer 43

5-HT1A receptor partial agonism can potentially improve the treatment of negative symptoms and cognitive deficits in schizophrenia by enhancing dopamine release in the prefrontal cortex, potentially leading to better cognitive function and reducing extrapyramidal side effects, while also having a positive impact on anxiety symptoms associated with psychosis ## Footnote Examples include Ziprasidone and Aripiprazole.

Question 44

What is a key characteristic of the second-generation antipsychotics?

Answer 44

They have a superior and broader spectrum of antipsychotic efficacy compared to classical antipsychotics ## Footnote They also have minimal elevation of prolactin levels.

Question 45

severe psychiatric diseases are characterised by?

Answer 45

Abnormal motor behaviour Disturbances of the mental state (perception) Disturbances of emotional state of the individual (e.g. social relationship)

Question 46

which parts of the brain are proven to be activated during hallucinations

Answer 46

the ones that are activated by actual stimuli such as auditory hallucinations (the primary auditory cortex), the hippocampus, the amygdala and various regions within the frontal lobe

Question 48

some cognitive symptoms of schizophrenia

Answer 48

impairment of; Speed of Processing Attention/Vigilance Working Memory (verbal) Verbal Learning Visual Learning Working Memory (nonverbal) Social Cognition Reasoning and Problem Solving

Question 49

the three subtypes of schizophrenia

Answer 49

paranoid, disorganised and catatonic schizophrenia

Question 50

dopamine functions

Answer 50

Reward: Dopamine is involved in the brain's reward system, causing feelings of pleasure, satisfaction, and motivation. Movement: Dopamine controls movement. Learning: Dopamine is involved in learning and attention . Mood: Dopamine affects mood. Memory: Dopamine plays a role in memory. Sleep: Dopamine affects sleep. Concentration: Dopamine affects concentration. Pain processing: Dopamine affects pain processin