Psychosis and schizophrenia

Question 1

When does onset of schizophrenia typically occur?

Answer 1

Early adulthood

Question 2

What is the prevalence of schizophrenia?

Answer 2

1.2%

Question 3

What percent of schizophrenia patients will typically die by suicide?

Answer 3

10%

Question 4

What are possible causes for schizophrenia?

Answer 4

Inherited risk factor
Environment
Epigenetics

Question 5

What are positive symptoms of schizophrenia?

Answer 5

Hallucinations
Delusions
Paranoia
Inappropriate emotions
Persecution complexes

Question 6

What are negative symptoms of schizophrenia?

Answer 6

Apathy
Depression
Social incompetence

Question 7

What are cognitive symptoms of schizophrenia?

Answer 7

Attentional defects
Memory loss
Executive dysfunction

Question 8

Describe the hyperactive dopaminergic theory of schizophrenia and its support

Answer 8

Increased dopamine transmission
D2 receptor agonists and dopamine in animals causes schizophrenic behaviour
There is a strong correlation between antipsychotic potency and D2 receptor blocking effects

Question 9

What doubts the hyperactive dopaminergic theory of schizophrenia?

Answer 9

There is no support for the theory in post-mortems or PET studies
No evidence to see if D2 receptors are abnormal in untreated schizophrenia
Unknown genetic aetiology

Question 10

Describe the hypoactive glutamatergic theory of schizophrenia and its support

Answer 10

Reduced glutamate in pyramidal cells
Allelic variants of Glu receptors are well documented and implicated in schizophrenia
Glutamate receptor antagonism causes positive and negative symptoms

Question 11

What evidence suggests serotonin is implicated in schizophrenia?

Answer 11

5-HT receptor antagonists are effective antipsychotics

Question 12

Describe the mechanism of typical antipsychotics

Answer 12

Selective D2 or D3 antagonism

Question 13

Which symptoms do typical antipsychotics treat?

Answer 13

Positive

Question 14

Give an example of a typical antipsychotic?

Answer 14

Chlorpromazine, haloperidol, thioridazine, flupenthixol

Question 15

Describe the mechanism of atypical antipsychotics

Answer 15

Selective D2 or D3 antagonism with added affinities depending on the drug

Question 16

Give an example of an atypical antipsychotic

Answer 16

Sulpiride, pimozide, remoxipride or clozapine

Question 17

What is the added affinity for clozapine and why is it the ‘gold-standard’ antipsychotic

Answer 17

It is a D4 receptor antagonist

Treats negative symptoms as well as positive

Question 18

What gives rise to the delayed therapeutic effect of antipsychotics?

Answer 18

Synthesis and expression of dopamine and its receptors increases to counteract the initial decrease
Initial increased firing of mesolimbic and nigrostriatal pathways

Question 19

What are side effects of anti-psychotics?

Answer 19

Sedation, apathy and indifference

Question 20

Why is it difficult to treat a patient using antipsychotics

Answer 20

Difficult to determine dosage
Individual response to different drugs
Low compliance

Question 21

Describe extrapyramidal syndrome and its treatment

Answer 21

Dopamine antagonism causes Parkinson-like syndromes

Reversed by stopping treatment or co-treatment with atropinic drugs

Question 22

Describe tardive dyskinesia

Answer 22

Choreic symptoms that develop after long-term antipsychotic use

Question 23

Describe the endocrine effects arises from taking antipsychotics

Answer 23

Dopamine inhibits prolactin production

Prolactin causes galactorrhoea, infertility and gynaecomastia

Question 24

What other side effects are common with antipsychotics?

Answer 24

Muscarinic blockade, adrenoreceptor blockade, hypothermia, weight gain, jaundice and leucopenia

Question 25

Why are atypical antipsychotics preferred, despite a lower therapeutic effect?

Answer 25

They have fewer side effects