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Psychiatry > Psychosis: Basic Science > Flashcards

Psychosis: Basic Science Flashcards

1
Q

What are the positive symptoms of schizophrenia?

A

Delusions
Hallucinations
Thought disorder

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2
Q

What are the negative symptoms of schizphrenia?

A

Apathy
Lack of volition
Social withdrawal
Cognitive impairment

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3
Q

What are schnieders first rank symptoms in schizphrenia?

A 
Thoughts spoken aloud
Running commentary
Third person voices
Delusional perception
Passivity phenomena
Though withdrawal
Thought broadcasting
Thought insertion
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4
Q

What is the suicide rate of schizophrenia?

A

10 - 15%

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5
Q

What symptoms predict a better prognosis in schizophrenia?

A

Older age of onset
Female gender
Marked mood disturbance esp elation
Family history of mood disorder

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6
Q

What symptoms predict a poorer prognosis in schizophrenia?

A 
Longer duration of untreated psychosis
Poor pre-morbid adjustment
Insidious onset
Early onset  -  childhood / adolescence
Cognitive impairment
Enlarged ventricles
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7
Q

What in - utero factors are thought to increase the likelihood of schizophrenia?

A

2nd trimester viral illness

Obstetric such as pre eclampsia. fetal hypoxia and emergency caesarian section

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8
Q

What kind of childhood infection increases the risk of schizophrenia by 50%?

A

Viral CNS infection

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9
Q

What is seen on a brain scan of patients with schizophrenia (mostly in patients with a poorer prognosis)

A
  1. Reduced frontal lobe volume
  2. Reduced frontal lobe grey matter
  3. Enlarged lateral ventricle volume
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10
Q

In schizophrenia are the brain changes seen a reduction in grey or white matter?

A

Grey

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11
Q

What causes the grey matter loss seen in schizophrenia?

A

Reduced arborisation - the neurones have less connections/synapses (NOT less neurones)

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12
Q

Where is most of the grey matter loss in patients with schizophrenia?

A

Temporal cortex (especially the superior temporal gyrus)
Medial temporal lobe (especially the hippocampus)
Also see in orbitofrontal cortex, parietal cortex and basal ganglia.

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13
Q

Overactivity of which neurotransmitter pathway is thought to be related to schizophrenia?

A

Dopamine

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14
Q

What pathway do amphetamines work on?

A

D2 receptor pathway

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15
Q

What channel do dopamine receptors block?

A

D2

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16
Q

What do the D1 family receptor pathways do?

A

Stimulate cAMP

17
Q

What do the D2 family receptor pathways do?

A

Inhibit adenylyl cyclase
Inhibit voltage activated calcium channels
Open pottassium channels

18
Q

Name a drug that is a D2 channel agonist?

A

Bromocriptine

19
Q

Name a drug that is a D2 receptor antagonist?

A

Haloperidol

Raclopride

20
Q

Name a drug that is a D4 receptor antagonist?

A

Clozapine

21
Q

What side effects do you get with typical anti - psychotics?

A 
"Extra Pyramidal side effects"
- Acute dystonic reaction
- Parkinsonism
- Akathisia
- Tardive dyskinesia
Hyperprolactinaemia
22
Q

What are the typical anti psychotics?

A

Chlorpromazine
Fluphenazine
Haloperidol
Zuclopentixol

23
Q

A women with well controlled schizophrenia present to her GP. She says her husband has noticed that her mouth is moving in funny ways and her lips keep smacking together.. What has she got and what drug is most likely causing this?

A

Tardive dyskinesia.

Caused by typical anti psychotics such as haloperidol and chlorpromazine.

24
Q

What side effects can anti psychotics causing D2 blockade cause?

A

Hyperprolactinaemia (causing low sex drive, gynaecomastia, galactorrhea)

25
Q

What are the main differences between typical and atypical anti psychotics?

A
  • Atypicals are less likely to cause extra pyramidal side effects
  • They have a higher 5 HT2A to D2 ratio (in terms of blockade)
26
Q

List some atypical anti - psychotics

A

Olanzapine, risperidone, quetiapine, clozapine, aripiprazole, amisulpride

27
Q

What is the main adverse affect of 5HT - 2 blockade?

A

Metabolic syndrome (weight gain)

28
Q

What is the main side effect of histamine blockade?

A

Sedation

Increased appetitie

29
Q

What are the two main side effects of cloazapine

A

Excess drooling

Agranulocytosis

30
Q

How often do you need to take a full blood count when a patient is on clozapine?

A

Weekly for the first six months
Fortnightly for the next six months
Every four weeks thereafter
For one month after cessation of clozapine

31
Q

How do you measure white matter tracts in the brain?

A

Diffusions tensor imaging

32
Q

What do you measure in diffusion tensor imaging and what do these results mean?

A

Fractional anisotropy: higher numbers mean healthy white matter tracts
Mean diffusivity: higher numbers = less healthy WM tracts

33
Q

When does the ventricular development seen in schizophrenia develop and how does it progress?

A

Ventricular development is present at diagnosis and is non progressive

34
Q

In the dopaminergic pathway; what does the tuberoinfundibular pathway do?

A

Controls prolactin release

35
Q

In the dopaminergic pathway; what does the mesolimbic/cortical pathway do?

A

Motivation and reward systems

36
Q

In the dopaminergic pathway; what does the nigrostriatal pathway do?

A

Extrapyramidal motor system

37
Q

What is the difference in the neurobiological targets of atypical and typical antipsychotics?

A

Atypical have a higher 5HT2A to D2 ratio than typical antipsychotics

38
Q

Are typical or atypical antipsychotics more likely to cause weight gain?

A

Atypical

39
Q

What is agranulocytosis? What antipsychotic puts you most at risk of this?

A

When bone marrow fails to make enough granulocytes (these are WBCs that release granules such as basophils, eosinophils and neutrophils)
Clozapine

Psychiatry (24 decks)

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