Psychosis: basic sciences

Question 1

What structural brain features are seen in a patient with poor prognosis?

Answer 1

reduced frontal lobe volume
reduced frontal lobe grey matter
enlarged lateral ventricles

Question 2

What happens to grey matter volume in schizophrenic patients?

Answer 2

Reduced

Question 3

In schizophrenia, grey matter loss occurs in focal points - T/F?

Answer 3

False - widely distributed

Question 4

Neuronal loss causes the grey matter reduction in schizophrenia - T/F?

Answer 4

False - reduced arborisation causes grey matter loss.

Question 5

What imaging modality is used to investigate white matter in the brain?

Answer 5

Diffusion tensor imaging

Question 6

is it possible to diagnose schizophrenia by radiology?

Answer 6

No - normal variation in healthy brain structure precludes this.

Question 7

Is ventricular enlargement progressive when found at diagnosis?

Answer 7

No - non-progressive

Question 8

Is gliosis a common feature of schizophrenia?

Answer 8

No

Question 9

Which neurotransmitter is commonly thought to be responsible for the pathology in schizophrenia?

Answer 9

dopamine - drugs which release dopamine in the brain induce a psychotic state in man.

AMPHETAMINE

Question 10

Why can dopamine receptor antagonists be used to treat schizophrenia?

Answer 10

it is assumed that schizophrenia is related to overactivity in dopamine pathways of the brain.

Question 11

What are the 3 main dopaminergic pathways in the brain?

Answer 11

nigrostriatal

mesolithic/cortical

tuberinfundibular

Question 12

What is the function of the D1 receptor family?

Answer 12

stimulate cAMP

Question 13

What is the function of D2 receptor family? (D2,3,4)

Answer 13

inhibit adenylyl cyclase

inhibit voltage-activated Ca2+ channels

open K+ channels

Question 14

Which drugs inhibit D2 receptors?

Answer 14

haloperidol

raclopride

Question 15

Which receptors does raclopride block?

Answer 15

D2 + D3

Question 16

Where are D1 and D2 receptors found?

Answer 16

limbic and striatal areas

Question 17

Where are D5 receptors found?

Answer 17

hippocampus

hypothalamus

Question 18

Where are D4 receptors found?

Answer 18

midbrain

amygdala

Question 19

Which medication acts as an antagonist to D4 receptors?

Answer 19

Clozapine

Question 20

What happens in subcortical dopamine hyperactivity?

Answer 20

psychosis

Question 21

Which gene alterations are identified in psychotic brain pathology?

Answer 21

neuregulin

dysbindin

DISC-1

Question 22

What is neuregulins role?

Answer 22

a signalling protein that mediates cell-cell interactions and plays critical roles in growth and development

Question 23

What is the role of dysbindin?

Answer 23

essential for adaptive neural plasticity

Question 24

What is the function of DISC-1?

Answer 24

involved in neurite outgrowth and cortical development through its interaction with other proteins

Question 25

What are some examples of typical antipsychotics?

Answer 25

``` chlorpromazine thioridazine fluphenazine haloperidol primozide ```

Question 26

in antipsychotics, the blockade of D2 is immediate, and clinical effect if instant - T/F?

Answer 26

False - blockade is immediate and clinical effect is delayed.

Question 27

What is beneficial about atypical antipsychotics?

Answer 27

less likely to cause extrapyramidal side-effects better efficacy against negative symptoms effective in refractory patients

Question 28

Name some atypical antipsychotic drugs

Answer 28

``` clozapine aripiprazole risperidone quetiapine olanzapine ```

Question 29

What are some common side effects of D2 blockade?

Answer 29

EPSE Hyperprolactinaemia

Question 30

What side-effects are caused by Serotonin blockade

Answer 30

metabolic syndrome - modulate immune response and inflammation. weight gain may partially involve antagonist activity at 5-HT2C

Question 31

What side-effects are seen in histamine blockade?

Answer 31

sedation increased appetite

Question 32

What are the side-effects of alpha adrenergic blockade?

Answer 32

increased BP and HR | postural hypotension

Question 33

What effects are seen in muscarinic receptor blockade?

Answer 33

dry mouth constipation urinary retention dizziness

Question 34

What are common side effects of clozapine?

Answer 34

weight gain | tiredness

Question 35

Which serious side-effect of clozapine renders continuous monitoring appropriate?

Answer 35

agranulocytosis

Question 36

How often is a full blood count done in clozapine patients?

Answer 36

weekly for first 6m fortnightly for next 6m every four weeks thereafter for one month after stopping clozapine

Question 37

Can clozapine induce myocarditis?

Answer 37

Yes