Psychotic disorders (Schizophrenia) - Law Flashcards
What are 5 symptoms/categories of symptoms associated with schizophrenia?
What are the diagnostic criteria associated with these symptoms?
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms such as affective flattening
2 symptoms for 1 month, or a 6 month duration (unclear in notes)
What are positive symptoms? What it the other term for positive symptoms?
Hallucinations, delusions
Type 1 symptoms.
What are negative symptoms? What it the other term for negative symptoms
Thought disorder
Language disorders
Affective flattening or incongruity
Type II symptoms.
What is the prevalence of schizophrenia?
How does this change if you have a family member with the disorder?
1% in the general population
1st degree relative: 10%
Monozygotic twin: 70%
What is the proposed inheritance of schizophrenia? Give some big-picture concepts.
(a) Genetic effects are important risk factors for the
disorder
(b) Schizophrenia is not completely caused by genes, it is a multifactorial trait, with non-genetic (or environmental) factors
(c) Patterns of transmission in families are inconsistent with single gene of large effect, complex trait influenced by a large number of genes, which produce a modest individual increase in risk.
What are some specific examples of genetic associations with schizophrenia (categories, not specific loci/genes).
Low yield?
1) Copy Number Variants (dysregulation of GABA, GLUtaminergic neurons)
2) Small nucleotide polymorphisms (MHC)
3) Growth factors
4) Spontaneous mutations in genes important during fetal life
What are some environmental factors thought to contribute to schizophrenia?
- Season of birth (winter)
- Prenatal nutrition (lacking)
- Prenatal infection
- Pregnancy and birth complications/obstetric events
- Social biology (migration, urbanicity etc.)
- Drug abuse, marijuana use
What was an imaging finding that is highly consistent across multiple studies?
Increased size of lateral ventricles.
True or false: many drugs can mimic schizophrenia?
True. (Cocaine, Ketamine, phencyclidine (PCP), LSD, amphetamines, atropine)
[At a neurobiological level, all of these drugs increase the response of the brain to stimuli, either by exciting principal neurons or inhibiting interneurons.]
What is the dopamine theory of schizophrenia?
What two pathways are involved, and what symptoms result from dysregulation of each?
Mesolimbic system: VTA neurons that release dop onto the nucleus accumbens. This system regulates reward pathways. HYPERactivity of this system is assx with the positive symptoms of schizophrenia.
Mesocortical system: VTA neurons release dopamine onto the dorsal lateral prefrontal cortex (the part responsible for executive function). Substantia nigra neurons release dop onto the basal ganglia. HYPOactivity of this system is assx with the negative symptoms of schizophrenia.
What is cited as evidence that dopamine is implicated in schizophrenia?
Low yield.
- high doses of L-dopa can induce psychosis
- all medications that treat psychosis are dopamine blockers
-amphetamines hyperactivate the mesolimbic
system–>paranoid delusions, hallucinations, etc.
What is the glutamate model of schizophrenia?
Glutamate binds dopaminergic neurons and causes mesolimbic HYPERactivity and mesocortical HYPOactivity.
NMDA antagonists (PCP, Ketamine) exacerbate and cause schizophrenic symptoms, both positive and negative.
Which drugs are more efficaceous, 1st or 2nd generation? Which are more prescribed and why?
same efficacy, fewer sfx with 2nd generation drugs. They are more prescribed for this reason.
What was the first agent used to treat schizophrenia?
What are the side effects of 1st gen drugs like this one?
What is the mechanism of action?
Chlorpromazine.
Extra-pyramidal signs (parkinsonism, dystonias)
Weight gain
Cramping
Dry mouth
D2 antagonists
What are the sfx of second generation drugs?
What is an example of a 2nd gen drug?
- Weight gain/metabolic side effects
- Hypercholesterolemia
- Diabetes mellitus
- agranulocytosis
Clozapine
