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Years 1+2 > S3C8 (2.0) > Flashcards

S3C8 (2.0) Flashcards

1
Q

How do you treat acute psychotic episodes?

A

Short acting antipsychotics (e.g. Olanzapine)

Mood stabiliser for acute mania (e.g. Lithium, valproate, carbamazepine)

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2
Q

What is the first-line treatment for schizophrenia?

A

Second-generation antipsychotics (e.g. Olanzapine, risperidone, quetiapine)
Good at treating positive symptoms

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3
Q

What is the treatment for schizophrenia for patients with poor adherence?

A

First-generation antipsychotics in depot form (e.g. Fluphenazine, haloperidol, chlorpromazine)

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4
Q

When should clozapine be given to patients?

A

For treatment resistant schizophrenia

Persistent positive symptoms despite trials lasting over 6 weeks of 2 different antipsychotics at their maximum doses

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5
Q

What are all antipsychotics?

A

Reversible antagonists at D2 dopamine receptors

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6
Q

What is the threshold for antipsychotic efficacy?

A

65% D2 receptor occupancy

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7
Q

What is the D2R occupancy patterns for resperidone and olanzapine?

A

Relatively sustained over 24 hours.

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8
Q

What are the adverse effects of D2 antagonism?

A

Nigrostriatal motor pathway – Extrapyramidal side effects (EPSE) – Parkinsonism.
Mesolimbic pathway – excessive blockade leads to worsening of the negative symptoms.
Mesocortical pathway – may exacerbate low dopamine, leading to deterioration in cognitive function.
Tuberoinfundibular pathway – hyperprolactinaemia secondary to antipsychotics.

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9
Q

At what efficacy to D2 antagonism side effects occur?

A

> 72% D2 receptor occupancy

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10
Q

What does 5-HT2A receptor blockade result in? (schizophrenia)

A

Decreased risk of extrapyramidal symptoms, likely by increasing dopamine release from the frontal cortex, and not the nigrostriatal tract

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11
Q

What is the MOA for risperidone?

A

Blockade of D2 receptors in the ventral striatum, alleviating positive symptoms of schizophrenia.
Blockade of 5-HT2receptors in the mesocortical tract, causes an excess of dopamine, resulting in an increase in dopamine transmission, and an elimination of core negative symptoms.

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12
Q

What are the side effects of risperidone?

A 
Hypotension
Weight gain
Rash
Vomiting
Constipation
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13
Q

What is clozapine?

A

Atypical antipsychotic

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14
Q

What are the side effects of clozapine?

A

Sedation
Hunger
Hypersalivation
Diabetes

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15
Q

What is the main psychoactive substance in cannabis?

A

Δ-9-tetrahydrocannabinol (THC)

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16
Q

What does smoking cannabis lead to?

A

Decreased BP
Bloodshot eyes
Feeling dizzy
Increased appetite

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17
Q

What are the types of cannabinoid receptors?

A

CB1 receptors – mediate most effects of cannabinoids on the CNS (also in the lungs, liver and kidneys).
CB2 receptors – found in the PERIPHERY and are expressed mainly in the immune system and in hematopoietic cells.

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18
Q

What is the role of CB1 receptors?

A

These are involved in physiological processes such as appetite, pain-sensation, mood and memory.
These receptors are responsible for the euphoric and anticonvulsive effects of cannabis.

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19
Q

What are cannabinoid receptors activated by?

A

Plantcannabinoids – THC – through the production of an endocannabinoid (a ligand known as anadamide)
Endocannabinoids (produced by humans)

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20
Q

What is the MOA of THC?

A

Increases the release of dopamine in the brain.
This causes stimulation of the D2 dopamine receptors in the striatum.
This causes an increase in the formation and release of a ligand called anandamide.
Anandamide activates cannabinoid receptors.
This leads to the euphoria.

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21
Q

What is the role of endocannabinoids?

A

Used in retrograde signalling between neurons, in to temporarily reduce the amount of conventional neurotransmitter released

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22
Q

Where are endocannabinoids produced?

A

Post-synaptic GABA neurons

Their production is Ca2+ dependent

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23
Q

What is the anticonvulsive MOA of endocannabinoids

A

Intense firing of corticostriatal neurones leads to release of glutamate which causes as influx of Ca2+ ions in the post-synaptic membrane.
Constant glutamate release causes Ca2+ ions to build up in the post-synaptic membrane.
This accumulation causes Ca2+ ions to synthesise endocannabinoids in the medium-sized striatal spiny neurones.
These stimulate CB1 receptors on the pre-synaptic corticostriatal fibres leading to a decreased release of glutamate.

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24
Q

What is patient compliance?

A

The extent to which a person’s behavior coincides with the medical advice he/she has received
adhering to < 70% of prescribed medication during the last week

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25
Q

What amount of schizophrenic patients are fully complaint with therapy

A

A third are fully compliant with therapy.
Another third are partially compliant, meaning that they will either reduce the dose of the drug prescribed or fail to take drugs from time to time
The final third of patients do not follow prescription instructions at all.

26
Q

What does partial compliance in schizophrenia increase?

A

Psychotic symptoms
The risk of relapse and rehospitalisation
Suicide.

27
Q

What 3 things lead to compliance in Ley’s model of compliance?

A

Understanding
Satisfaction
Memory

28
Q

What does section 5(2) of the MHA allow?

A

A consultant or their “nominated deputy” to detain an inpatient for 72h until further assessed

29
Q

What does section 5(4) of the MHA allow?

A

A nurse to detain an inpatient for 6h

30
Q

What does section 2 of the MHA allow?

A

2 doctors (either both trained as prescribed in Section 12 of the Act, or one “section 12 approved” psychiatrist and the patient’s GP) and an “Approved Mental Health Professional” (usually a social worker) to detain anyone in hospital for 28 days for assessment (including assessing response to treatment) if they believe they might have a mental illness of “sufficient nature and degree” and are at risk of harming themselves or others

31
Q

What does section 3 of the MHA allow?

A

The same professionals to detain someone in hospital for 6 months for treatment if they definitely have a specific mental illness that causes a risk to others or their own “health or safety” and there is appropriate treatment available.

32
Q

What are the functional subdivisions of the striatum?

A

Sensorimotor - Putamen
Associative - Globus Pallidus
Limbic/Ventral - Ventral Tegmental Area

33
Q

What are the 4 dopamine pathways?

A

Tuberoinfundibular
Mesolimbic
Mesocortical
Nigrostriatal

34
Q

What is the tuberoinfundibular pathway?

A

From the arcuate nucleus to the median eminence

Dopamine release inhibits prolactin secretion from the anterior pituitary

35
Q

What is the mesolimbic pathway?

A

the VTA to the nucleus accumbens and olfactory tubercle

Controls the reward system on the brains (i.e. Pleasure, positive reinforcement)

36
Q

What is the mesocortical pathway?

A

VTA to the prefrontal cortex

Controls executive function

37
Q

What is the nigrostrital pathway?

A

From substantia nigra to striatum

Controls movement

38
Q

What dopamine pathway is responsible for the negative symptoms of schizophrenia?

A

Mesocortical

39
Q

What dopamine pathway is responsible for the positive symptoms of schizophrenia?

A

Nigrostriatal - associative striatum

40
Q

What are the 2 dopamine receptor family?

A

D1 - activate adenylyl cyclase

D2 - inhibit formation of cAMP by inhibiting adenylyl cyclase

41
Q

Where are the D1 receptors located?

A

Motor striatum
Associative striatum
Ventral striatum
Cerebral cortex

42
Q

Where are the D5 receptors located?

A

Hippocampus

Hypothalamus

43
Q

Where are the D2 receptors located?

A

Motor striatum
Associative striatum
Ventral striatum

44
Q

Where are the D3 receptors located?

A

Hippocampus
Associative striatum
Ventral striatum
Amygdala

45
Q

Where are the D4 receptors located?

A

Frontal Cortex
Medulla
Midbrain
Amygdala

46
Q

What is glutamates role in schizophrenia?

A

NMDA receptor hypofunction is a model for symptoms of schizophrenia.
Hypoactivity of NMDA receptor function → excessive glutamate release which leads to glutamate excitotoxicity → impaired neuronal development → worsening of schizophrenia and progression.

47
Q

What is the UK prevalence of schizophrenia?

A

0.4%

48
Q

What is the age of onset for schizophrenia?

A

Men: typically early 20s
Women: typically late 20s
Can get very late onset (>60) - make up 25% of total incidence but hard to distinguish from organic disorders and dementia

49
Q

What are the environmental risk factors of schizophrenia?

A 
Child sexual abuse
Taken into care
Migration
Peri-natal oxygen deprivation
Maternal starvation while in utero
Urban living, over crowding
Parental separations
General deprivation as a child
Stress
Cannabis use
50
Q

What are the 3 groups of genes linked to schizophrenia?

A

Connected to glutamate, dopamine or GABA neurotransmitter function
Connected to neuronal structure (often at synapses), plasticity or general synaptic function
Connected to inflammatory/immune response

51
Q

What are the % increase of risk of schizophrenia depending on family relations also having schizophrenia?

A 
First-degree relative - 7%
Second-degree relative - 2-3%
Dizygotic twins - 10%
Monozygotic twins - 45%
Both parents - 40%
52
Q

What % of schizophrenic patients present with psychosocial dysfunction?

A

> 30%

53
Q

What are the predictive factors for an unfavourable course of schizophrenia?

A 
FH
Early onset
Poor network of social support
Male
Slow onset of illness
More negative symptoms
Concomitant substance use disorder
54
Q

What are the predictive factors for a favourable course of schizophrenia?

A 
Late onset
Female
Mood symptoms
Good network of social support
Acute onset of illness
More positive symptoms
55
Q

What % of schizophrenic patients with attempt suicide?

A

50%

56
Q

What are the positive symptoms of schizophrenia?

A

Hallucinations
Delusions
Illusions
Disorganised thought and speech

57
Q

What are hallucinations?

A

A perceptual abnormality, in which sensory experiences occur in the absence of external stimuli

58
Q

What are delusions?

A

Fixed, false beliefs that are not amenable to reason, despite evidence to the contrary

59
Q

What are illusions?

A

A perceptual abnormality, in which real external stimuli are misinterpreted

60
Q

What is the diagnostic criteria for schizophrenia?

A 
>=2 for atleast 1 month
Delusions
Hallucinations
Disorganised speech
Grossly disorganised or catatonic behaviour
Negative symptoms
61
Q

What is the aim of the EIS

A

Detect emergent symptoms
Reduce the duration of untreated psychosis (DUP)
Improve access to effective treatments, particularly in the ‘critical period’ (first 3-5 years following onset).

62
Q

What is catatonia?

A

A behavioural syndrome characterised by abnormal movements and reactivity to the environment

Years 1+2 (21 decks)

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