Schizophrenia

Question 1

What is the dopamine theory of schizophrenia?

Answer 1

Dopamine found to act as a neurotransmitter involves in symptoms of schizophrenia
The pathway produces the most distressing symptoms, functional impairment

Question 2

Is schizophrenia a purely dopamine problem?

Answer 2

No!

Question 3

Which pathway for schizophrenia do you want to target?

Answer 3

Mesolimbic dopaminergic pathway

Question 4

Limbic system is for

Answer 4

Behavioural and emotional: feeding, fight or flight, protection

Question 5

________ dopaminergic pathway is affected in Parkinson’s

Answer 5

Nigrostriatal

Question 6

What is the ideal antipsychotic

Answer 6

Pure D2 antagonist, only in the mesolimbic pathway

Question 7

Glutamatergic hypothesis of schizophrenia

Answer 7

Altered NMDA receptor subunit expression (ketamine can induce psychotic symptoms, as well as dissociation and indifference)

Question 8

What % of dopaminergic receptors do you want to block?

Answer 8

60-80%

Question 9

What are some dopaminergic side effects?

Answer 9

Extrapyramidal side effects Neuroleptic malignant syndrome
Hyperprolactinaemia
Akathesia/restless legs

Question 10

Extra pyramidal side effects examples

Answer 10

Acute dystonic reaction (onset in minutes, increasing muscle tone, tongue protrusion)
Parkinsonism
Tardive dyskinesia (long term and often permanent, involuntary repetitive orofacial movements)

Question 11

In schizophrenia, there is an excess of ________

Answer 11

Dopamine

Question 12

Treat EPSE

Answer 12

Procyclidine

Question 13

Akathisia

Answer 13

Inability to sit

Pacing/poor sleep/rocking from foot to foot

Question 14

How do you treat akathisia ?

Answer 14

BB !

Benzodiazepines

Question 15

1st generation anti-psych SE vs 2nd

Answer 15

1st: EPSE
2nd: weight gain, sedation

Question 16

Best anti-psychotic, when do you use?

Answer 16

Clozapine
-ve syndrome, anti-suicidal
SIGNIFICANT SIDE EFFECTS!

Question 17

Side effects of clozapine

Answer 17

Agranulocytosis !!!
Lowered seizure threshold
Myocarditis 
Constipation 
Weight gain 
Sedation 
Sialorrhea

Question 18

1st line antipsychotic

Answer 18

2nd generation, then 1st or second

Question 19

Examples of first generation

Answer 19

Chlorpromazine

Haloperidol

Question 20

Examples of 2nd generation

Answer 20

Clozapine
Olanzapine
Risperidone
Paliperidone

Question 21

Inheritance % of schizophrenia

Answer 21

78

Question 22

During pregnancy, what would increase risk of schizophrenia?

Answer 22

2nd trimester viral illness

Pre-eclampsia, fetal hypoxia, C-section

Question 23

Risk of schizophrenia increased by 50% by childhood ___ _____ _______

Answer 23

Viral CNS infection

Question 24

Risk of psychosis is increased by substance misuse of

Answer 24

Amphetamines, cocaine, cannabis

Question 25

Schizophrenia and the brain

Answer 25

Enlarged lateral ventricles | Reduced frontal lobe volume and grey matter

Question 26

It is assumed that schizophrenia is due to ________ activity of dopaminergic activity in the brain

Answer 26

Increased

Question 27

Mesolimbic/cortical system is for

Answer 27

Emotions/reward system

Question 28

D1 receptor family action

Answer 28

Stimulates cAMP

Question 29

D2 receptor family action

Answer 29

Inhibits adylyl cyclase Inhibit Ca2+ channels Open K+ channels

Question 30

What is the most abundant dopamine receptor in brain?

Answer 30

D1

Question 31

What kind of dopamine hyperactivity leads to psychosis?

Answer 31

Subcortical

Question 32

What kind of dopamine hypo activity leads to negative and cognitive symptoms?

Answer 32

Mesocortical

Question 33

Genes involved in brain pathology of schizophrenia

Answer 33

Neuregulin Dysbindin DISC-1

Question 34

What is neurkgulin?

Answer 34

Signalling protein that mediates cell-cell interactions and plays critical roles in the growth and development of multiple organ systems

Question 35

What is dysbindin essential for?

Answer 35

Adaptive neural plasticity