Schizophrenia Flashcards
Hypnogogic and hypnopompic hallucinations
Hallucinations that happen when you’re first waking up or falling asleep. It’s a normal thing.
Schizophrenia effects not only cognition, perception, emotions, and behaviors, it also effects
socialization and eye movement
Genetics of schizophrenia
50% risk for an identical twin, 15% of non identical
40% risk if both parents have schizophrenia
A polygenic SNIP defect is suspected
Chromosomes 6p24-22 have been implicated
Neurodevelopmental theory of schizophrenia
Genetic defects can cause abnormal cell development, connection, organization, and migration.
These include inadequate synapse formation, excessive pruning of synapses, and excitotoxic death of neurons.
There can be intrauterine insults like toxins, O2 deprivation, malnutrition, substance abuse, etc.
Brain abnormalities in schizophrenia
Enlarged ventricles
Reduced symmetry in the temporal, frontal, and occipital lobes
Smaller frontal and temporal lobes
Cortical atrophy
Decreased cerebral blood flow
Hippocampal and amygdala redurection
Neurotransmitter differences in schizophrenia
Too much DA in the mesolimbic pathway
Not enough DA in the mesocortical pathway
Too much glutamate
Not enough serotonin and GABA
Risk factors
Urban born First born Poor Born in winter or early Spring More common in men Prenatal exposure to flu or virus malnutrition Obstetrical complications CNS infection in early childhood
schizophrenia gender differences
men’s onset is 18 to 25
They have more negative symptoms, worse prognosis, more hospitalizations, and less response to meds
women’s onset is 25 to 35
They have less premorbid dysfunction, more dysphoria than men, more likely to have paranoid delusions and hallucinations
Earlier age of onset
Tend to be male Worse premorbid functioning More brain abnormalities More negative symptoms More cognitive symptoms Worse prognosis
Positive symptoms are caused by
Too much DA in the mesolimbic pathway
Negative symptoms are caused by
Not enough DA in the mesocortical pathway
The most debilitating symptoms are
negative
What happens with the different kinds of symptoms over time
Positive symptoms decrease, negatives remain
Things that give you a good prognosis
Family history of mood disorder, but no family history of schizophrenia
High level of premorbid functioning Acute onset Later age of onset Clear precipitating event Married/Good support system Positive symptoms Getting treatment quickly Absence of brain abnormalities
Physical exam findings of schizophrenia
Abnormal smooth pursuit eye movements
Abnormal saccadic eye movement
Poor eye-hand coordination (clumsy or awkward)
Astereognosis Twitches, tics, rapid eye blinking Dysdiadochokinesia Impaired fine-motor movement Left-right confusion Mirroring
Weakness
Decreased reflexes
Highly arched palate
Narrow or wide set eyes
Subtle ear malformations
A more detailed look at structural abnormalities of the schizophrenic brain
Enlargement of lateral ventricles
Widened cortical sulci
Diffuse decrease in volume of gray and white matter
Decreased volume of temporal lobe
Decreased volume in hippocampus, amygdala, and thalamus
Functional changes in the schizophrenic brain
Hypofrontal
Decreased cerebral blood flow and metabolism
Diffuse hypometabolic action in cortical-subcortical circuitry
2nd gen mode of action
Normally, serotonin binds to 5HT2a on DA neurons, which means it further shuts off the release of DA.
The second gens antagonize (block) the 5HT2a receptors on DA neurons, which increases DA in the nigrostriatal, tuberoinfundibular, and mesocortical pathways.
What do 2nd gens do in the mesolimbic pathway
It blocks DA, which decreases positive symptoms
What do 2nd gens do in the mesocortical pathway
The increase DA, which helps with negative symptoms
What do 2nd gens do in the nigrostriatal pathway
DA has a reciprocal relationship with ACh. When serotonin is blocked by the 2nd gen, DA increases, which means ACh decreases. Because there is less ACh, you have less EPS (EPS is caused by too much ACh, which is why we give ANTIcholinergics)
What do 2nd gens do in the tuberoinfundibular
DA inhibits prolactin. The blockade of DA by 2nd gens causes prolactin to increase, causing galactorrhea and gynecomastia.
Hyperprolactinemia associated with the antipsychotics may cause sexual problems, galactorrhea, amenorrhea, gynecomastia, and bone demineralization in postmenopausal women not on estrogen.
The 5 components of EPS
Akathisia
Akinesia- opposite of akathisia, you can’t move
Dystonia
Pseudo-parkinsons
TD
Overview of how 1st gens work
They improve positive symptoms by blocking DA in the mesolimbic pathway, but they might actually make negative symptoms worse by blocking DA in the mesocortical.
