Schizophrenia Flashcards
What is the annual incidence of schizophrenia?
1 - 1-2 / 100,000
2 - 10-20 / 100,000
3 - 100-200 / 100,000
4 - 1000-2000 / 100,000
2 - 10-20 / 100,000
What is the prevalence of schizophrenia?
1 - 4 / 1000
2 - 20 / 1000
3 - 100 / 1000
4 - 1000 / 1000
1 - 4 / 1000
What is the lifetime risk of developing schizophrenia?
1 - 1 / 1000
2 - 10 / 1000
3 - 100 / 1000
4 - 1000 / 1000
2 - 10 / 1000
- higher in deprived areas
Do men or women develop schizophrenia at a younger age?
- men
- typically 15-35 y/o
Based on monozygotic twins from a schizophrenic patient, what is the genetic susceptibility of developing schizophrenia?
1 - 4%
2 - 10%
3 - 40%
4 - 80%
3 - 40%
In psychosis there are hypothesised to be different stages of the condition. What is the prodromal phase, what does this mean?
1 - patient starts to experience changes in themselves
2 - patient is having delusions
3 - patient is having hallucinations
4 - patient has a fear of social events
1 - patient starts to experience changes in themselves
- generally gradually worsens until patient has full psychotic episode
How long does the prodromal phase in psychosis typically last?
1 - hours to days
2 - days to weeks
3 - weeks to months
4 - days to years
4 - days to years
- can vary significantly
Is identifying the the prodromal phase in psychosis important?
- yes
- could allow intervention and stopping a full blow psychotic event
It can be really useful to identify the prodromal phase in psychosis, as this could therefore be treated and limit the full blown psychotic episode. However, this can be difficult as the prodromal phase is similar to a number of other clinical presentations. Which of the following can the prodromal phase resemble?
1 - Social withdrawal & isolation
2 - Transient low intensity psychotic symptoms
3 - Irritability and anger
4 - Sleep disturbance
5 - Functional impairment
6 - Blunted affect (emotions are lower)
7 - all of the above
7 - all of the above
What is psychosis?
- a loss of boundaries with reality and loss of insight (aware that something is wrong with them)
When we talk about patients hearing voices, we can hear the examples where people say it was 2nd and 3rd person. What does 2nd and 3rd person mean in terms of psychosis?
- 2nd = when someone refers to you. For example: ‘you can wait here’
- 3rd = when you are being talked about. For example: ‘he is being unreasonable’
Patients with psychosis can experience hallucinations. What are hallucinations?
1 - patient is able to sense (hear, smell, taste etc) something that doesn’t exist, but no external stimulus
2 - patient has false and fixed belief that doesn’t keep with non social grounding
3 - loses touch with social surroundings like not there but looking from outside through glass
4 - loses touch with social surrounding and no longer interacts with society
1 - patient is able to sense (hear, smell, taste etc) something that doesn’t exist, but no external stimulus
What does it mean when a patient has insight into psychosis?
- they are aware of their condition
- they are aware what is happening (voices etc) are abnormal
- do they think their condition requires treatment
What is schizophrenia?
1 - scattered/fragmented thinking
2 - reclusive thinking
3 - hearing voices
4 - manic episodes
1 - scattered/fragmented thinking
- disorganised thinking presents as thought disorder
- located on the spectrum of psychosis
- patient may not always be able to distinguish their own thoughts and ideas from reality
In clinical practice symptoms of schizophrenia (and psychosis) are often grouped into 3 categories. Which of the following is NOT one of these categories?
1 - neutral
2 - positive
3 - negative
4 - cognitive
1 - neutral
In clinical practice symptoms of schizophrenia (and psychosis) are often grouped into 3 categories: positive, negative symptoms and cognitive symptoms. Which of the following is NOT a positive symptoms?
1 - hallucinations
2 - delusions
3 - disordered thoughts
4 - flat affect
4 - flat affect
In clinical practice symptoms of schizophrenia (and psychosis) are often grouped into 3 categories: positive, negative symptoms and cognitive symptoms. Which of the following is NOT a negative symptom?
1 - flat affect
2 - poor motivation
3 - loss of social skills
4 - thought input
5 - poverty of thought
4 - thought input
In clinical practice symptoms of schizophrenia (and psychosis) are often grouped into 3 categories: positive, negative symptoms and cognitive symptoms. Which of the following is NOT a cognitive symptom?
1 - poor attention
2 - poor memory
3 - poor planning ability
4 - inability to speak
4 - inability to speak
When trying to diagnose schizophrenia, which of the following is most important?
1 - imaging
2 - history and examination
3 - haematology/biochemistry
4 - all equally important
2 - history and examination
- typically a clinical diagnosis
- imaging and blood tests rule out other conditions
To be diagnosed with schizophrenia, according to the ICD-11 criteria, how long do symptoms need to be present for before a diagnosis can be made?
1 - 1 day
2 - 1 week
3 - 1 month
4 - 1 year
3 - 1 month
Schizophrenia (and psychosis) are illnesses characterised by a loss of boundaries with reality and loss of insight, with primary features of delusions, hallucinations, conceptual disorganisation, negative symptoms and cognitive disorder. A psychotic episode must include any of these symptoms with a significant severity, delusions, hallucinations, conceptual disorganisation, negative symptoms and cognitive disorder). How long does a psychotic episode need to last to be called a psychotic episode?
1 - 1 episode = >1 week
2 - 1 episode = >2 weeks
3 - 1 episode = >3 weeks
4 - 1 episode = >4 weeks
1 - 1 episode = >1 week
Which of the following is NOT a vulnerability factor that increases the risk of developing schizophrenia?
1 - Genetics
2 - Adverse Childhood Experiences
2 - Social Deprivation
4 - Head injury
5 - Structural brain changes
6 - Sleep deprivation
6 - Sleep deprivation
Which of the following is NOT a precipitant factor that increases the risk of developing schizophrenia?
1 - Genetics
2 - Life events (stress)
3 - Substance Misuse
4 - Sleep deprivation
5 - Trauma
6 - Social Adversity
7 - Migration
1 - Genetics
In a patient with suspected schizophrenia, how many of the following must be present
1 - hallucinations (perceptions)
2 - delusions (thoughts)
3 - disorganised thinking
4 - experience influence over their own control and influence
- > 1 must be present
- also need 1 of the following:
e) Negative symptoms
f) Grossly disorganized behaviour
g) Psychomotor disturbances such as
There are lots of differentials for schizophrenia. Which of the following is NOT one of these?
1 - delirium
2 - drug induced state
3 - OCD
4 - organic syndromes
5 - dementia
6 - personality disorder
7 - schizoaffective disorder
3 - OCD
Which 2 key neurotransmitter have been linked with the pathophysiology of psychosis?
1 - dopamine
2 - glutamate
3 - serotonin
4 - noradrenaline
1 - dopamine
2 - glutamate
What is a delusion?
1 - patient is able to sense (hear, smell, taste etc) something that doesn’t exist, but no external stimulus
2 - patient has false and fixed belief that doesn’t keep with non social grounding
3 - loses touch with social surroundings like not there but looking from outside through glass
4 - loses touch with social surrounding and no longer interacts with society
2 - patient has false and fixed belief that doesn’t keep with non social grounding
What is the difference between hallucinations vs delusions?
- BOTH are part of a false reality
- hallucination = sensory perception
- delusion = false belief
What is conceptual disorganisation?
1 - patients thought process is organised and succinct
2 - patients thought process is ok, but actions are not
3 - patients thoughts are confused/disorganised with no flow or links
3 - patients thoughts are confused/disorganised with no flow or links
- the topics they talk about do not logically link together
- patients are observed doing this but do not complain about it
Hallucinations are where someone sees, hears, smells, tastes or feels things that don’t exist outside their mind (only they experience this), with no external stimulus. Essentially patients experience a perception without a stimulus. What does it mean to have a perception, but no stimulus?
1 - neurons in brain fire, telling the brain something is there, but there is no auditory stimulus
2 - neurons in brain do not fire, but brain thinks something is there, no auditory stimulus
3 - neurons in brain fire, telling the brain something is there, with auditory stimulus
1 - neurons in brain fire, telling the brain something is there, but there is no auditory stimulus
- auditory processing of the brain is firing and hearing something
- no auditory stimulus was provided in the first place, so auditory processing of the brain is working without an auditory stimulus
Schizophrenia is a form of psychosis, where a patient may not always be able to distinguish their own thoughts and ideas from reality. Hallucinations are common, where there is no external stimulus, but the patient experiences the sensory stimulus in their own minds. What is the most common sensory hallucination in schizophrenia?
1 - visual
2 - auditory
3 - smell
4 - touch
2 - auditory hallucinations
- 60-70% of schizophrenia experience them
Schizophrenia is a form of psychosis, where a patient may not always be able to distinguish their own thoughts and ideas from reality. Patients commonly experience auditory hallucinations (MOST COMMON), for which there is no external stimulus. In patients with schizophrenia, what % experience auditory hallucinations?
1 - 15-25%
2 - 35-55%
3 - 60-70%
4 >85%
3 - 60-70%
Schizophrenia is a form of psychosis, where a patient may not always be able to distinguish their own thoughts and ideas from reality. 60-70% of patients commonly experience auditory hallucinations (MOST COMMON), for which there is no external stimulus. What are the most common types auditory voices patients hear and what does this increase the risk of?
1 - happy voices and increase joy
2 - sad voices that make patient feel upset and sad
3 - derogatory, increasing the risk of suicide
3 - derogatory, increasing the risk of suicide
What is attrition error?
1 - incorrect attrition of an individuals actions
2 - incorrect attrition of a patients diagnosis
3 - incorrect attrition of a patients disease severity
4 - incorrect attrition relating to a patients wellbeing
1 - incorrect attrition of an individuals actions
- e.g. you are cut up on the road, you think its because the other driver is just reckless
- BUT in reality the driver may be rushing to see a loved one at the hospital
During imaging of auditory hallucinations, oddly which part of the brain involved with speech has been shown to be activated?
1 - brodmanns areas 1, 2 and 3
2 - brodmanns area 4
3 - brodmanns area 17
4 - brodmanns areas 44 and 45
4 - brodmanns area 44 and 45
- referred to as Broca’s area
- commonly referred to as Brocas area and are important for hearing
The figure below shows data where patients listened and thought about words after in controls and patients with schizophrenia who are prone to auditory hallucinations. What does the figure tell us?
- both groups have similar neuronal activity when listening to an external stimulus
- controls switch off neuronal parts when thinking about words, but schizophrenia patients have higher activity suggesting this may be due to increase neuronal activity
- THIS COULD PRESENT AS AN AUDITORY HALLUCINATION, AS THEY HAVE A STIMULUS IN THEIR HEADS ONLY
What are neurodevelopmental trajectories?
- longitudinal developmental patterns captured by behavioural features such as motor function and language, in the general population as a whole
What is functional MRI?
- MRI that measures brain activity
- brain activity is detected by changes blood flow
Functional MRI is an MRI that measures brain activity by detecting changes in blood flow. How can this be useful in psychosis and schizophrenia?
- can monitor patients brains when they are having hallucinations
- when they hear voices we can see activity in the auditory cortex
- so patients brains are active during hallucinations
Dopamine is involved in inhibitory and excitatory pathways in the brain. One of the those pathways is the mesolimbic pathway. Where does this pathway begin and end?
1 - begin at SN and ends at dorsal striatum (caudate nucleus and putamen)
2 - begins at VTA and ends at pre-frontal cortex
3 - begins at VTA and ends at NAcc (striatum)
4 - begins at hypothalamus and ends at brain stem
SN = substantia niagra
VTA = ventral tegmental area
NAcc = nucleus accumbens, striatum
3 - begins at VTA and ends at NAcc (striatum)
Dopamine is involved in inhibitory and excitatory pathways in the brain. One of the those pathways is the mesocortical pathway. Where does this pathway begin and end?
1 - begin at SN and ends at dorsal striatum (caudate nucleus and putamen)
2 - begins at VTA and ends at pre-frontal cortex
3 - begins at VTA and ends at NAcc (striatum)
4 - begins at hypothalamus and ends at brain stem
SN = substantia niagra
VTA = ventral tegmental area
NAcc = nucleus accumbens, striatum
2 - begins at VTA and ends at pre-frontal cortex
Dopamine is involved in inhibitory and excitatory pathways in the brain. One of the those pathways is the nigrostriatal pathway. Where does this pathway begin and end?
1 - begin at SN and ends at dorsal striatum (caudate nucleus and putamen)
2 - begins at VTA and ends at pre-frontal cortex
3 - begins at VTA and ends at NAcc (striatum)
4 - begins at hypothalamus and ends at brain stem
SN = substantia niagra
VTA = ventral tegmental area
NAcc = nucleus accumbens, striatum
1 - begin at SN and ends at dorsal striatum (caudate nucleus and putamen)
Dopamine is involved in inhibitory and excitatory pathways in the brain. One of the those pathways is the mesolimbic pathway. The pathway begins at the ventral tegmental area and ends at the nucleus accumbens, striatum. What is the main function of this pathway?
1 - reward and salience
2 - regulates prefrontal cortex
3 - regulates the HPA axis
4 - regulates the basal ganglia
1 - reward and salience
- regulates limbic (behaviour and emotion) system
- rewards = pleasure
- salience = threat evaluation
Dopamine is involved in inhibitory and excitatory pathways in the brain. One of the those pathways is the mesolimbic pathway. The pathway begins at the ventral tegmental area and ends at the nucleus accumbens, striatum. The main function of this pathway is the regulation of the limbic (behaviour and emotion) system, specifically rewards = pleasure, and salience = threat evaluation. In psychosis what happens to this pathway?
1 - increases salience
2 - increases reward stimulus
3 - inhibits salience
4 - inhibits reward stimulus
1 - increases salience
- patients can believe they are under threat due to hyperactivty
Dopamine is involved in inhibitory and excitatory pathways in the brain. One of the those pathways is the mesolimbic pathway. The pathway begins at the ventral tegmental area and ends at the nucleus accumbens, striatum. The main function of this pathway is the regulation of the limbic (behaviour and emotion) system, specifically rewards = pleasure, and salience = threat evaluation. In psychosis the salience (threat evaluation) aspect of this pathway becomes hyperactive. What is the aim of drugs in treating this pathway in psychosis?
1 - increases salience
2 - increases reward stimulus
3 - inhibits salience
4 - inhibits reward stimulus
2 - increases reward stimulus
- increases feelings of pleasure
Dopamine is involved in inhibitory and excitatory pathways in the brain. One of the those pathways is the mesolimbic pathway. The pathway begins at the ventral tegmental area and ends at the nucleus accumbens, striatum. The main function of this pathway is the regulation of the limbic (behaviour and emotion) system, specifically rewards = pleasure, and salience = threat evaluation. In psychosis the salience (threat evaluation) aspect of this pathway becomes hyperactive. Drugs to treat this pathway in psychosis target the reward processing part of the pathway and thus increase feelings of pleasure. However, what can chronic drug use cause, such as amphetamines, which are a brain stimulant?
- dysregulation of the salience part, causing drug-induced psychosis
- patients have hyperactive salience stimulation
Dopamine is involved in inhibitory and excitatory pathways in the brain. One of the those pathways is the mesocortical pathway. The pathway begins at the ventral tegmental area and ends at the pre-frontal cortex. What is the main function of this pathway?
1 - reward and salience
2 - regulates prefrontal cortex
3 - regulates the HPA axis
4 - regulates the basal ganglia
2 - regulates prefrontal cortex
- modulates important functions including cognition, social involvement and motivation
Dopamine is involved in inhibitory and excitatory pathways in the brain. One of the those pathways is the mesocortical pathway. The pathway begins at the ventral tegmental area and ends at the pre-frontal cortex. This pathway regulates the prefrontal cortex (PFC) and governs important functions including cognition, social involvement and motivation. What happens to this pathway in psychosis?
- dysfunction of the system making it hypoactive
- contributes to cognition symptoms and negative symptoms (social involvement and motivation)
Dopamine is involved in inhibitory and excitatory pathways in the brain. One of the those pathways is the mesocortical pathway. The pathway begins at the ventral tegmental area and ends at the pre-frontal cortex. This pathway regulates the prefrontal cortex (PFC) and governs important functions including cognition, social involvement and motivation. In psychosis there is dysfunction of the system making it hypoactive, which can cause negative symptoms of psychosis. What 3 common negative symptoms?
1 - disordered thoughts, reduced motivation, social withdrawal
2 - impaired cognition function, delusions, social withdrawal
3 - hallucinations, reduced motivation, social withdrawal
4 - impaired cognition function, reduced motivation, social withdrawal
4 - impaired cognition function, reduced motivation, social withdrawal
Dopamine is involved in inhibitory and excitatory pathways in the brain. One of the those pathways is the nigrostriatal pathway. This pathway begins at the substantia nigra in the midbrain and ends at the dorsal striatum. What is the main function of this pathway?
1 - reward and salience
2 - regulates prefrontal cortex
3 - regulates the HPA axis
4 - regulates the basal ganglia
4 - regulates the basal ganglia
- important for movement (especially the initiation of movements)
Dopamine is involved in inhibitory and excitatory pathways in the brain. One of the those pathways is the nigrostriatal pathway. This pathway begins at the substantia nigra and ends in the midbrain. The main function of this pathway is to regulates the basal ganglia, which is crucial for movement (especially the initiation of movements). This system is not thought to be affected by schizophrenia, but can be affected by what?
- drugs used to treat schizophrenia
- can affect basal ganglia causing parksinon like symptoms
Dopamine is involved in inhibitory and excitatory pathways in the brain. One of the those pathways is the tuberoinfundibular pathway. This pathway begins at the hypothalamus and ends at the brain stem. What is the main function of this pathway?
1 - reward and salience
2 - regulates prefrontal cortex
3 - regulates the HPA axis
4 - regulates the basal ganglia
3 - regulates the HPA
- controls the endocrine system (including sex and growth hormones)
Dopamine is involved in inhibitory and excitatory pathways in the brain. One of the those pathways is the tuberoinfundibular pathway. This pathway begins at the hypothalamus and ends at the brain stem. The main function of this pathway is regulation of the HPA, which controls the endocrine system (including sex and growth hormones). Although this pathway is not directly affected by schizophrenia, antipsychotic medication can interfere with it, causing what?
- hormonal problems
All antipsychotic drugs target which neurotransmitter system?
1 - dopamine
2 - glutamate
3 - serotonin
4 - GABA
1 - dopamine
- all are post-synaptic antagonists
Dopamine is involved in inhibitory and excitatory pathways in the brain. One of the those pathways is the mesolimbic pathway. The pathway begins at the ventral tegmental area and ends at the nucleus accumbens, striatum. The main function of this pathway is the regulation of the limbic (behaviour and emotion) system, specifically rewards = pleasure, and salience = threat evaluation. In psychosis what do typical (1st generation) anti-psychotic drugs do to this pathway?
1 - dopaminergic receptor antagonist (reduced salience and reward)
2 - inhibits dopamine, accentuates negative but inhibiting positive symptoms
3 - inhibits salience only
4 - inhibits reward only
1 - dopaminergic receptor antagonist (reduced salience and reward)
- creates a generalised unhappiness, restlessness, dissatisfaction, or frustration
Atypical drugs, also known as second generation drugs mean are newer drugs that offer the same anti-psychotic effects (both positive and negative symptoms improved), BUT do not have normal neurological side effects, BUT can cause metabolic and CVD side effects. They do not cause the same side effects as typical drugs as they do not bind to the post-synaptic receptors as long. They also have a secondary function that is able to increase dopamine release that typical drugs do not posses. What is this?
1 - bind serotonin receptors on post synapse increasing dopamine release
2 - bind serotonin receptors on pre synapse inhibiting dopamine breakdown
1 - bind serotonin receptors on post synapse increasing dopamine release
- binding serotonin receptors increases dopamine release from the pre-synaptic membrane and the neurological side effects
Of all the anti-psychotic drugs, clozapine is the most effective. It acts on both serotonin and dopamine neurotransmitter receptors. What is the mechanism of action of this drug?
1 - D2 antagonist on post synapse and serotonin receptor on pre- synapse
2 - D2 agonist on post synapse and serotonin receptor on pre- synapse
3 - D2 antagonist on post synapse and agonist serotonin receptor on pre- synapse
4 - D2 agonist on post synapse and antagonist on serotonin receptor on pre- synapse
1 - D2 antagonist on post synapse and serotonin receptor on pre- synapse
- D2 antagonist inhibits dopamine binding on post synapse, where dopamine levels are high causing positive symptoms, such as in the mesolimbic system
- if serotonin binds to pre-synapse it inhibits dopamine release. Antagonist of this means more dopamine will be released and able to bind to receptors where dopamine is low causing negative symptoms, like in the nigrostriatal pathway
Typical (1st generation) anti-psychotic medication tend to target specifically all D2 receptors in the brain. Why can this be bad when we consider the 4 dopamine pathways: mesolimbic, mesocortical, nigrostriatal, tuberoinfundibular? (image below)
- inhibits all D2 receptors
- can have beneficial and negative side effects
The nigrostriatal pathway runs from the substantia nigra in the midbrain to the dorsal striatum. What are the 2 parts of the substantia nigra, and which part is key in the initiation of movement as part of the direct pathway?
1 - pars compacta = key in direct pathway
2 - pars reticula
- releases dopamine as part of direct and indirect pathways
The nigrostriatal pathway runs from the substantia nigra in the midbrain to the dorsal striatum. What 2 parts of the brain make up the dorsal striatum?
1 - caudate nucleus
2 - putamen
Clozapine is atypical (2nd generation) drug that is a core anti-psychotic drug. It is generally used as a last line drug treatment for psychosis, when up to 2 other drugs have already been tried, 1 of which must have been an atypical drug. What is the mechanism of action of Clozapine?
1 - agonist of dopaminergic receptors and antagonist of serotonin receptors
2 - antagonist of dopaminergic receptors and antagonist of serotonin receptors
3 - partial agonist of dopaminergic receptors and agonist of serotonin receptors
4 - partial agonist of dopaminergic receptors and antagonist of serotonin receptors
2 - antagonist of dopaminergic receptors and antagonist of serotonin receptors
- antagonist for dopamine receptors
- serotonin 5HT2A antagonist
