Schizophrenia Flashcards
Describe the triad of core symptoms that occur in schizophrenia [3]
POSITIVE SYMPTOMS- hallucinations, delusions, agitation, disorganised thinking
NEGATIVE SYMPTOMS – introversion, apathy, low self-esteem, personal neglect
COGNITIVE SYMPTOMS – poor memory (working memory is particularly affected), attention deficit, executive dysfunction
What is the average age range for the onset of schizophrenia for:
males [1]
females [1]
males (18-25 years)
females (25-35 years)
To meet the criteria for diagnosis of schizophrenia, the patient must have experienced at least two of the which symptoms :[5]
What else needs to occur? [1]
Two of the following:
* Delusions
* Hallucinations
* Disorganized speech
* Disorganized or catatonic behaviour
* Negative symptoms (i.e. affective flattening, avolition…)
At least one of the symptoms must be the presence of delusions, hallucinations, or disorganized speech.
The problems reported must not be attributable to another condition.
genetic pathophysiology of schizophrenia
Name three genes that are strongly implicated with schizophrenia [3]
Schizophrenia is a complex polygenic disorder:
- Dysbindin
- Neuregelin I
- DISC 1
- BDNF (brain derived neurotrophic factor)
- COMT (catechol-O –methyltransferase)
- DAOA (D-amino acid oxidase activator)
genes associated with schizophrenia
Describe the role of neuregulin 1, DISC 1 and dysbindin [3]
Neuregulin 1 – involved in synaptic plasticity and myelination
Dysbindin – may affect dopamine D2 receptor levels and glutamate and GABA transmission
DISC1 – associated with neurodevelopment and also signalling in corticolimbic areas
Describe the patterns of lifetime evolution of schizophrenia
Schizophrenia is a severe mental health disorder which is highly polymorphic
What is critical for predicting outcome / better prognosis of schizophrenia? [1]
Cognitive function / dysfunction
Describe the structural changes of brain in schizophrenia patients [3]
Larger ventricles and
smaller mesial temporal lobe structures:
- Ventricular enlargement is around 25%
- Overall reduction in brain volume of around 2%
- Greater reduction in grey matter compared to normal populations
Describe the functional changes of brain in schizophrenia patients [3]
Gray matter loss is widespread in adolescents with schizphrenia.
What does this mean abnormalities in? [2]
Patients have abnormalities in:
- maturation of the brain
- the stabilisation of neural networks
Schizophrenic patients often have a decreased activation in which part of the brain? [1]
Decreased activation mainly in dorsolateral prefrontal area
What is the name of this test [1]
Wisconsin Card Sorting Test
Failure to properly pass the Wisconsin Card Sorting Test would indicate what? [1]
What does Wisconsin Card Sorting Test test? [1]
Frontal lobe dysfunction
assess preservation and abstract thinking in subjects
Explain how to use the Wisconsin Cart Sorting Test [3]
Know for awareness
Stimulus cards are shown to the participant and the participant is then instructed to match the cards
They are not given instructions on how to match the cards but are given feedback when the matches they make are right or wrong
The classification rule changes every 10 cards, and this implies that once the participant has figured out the rule, the participant will start making one or more mistakes when the rule changes. The task measures how well people can adapt to the changing rule
Describe the timeline of brain changes seen in SCH patients compared to need for medication / disease onset [1]
Brain matter loss is seen in a subset of patients; it is more significant in the first period of the disease
Pathophysiology of schizophrenia
Describe the impact of schizophrenia on synaptic pathways [2]
Neurodevelopmental link:
Associated with decreased synaptic spines and decreased dendritic complexity in the cortex
This occurs due to abnormalities in the formation and maturation of brain circuits
C
Pathophysiology of schizophrenia
Describe the link between schizophrenia and neuroinflammation:
- During pregnancy? [2]
- In specific areas of the brain? [1]
- Which cell types become activated in SCH patients? [1]
During pregnancy:
* Prenatal viral infection and increased level of cytokines during pregenacny increase risk of SCH in offspring
- Pro-inflammatory cytokines are elevated in the prefrontal cortex of SCH patients
- Activated microglia are present in the brains of SCH patients within a few years of the disease onset
Schizophrenia, white matter and myelination
Describe the relationship between SCH and white matter myelination in the brain [2]
Reduced oligodendrocyte density in SCH
Key molecules regulating myelination are differentially expressed in SCH (e.g. neuregulin 1 – which is also a genetic hit)
What is the default brain network? [1]
Describe the impact of schizophrenia on the default brain network [1]
DBD:
* a network of brain regions that show synchronized activity when subjects rest and allow their minds to wander
DBD & SCH:
* DBD is increased in patients with schizophrenia
What is the default brain network? [1]
Describe the impact of schizophrenia on the default brain network [1]
DBD:
* a network of brain regions that show synchronized activity when subjects rest and allow their minds to wander
DBD & SCH:
* DBD is increased in patients with schizophrenia
What is transcriptome trajectory turning points?
TTTP:
* This is a point in adolescence during which there is substantial enrichment of synapse associated genes
TTTP & SCH:
* At the TTTP time point, which occurs around the mid-twenties, there is substantial enrichment in synapse-associated genes, which are also schizophrenia susceptibility genes
Dopaminergic pathways in the central nervous system
Describe the effect of SCH on mesocortical and mesolimbic patients
Mesolimbic is hyperactive
Mesocortical is hypoactive
SCH management
All drugs used at present to treat SCH
act as [agonist or antagonist] at that which receptors? [2]
All drugs used at present to treat SCH
act as antagonist at that D2 receptors
Gray matter loss is widespread in adolescents with schizphrenia.
What does this mean abnormalities in? [2]
Patients have abnormalities in:
- maturation of the brain
- the stabilisation of neural networks
Gray matter loss is widespread in adolescents with schizphrenia.
What does this mean abnormalities in? [2]
Patients have abnormalities in:
- maturation of the brain
- the stabilisation of neural networks
