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SGUL - Physiology 2 > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

Why is schizophrenia important?

A
  • Has an early onset
  • Prevalent
  • Disabling and chronic
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2
Q

What are some features of schizophrenia?

A
  • Mental state that is out of touch with reality
  • Abnormalities of perception thought & ideas
  • Profound alterations in behaviour (bizarre and disturbing alienation)
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3
Q

Describe the prevalence of schizophrenia

A
  • Affects up to 1% of the population
  • no significant influence of culture, ethnicity, background socioeconomic groups
  • Increased in urban areas
  • Difference between sexes
  • A chronically disabling condition: responsible for great deal of the populations morbidity
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4
Q

How can the prevalence of schizophrenia be spotted?

A
  • Before the illness is recognised, there is often a phase in late teenage years associated with social isolation, interest in fringe cults and social withdrawal
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5
Q

List the 3 classes of schizophrenia symptoms

A
  • Positive
  • Negative
  • Cognitive
  • Two or more of these symptoms must persist for at least 6 months to be classed as schizophrenic
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6
Q

List the positive symptoms of schizophrenia

A
  • Hallucinations
  • Delusions
  • Disorganised speech
  • Movement disorders
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7
Q

List the negative symptoms of schizophrenia

A
  • Social withdrawal
  • Anhedonia
  • Lack of motivation
  • Slurred speech
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8
Q

List the cognitive symptoms of schizophrenia

A
  • Impaired working memory
  • Impaired attention
  • Impaired comprehension
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9
Q

Describe some features of hallucinations

A
  • Perception experience without stimulus
  • Most commonly auditory
  • Patient hears voices talking to/about them or giving a running commentary
  • patients may engage in a dialogue with voices or obey their commands
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10
Q

Describe features of delusions

A
  • A fixed unshakable belief
  • Not consistent with cultural/social norms
  • Often paranoid or persecutory
  • Passivity of thoughts and actions
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11
Q

What is a motor,volitional and behavioural disorder?

A

Peculiar forms of motility, stupor, mutism, stereotypy, mannerism, negativism, spontaneous automatism, impulsivity

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12
Q

List some symptoms of Motor, volitional and behavioural disorders

A
  • Stereotypies: purposeless, repetitive acts
  • Bizzare postures, strange mannerisms
  • Altered facial expression - grimacing
  • State of Catatonia: motionless, mute expressionless, uncomfortable or contorted postures
  • State of catalepsy: Waxy flexible
  • Bouts of extreme hypactivity
  • Impulsive behaviour: Violent acts: murder without reason
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13
Q

What is a formal thought disorder?

A
  • A disorder of conceptual thinking, reflected in speech that is difficult to understand and rapid shifts from one subject to another
  • New words are invented
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14
Q

List some symptoms of formal thought disorder

A
  • Disturbances in thinking: Unintelligible speech
  • Derailment of speech
  • Loosening of associations; failure to follow train of thought to its conclusion
  • Poverty of speech (speech fails to convey sense/information): Manifests as distorted or illogical speech
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15
Q

What is social withdrawal?
List some symptoms

A
  • Patients withdraw from their families and friends and spend a lot of time on their own
  • Lack of initiative or motivation
  • Do not want to do anything
  • No longer interested in things that used to interest them
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16
Q

What is Cognitive deficits?
List some symptoms

A
  • Deficits in selective attention, problem solving and memory
  • Blunted affect
  • Decreased responsiveness to emotional issues
  • Incongruous affect
  • Expression of affect inappropriate to circumstances
17
Q

What is an insight in regards to schizophrenia?

A
  • An understanding of what is wrong
  • Insight lacking in schizophrenia
  • Patients usually do not accept that anything is wrong or that treatment is necessary
18
Q

List the 4 phases of schizophrenia (LO)

A
  1. The prodrome: Late teens/early 20’s often mistaken for depression or anxiety, can be triggered by stress
  2. The active/Acute phase: Onset of positive symptoms, differentiation of what is and isn’t real becomes difficult
  3. Remission: Treatment return to normality
  4. Relapse
19
Q

Discuss the genetic causes of schizophrenia

A
  • In monozygotic twin studies, there is a 50% chance of developing schizophrenia if one twin is diagnosed
  • Between dizygotic twins, there is a 14% change of developing schizophrenia if one twin is diagnosed
20
Q

Describe candidate genes as a genetic cause for schizophrenia

A
  • Sickle cell disease, cystic fibrosis, colour blindness
  • We know the exact genetic abnormalities that lead to these disorders
21
Q

List some pregnancy/birth complications as nurture effects for schizophrenia

A
  • Low birth weight
  • Premature birth
  • Asphyxia during birth
  • These all causes early life stresses
22
Q

Describe stress as a nurture effect for schizophrenia

A
  • Moving country
  • Early life bereavement
  • Loss of job/home/relationship
  • Physical/emotional/sexual abuse
23
Q

List the causes of nature vs nurture for schizophrenia

A

Nature
- Scz isn’t directly inherited but can run in families
- Candidate risk genes: Gene deletions/mutations

Nurture
- Pregnancy/birth complications
- Stress
- Drug use

24
Q

List some Pathophysiology causes of schizophrenia

A
  • Dopamine hypothesis
  • Brain structure differences
  • Hypofrontality
  • NMDA receptor hypofunction
  • Oxidative stress
  • Neuroinflammation
25
Q

Discuss the dopamine theory causing scz

A
  • Dopamine release (Amphetamine) produces scz
  • Amph enhances dopamine release in schizophrenics more than controls which makes the disease worse
  • D2 agonists produce stereotyped behaviour (not D1)
  • Reserpine depletes dopamine, controls positive symptoms
  • Strong correlation D2 blocking activity & antipsychotic action
  • Dopamine release only in mesolimbic, mesocorrical not nigrostriatal
26
Q

Discuss the dopamine theory against causing scz

A

Evidence against
- No clear change in CSF HVA concentration
- No change in DA receptor in drug free patients
(Increased D2 receptors in samples attributed to drug treatment

27
Q

List some brain structure abnormalities in twins with scz compared with healthy twins

A
  • Overall brain size slightly smaller
  • Reductions in grey matter
  • Enlarged lateral ventricles, smaller hippocampus
  • Not all people with scz have such profound structural brain differences
28
Q

What is hypofrontality?

A

Reduced blood flow to the frontal cortex causing Reduced activity

29
Q

Describe NMDA receptor hypofunction?

A
  • NMDA antagonists (Ketamine/phencyclidine)
  • ã [glutamate] and glutamate receptor density in prefrontal cortex
  • Transgenic mice with ã NMDA receptor expression
  • Stereotyped behaviour & ã social interaction, responsive to antipsychotics
30
Q

What is the serotonin theory of causing scz

A

Main current theory
- Over stimulation of mesolimbic D2 receptors
- Hypoactivity of frontal cortical D1 receptors
- Reduced prefrontal glutaminergic activity
- Serotonin involved

31
Q

What types of treatment could be reviewed for scz

A
  • Pharmacological treatments
  • Cognitive behavioural therapy (CBT)
  • Electroconvulsive therapy (ECT)
32
Q

What are the main dopamine pathways?

A
  • Tubero hypophyseal pathway
  • Mesocortical pathway
  • Mesolimbic pathway
  • Nigrostiatial pathway
    Involved in: Movement,cognition,emotions,Motivation,Reward
33
Q

Compare typical with atypical antipsychotics

A

Typical
- Also known as first generation
- First developed in the 1950’s
- Mainly antagonise D2 receptors

Atypicals
- Also known as second generations
- First developed in the 1980’s
- Mainly antagonise D2 & 5 HT2A receptors

34
Q

List the affects of the muscarinic blockade with the use of antipsychotics

A

Beneficial for treating extra pyramidal side effects
- Dry mouth
- Blurred vision
- Constipation
- Urinary retention

35
Q

List the affects of the ã adrenoceptor blockade with the use of antipsychotics

A
  • Postural hypotension
  • Nasal congestion
  • Hypothermia
36
Q

List the affects of the D2 receptor blockade with the use of antipsychotics

A

Nigro-striatal -> Basal Ganglia (striatum) -> movement disorders
- Parkinsonism
- Dystonia
- Dyskinesia
- Tardive

37
Q

List the affects of the D2 receptor blockade in regards to the pituitary gland with the use of antipsychotics

A

Has endocrine effects
- Breast swelling
- Lactation
- Impotence

38
Q

List the affects of the D2 receptor blockade in regards to the mesolimbic system with the use of antipsychotics

A

Goes to the Cortex limbic system which causes psychological effects

SGUL - Physiology 2 (37 decks)

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