Schizophrenia Flashcards
1
Q
Why is schizophrenia important?
A
- Has an early onset
- Prevalent
- Disabling and chronic
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)
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
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
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
6
Q
List the positive symptoms of schizophrenia
A
- Hallucinations
- Delusions
- Disorganised speech
- Movement disorders
7
Q
List the negative symptoms of schizophrenia
A
- Social withdrawal
- Anhedonia
- Lack of motivation
- Slurred speech
8
Q
List the cognitive symptoms of schizophrenia
A
- Impaired working memory
- Impaired attention
- Impaired comprehension
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
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
11
Q
What is a motor,volitional and behavioural disorder?
A
Peculiar forms of motility, stupor, mutism, stereotypy, mannerism, negativism, spontaneous automatism, impulsivity
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
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
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
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
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
- The prodrome: Late teens/early 20’s often mistaken for depression or anxiety, can be triggered by stress
- The active/Acute phase: Onset of positive symptoms, differentiation of what is and isn’t real becomes difficult
- Remission: Treatment return to normality
- 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
Discuss the dopamine theory causing scz
- 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
Discuss the dopamine theory against causing scz
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
List some brain structure abnormalities in twins with scz compared with healthy twins
- 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
What is hypofrontality?
Reduced blood flow to the frontal cortex causing Reduced activity
29
Describe NMDA receptor hypofunction?
- 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
What is the serotonin theory of causing scz
Main current theory
- Over stimulation of mesolimbic D2 receptors
- Hypoactivity of frontal cortical D1 receptors
- Reduced prefrontal glutaminergic activity
- Serotonin involved
31
What types of treatment could be reviewed for scz
- Pharmacological treatments
- Cognitive behavioural therapy (CBT)
- Electroconvulsive therapy (ECT)
32
What are the main dopamine pathways?
- Tubero hypophyseal pathway
- Mesocortical pathway
- Mesolimbic pathway
- Nigrostiatial pathway
Involved in: Movement,cognition,emotions,Motivation,Reward
33
Compare typical with atypical antipsychotics
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
List the affects of the muscarinic blockade with the use of antipsychotics
Beneficial for treating extra pyramidal side effects
- Dry mouth
- Blurred vision
- Constipation
- Urinary retention
35
List the affects of the ã adrenoceptor blockade with the use of antipsychotics
- Postural hypotension
- Nasal congestion
- Hypothermia
36
List the affects of the D2 receptor blockade with the use of antipsychotics
Nigro-striatal -> Basal Ganglia (striatum) -> movement disorders
- Parkinsonism
- Dystonia
- Dyskinesia
- Tardive
37
List the affects of the D2 receptor blockade in regards to the pituitary gland with the use of antipsychotics
Has endocrine effects
- Breast swelling
- Lactation
- Impotence
38
List the affects of the D2 receptor blockade in regards to the mesolimbic system with the use of antipsychotics
Goes to the Cortex limbic system which causes psychological effects
