Schizophrenia

Question 1

neuro disregulation of schizophrenia

Answer 1

mesocorticolimbic circuit

Question 2

must have 2 of 5 of these symptoms (and 1 from the first three)

Answer 2

delusions
hallucinations
disorganized speech
grossly disorganized or catatonic behaior
negative sxs

Question 3

must also have

Answer 3

social/occupational dysfunction
duration of 6 months of continuous symptoms
no schizoaffective and mood disorder
no substance abuse or othe rmedical issue
need to exclude autism

Question 4

relation to autism

Answer 4

autism has disorganized speech and negative symptoms, but does not have prominent hallucinations or delusions

Question 5

somatic delusion

Answer 5

feet mechanical, device implanted

Question 6

nihilistic delusion

Answer 6

world coming to an end

Question 7

Schizophreniform Disorder

Answer 7

sitting on the tipping point to schizophrenia

duration of 1-6 months with a 50% chance of going on to develop schizophrenia

Question 8

schizoaffective disorder

Answer 8

major depressive, manic, or mixed episodes concurrent with first criteria for schizo
–mood symptoms present for majority of total duration/delusions for 2+ weeks

Question 9

subtypes of schizoaffective disorder

Answer 9

bipolar

depressive

Question 10

delusional disorder

Answer 10

one or more delusions more than 1x month
criteria A not met
mood episodes brief compared to delusional periods

Question 11

attenuated psychosis syndrome

Answer 11

intact reality testing- but either delusions, hallucinations, or disorganized speech
more than once/week for past month
suddenly distressing and disabling

Question 12

schizo epi

Answer 12

1%

Question 13

when does schizo begin?

Answer 13

typically teens

Question 14

which episode is most responsive to treatment

Answer 14

first

Question 15

how many relapses until chronic schizo?

Answer 15

3

Question 16

women as compared to men

Answer 16

better premorbid function, estrogen is neuroprotective because inhibits D2 receptors

Question 17

3 phases of schizo

Answer 17

1) prodromal
2) active
3) residual

Question 18

prodromal phase

Answer 18

social, cognitive deficits may precede activity phase by many years

Question 19

active phase

Answer 19

full syndrome, typically 3-4 decades (teens, 20s, 50s)

Question 20

residual phase

Answer 20

1/3 remission, 1/3 attenuation of symptoms in older years, stages of illness propose

Question 21

suicide in schizo

Answer 21

20-40% attempt, 10% complete

Question 22

what med reduces risk of suicide and violence?

Answer 22

clozapine

Question 23

life expectancy schizo

Answer 23

10-30 years

Question 24

percentage of schizos that smoke

Answer 24

90%

Question 25

what neuroanatomy fnding?

Answer 25

dendritic spine density on deep layer 3 pyramidal neurons

–means decrease excitability to DLPFC layer 3 pyramidal cells–> dec cognitive ability

Question 26

functional brain abnormalities

Answer 26

diffuse cerebral dysfunction (esp prefrontal and medial temporal)

Question 27

neurochemical brain abnormalities

Answer 27

DA hypersensitivity in MESOLIMBIC

DA hypoactivity in MESOCORTICAL

glutamate NMDA

5ht, GABA, NE, Ach

Question 28

mesolimbic pathway

Answer 28

midbrain VTA–>Nucleus accumbens, olfactory tubercle, and limbic system

*overactivity due to postive symptoms

Question 29

mesocortical pathway

Answer 29

midbrain VTA–>frontal cortex

*learning and memory; reduce associated with negative symptoms

Question 30

nigostriatal pathway

Answer 30

control of movement

Question 31

tuberoinfundibular pathway

Answer 31

projects from hypothalamus to anterior pituitary gland and controls prolactin secretion

Question 32

if you treat the movement and prolactin pathway…

Answer 32

causes worsening of positive and negative symptoms

Question 33

NMDA antagonists

Answer 33

causes apoptosis/neuro degen due to excitotoxicity

Question 34

PCP and ketamine

Answer 34

neurodegen because they are NMDA antagonists

Question 35

atypical antipsychotics

Answer 35

treat schizo because inhibit neurodegen assocaited with excitotoxicity and apoptosis

Question 36

first generation antipsychotics

Answer 36

F2 antagonists (chlorpromazine, haloperidol)

Question 37

second generational antipsychotics

Answer 37

clozapine

G2, 5HT2 antag

Question 38

antipsychotics have limited improvement in

Answer 38

negative and cognitive symptoms

Question 39

antispyschot drugs help

Answer 39

psychotic (positive) symptoms, agitation, disorganizaiton