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Neuro > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

delusions/hallucinations

flat affect, diminution of thought and speech, lack of goal-direction

disorganized speech/behavior, decreased cognition

A

positive sx
negative sx
cognitive sx

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2
Q

mediating systems of thought/perception

schizophrenia results from these 3

A

PFC
Temporal lobe (cortex, amygdala, HC)
DA (VTA-MCL)

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3
Q

extensively interconnected w cortical/subcortical regions that process sensory info
“the executive”

A

PFC
highly processed/complex info
EXECUTIVE FUNCTION

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4
Q

working/ST memory
planning/prioritizing/multitask
behavioral flexibility

affective/emotional states (reigns in amygdala)

decreased activity in which disorder?

A

dorsolateral PFC

orbitofrontal PFC (mediofrontal)

schizophrenia

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5
Q

delayed response task: test of working memory supports what?

lesion here?

A

PFC regulates executive fxn
lesion here results in inability to switch strategies or change behavior (monkey keeps reaching for same side)
WI card sort test

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6
Q

perseveration

A

unable to show behavioral flexibility

pts w/PFC damage or schizo

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7
Q

neocortex+amygdala+HC+paraHC gyri

convergence of info from ALL sensory modalities

regulates info processing, sensory perception, emotion-laden memory

A

temporal lobe

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8
Q

seizure causing altered mental states including hallucinations, déjà vu, “out of body” experiences, all in absence of motor convulsions

A

Temporal lobe epilepsy

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9
Q

which lobe is activated during hallucinations? and is abnormal in schizophrenic brains?

A

temporal

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10
Q

reward+reinforcement
VTA to PFC, accumbens, temporal lobe
(projections to entire brain)

A

mesocortical limbic pathway

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11
Q

psychosis (3 sx)

A

hallucinations
paranoia
attention abnormalities

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12
Q

results of DA antagonists

which receptors?

A

D2 receptors

antipsychotics (reverse sx)

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13
Q

efficacy of antipsychotics is correlated with what?

A

affinity for D2 receptors

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14
Q

haloperidol has the greatest impact on what type of sx?

A

positive

not much effect on negative sx

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15
Q

atypical antipsychotics do what?

A

not only antagonize D2 receptors, but also other receptors and also IMPROVE NEGATIVE SX

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16
Q

there are not good treatments for what type of schizo sx?

A

cognitive

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17
Q

where’s the lesion?
thought disorder
emotional blunting/lability
psychosis

A

dlPFC
ofPFC
temporal, DA

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18
Q

what is reduced in schizophrenic brains?

name what changes occur in 1)ventricles 2)temporal lobe 3)cytoarchitecture

A

grey matter in PFC
ventricular enlargement
temporal lobe reduction
temporal/frontal changes

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19
Q

psychopathologic mechanism for schizo?

A

hypoactivity of PFC –> disinhibition of VTA –> hyperactivity of dopamine in MCL pathway

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20
Q

DA does what to the PFC?

A

inhibits

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21
Q

risk factors for suicide in schizos?

A 
male
depression
hopelessness
substance use
unemployment
social isolation
22
Q

epidemiology

A

1%
M=F
15-25 in men
27 in women

23
Q

schizophrenia is a d/o of?

A

thought and perception

24
Q

amygdala, hippo, parahippo gyrus are found in which lobe?

A

temporal

25
Q

2 DA pathways:
nigrostriatal
MCL

A

NS: cell bodies in SN, projects to forebrain
MCL: cell bodies in CTA and projects to limbic and cortical areas (incl PFC and temporal)

26
Q

3 drugs that are DA agonists and can produce paranoia and hallucinations

A

L-DOPA, amphetamines, cocaine

27
Q

antipsychotic MOA?

A

DA antagonists

28
Q

PCP MOA?

A

antagonist at the glutaminergic NMDA receptor

29
Q

glycine effect?

A

promotes glu binding to NMDA –> improves negative and cognitive sx

30
Q

cognitive dysmetria hypothesis: 5 components of the neural network disrupted in schizo that causes sx

A 
PFC
AC
thalamus
temporal cortex
cerebellum
31
Q

in schizo, DA hyperactivity where?

A

ventral striatum (–> MCL)

32
Q

risk factors of schizo

risk factor for relapse?

A 
IU injury
maternal influenza
maternal starvation (2nd tri)
cannabis during adolescence
low SES "downward drift"

families w/high expressed emotion

33
Q

schizo ddx

A 
temporal lobe epilepsy
wilson's, parkinson's, huntington's
Vitamin B12
neurosyphilis
lupus
heavy metal poisoning
deletion in 22q --> DiGeorge
34
Q

substance-induced psychotic d/o agents?

A 
stimulants
hallucinogens
antiparkinsonian's
anticholinergics
alcohol/BZD/barb w/d
35
Q

if hx of autism/communication d/o, then what additionally is needed for schizo dx?

A

prominent delusions/hallucinations

36
Q

majority of morbidity comes from these symptoms:

A

negative

37
Q

three chars of alogia

A

diminution of thought
lack of speech content
reduced speech

38
Q

name 3 main cognitive sx that show “disorganization of thought processes” (criteria A3 and A4)

A

loosening of associations
illogical thought processes
incomprehensible speech

39
Q

soft signs aka: what are they?

A

EPS
poor coordination
right/left confusion
gait impairment

40
Q

tell me about schizoaffective d/o
prognosis?
tx?

A

A) either MDE or manic episode concurrent with schizo Criterion A (MDE must include “depressed mood”)
B) delusions/halluc for 2+ wks in absence of a mood episode
C) Mood sx present for the majority of the illness

Better prognosis than schizo, but worse than MDD or bipolar

tx: antipsychotic w/antidepressant OR mood stabilizer

41
Q

tell me about delusional d/o

A

A) delusions w/duration of 1+ month
B) Schizo Crit A never been met (hallucinations, if present, not prominent and assoc w/delusion theme)
C) Functioning not impaired, behavior not odd outside of delusions themselves
D) if mood/MDE occurs, brief
E) r/o body dysmorphic d/o and OCD

women>men; mid-late life

42
Q

schizophreniform and

brief psychotic d/o

A

SPh: A, D, E of schizo but btw 1-6 months
BP: < 1mo

43
Q

prodromal sx of schizo active phase

A

social w/d
loss of interest
deterioration in hygiene
unusual behavior outbursts of anger

must have meds to bring active phase to end

44
Q

predictors of poor outcomes

A 
lower IQ
male gender
age of onset
neg/cog sx
structural brain abnormalities
long prodrome
absence of mood sx
presence of obessions/compulsions
soft signs
family hx
live in industrialized nation
45
Q

does early intervention (meds/psychosocial) during the prodrome reduce conversion to schizo?

A

no

46
Q

acute psychosis tx

A

atypicals
watch for wt gain/HTN/dyslipidemia/insulin resistance
monitor weight/circumference/lipid levels/glucose

47
Q

med for tx-refractory schizo

A

clozapine

SE: seizures/cardiomyopathy/agranulocytosis

48
Q

adverse effects of all antipsychotics?

A

QT prolongation
sudden cardiac death
caution in adolescents/elderly (dementia)

49
Q

timeframe for NMS?

A

w/in 30d of new antipsychotic OR increase in dose

sx arise over several days

50
Q

NMS sx?

SS sx?

A 
mental status changes
muscle rigidity (elevated CK)
hyperthermia
ANS instability (tachy/tachypnea)

CLONUS/hyperreflexia/hyperthermia/tachy/altered mental state

51
Q

antipsychotics mostly tx these symptoms, but not so much these sx…

what’s the best tx?

A

positive
negative/cognitive

psychosocial rehab= meds + teaching (e.g. ACT program)

also family psychoeducation (reduces relapse)
cognitive therapy (changing delusional thoughts and response to)
52
Q

which hormone regulates thought and perception?

A

DOPAMINE

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