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2nd Year: Drugs and the Mind > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

What is schizophrenia?

A

A serious mental disorder encompassing disordered thought, delusion and hallucination.

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2
Q

There are 3 categories of symptoms for schizophrenia. What are they?

A

Positive, negative and cognitive.

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3
Q

How are the positive symptoms of schizophrenia characterised?

A

By abnormal manifestation.

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4
Q

Give 3 examples of positive symptoms.

A
  1. Delusions
  2. Hallucinations
  3. Irrationality
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5
Q

What 3 types of delusion are most common?

A
  1. Grandeur: feelings of god-like status or secret powers
  2. Control: feel as though someone is controlling them
  3. Persecution: feel as though they are being watched
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6
Q

What is the most common form of hallucination?

A

Auditory.

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7
Q

Describe how irrationality might be manifest in a schizophrenic.

A

They cannot distinguish between normal and absurd ideas. They favour rhymes over meaningful sentences. They jump quickly between conversational topics.

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8
Q

How are the negative symptoms of schizophrenia characterised?

A

By the diminution of normal behaviours.

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9
Q

Give examples of negative symptoms.

A

Reduced emotional responses, reduced social interaction and withdrawal, lack of speech, anhedonia etc.

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10
Q

What are the cognitive symptoms of schizophrenia?

A

Problems with concentration, memory and learning and problem solving.

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11
Q

There has been found to be a genetic factor to schizophrenia. What is the incidence risk in a) DZ and b) MZ twins?

A

a) 17% risk

b) 48% risk

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12
Q

How do we know schizophrenia is not 100% genetic?

A

Because the incidence risk in MZ twins would be 100%.

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13
Q

How long is the onset of schizophrenia?

A

3-5 years.

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14
Q

What order do the symptoms appear in?

A

Negative, cognitive, positive.

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15
Q

Schizophrenia is often thought of as a developmental disease. Why?

A

Is occurs mostly in 16-24 year olds and is associated with abnormalities in neuronal circuitry.

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16
Q

Who discovered schizophrenia and what did he call it?

A

Franz Kraepelin and dementia pricox.

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17
Q

What kind of prevalence does schizophrenia have in the UK?

A

1%

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18
Q

How do patients usually respond to drug treatments?

A

Similarly to ADs, the rule of thirds. In the third that the drugs do not work on, suicide rate is extremely high.

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19
Q

The brain does not stop developing until the mid 20s. It is hypothesised that schizophrenia arises from developmental abnormalities in an already genetically pre-disposed brain. True or false?

A

True.

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20
Q

What kind of evidence is there for developmental disruption in schizophrenia? How might this arise?

A

There are ~7 neat tissues layers in the brain, but in a schizophrenic both the thickness and organisation is abnormal. Cells from the cerebral cortex migrate during development, this process may have gone wrong.

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21
Q

What is the dopamine theory of schizophrenia?

A

That schizophrenia is characterised by the over-activity of dopaminergic neurons.

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22
Q

What are neuroleptics?

A

Drugs that are D2-R antagonists, thus they inhibit the action of dopamine and reduce its transmission.

23
Q

Which part of the brain is involved in hallucination?

A

The mesocorticolimbic pathway: this is a dopaminergic pathway.

24
Q

Neuroleptics tend to induce unpleasant side effects due to the multiple roles of dopamine. Give 4 examples.

A
  1. Movement disorders (EPS)
  2. Hyperprolactinemia
  3. Tardive dyskinesia of the facial muscles
  4. Sialorrhoea (dribbling)
25
Q

Patients often do not take their medication as a result of the adverse side effects. True or false?

A

True.

26
Q

What happens in OD on neuroleptics, also called neuroleptic malignant syndrome?

A

Hyperthermia (too hot), respiratory failure, coagulation problems, gut damage etc. The symptoms are very similar to serotonin sickness.

27
Q

Neuroleptics appear to only be effective in the treatment of positive schizophrenia. True or false?

A

True.

28
Q

Reserpine is a neuroleptic. What does it do?

A

Acts as a D2-R antagonist that prevents monoamine storage in the vesicles, thus reducing monoamine transmission.

29
Q

Clozapine is a neuroleptic from the 1980s. How effective was it in treating schizophrenia?

A

Hugely effective, both the positive and negative symptoms of the disease were relieved.

30
Q

The rule of thirds applies to clozapine. True or false?

A

False: clozapine appeared to work on more than 1/3 of people the first time.

31
Q

The typical side effects of neuroleptics are less severe with clozapine. However new side effects arose, what were they?

A
  1. Arrhythmia
  2. Weight gain, a 7-10% increase in visceral fat in the organs and vasculature
  3. Seizures
32
Q

Why is visceral fat harmful?

A

It an cause type II diabetes and death.

33
Q

Clozapine was banned for a period of time, then reinstated. Why?

A

It can cause agranulocytosis, a severe WBC disorder. However it was reinstated as it was decided that the therapeutic effects were too great.

34
Q

Clozapine also improves cognitive schizophrenia. True or false?

A

False: it has no effect on cognition.

35
Q

Aripiprazole is another neuroleptic. Where is it active?

A

On D2-R in the frontal cortex.

36
Q

What is unique about aripiprazole?

A

It is effective in treating hypofrontality, which is decreased blood flow to the prefrontal cortex.

37
Q

Give 2 other effects of aripiprazole.

A
  1. Prevents hallucinations as it blocks ventral receptors

2. Does not produce EPS as is does not act on dorsal receptors

38
Q

Does aripiprazole have any effect on cognitive impairment?

A

It does not completely correct it but fares better than other medications.

39
Q

It was previously thought that more selective D2-R antagonists were better. Is this belief still held?

A

No: atypical drugs are now favoured that affect multiple receptors.

40
Q

Chlorpromazine is a neuroleptic. Is it a typical or atypical antagonist?

A

It is a typical neuroleptic.

41
Q

There are 2 isoforms of the D2-R. What are they?

A
  1. D2Lh: this is a post-synaptic receptor

2. D2Sh: this is a pre-synaptic receptor.

42
Q

Antagonism of the D2Sh receptor causes what?

A

Increases dopaminergic release.

43
Q

Neuroleptics are D2-R antagonists. Their aim is to reduce dopaminergic transmission but initially they increase it. Why?

A

Antagonism of the D2Sh receptor increases dopamine release. This is because dopamine is unable to bind to the D2Sh and thus cannot initiate a feedback loop for reuptake, so more dopamine is released into the synapse. This will over-stimulate the post-synaptic neuron. Eventually the post-synaptic receptors will lose sensitivity to dopamine and transmission will be reduced.

44
Q

Atypical D2-R antagonists have less side effects. True of false?

A

True: clozapine and aripiprazole are far more effective with fewer side effects than drugs like chlorpromazine.

45
Q

Give support for the dopamine hypothesis for schizophrenia.

A

Laurelle et al. 1996: administration of intravenous amphetamine and cocaine causes elevated dopamine in the striatum, leading to positive schizophrenic symptoms like hallucination.

46
Q

How does the administration of L-DOPA serve as support for the dopamine hypothesis?

A

L-DOPA is the dopamine precursor molecule: increasing levels of L-DOPA increases dopamine synthesis and transmission, resulting in positive schizophrenic symptoms.

47
Q

It is now believed that schizophrenia is more complicated than just an over-activity of dopamine. Why?

A

Typical neuroleptics that only target D2 receptors only treat the positive symptoms of schizophrenia.

Atypical antagonists that interact with numerous receptors seem to treat a wider range of symptoms (negative and cognitive, e.g. aripiprazole).

48
Q

How has glutamate been implicated in schizophrenia?

A

Lower numbers of NMDA glutamate receptors have been found in schizophrenics. The NMDA receptor is involved in memory etc., so less of these receptors may create the cognitive symptoms of schizophrenia.

49
Q

How do drugs like PCP and ketamine serve as support for glutamate’s role in schizophrenia?

A

They block NMDA receptors and result in cognitive impairment similar to that seen in schizophrenia.

50
Q

How does glutamate interact with dopamine?

A

Glutamate modulates dopamine release.

51
Q

Do glutaminergic drugs affect the positive symptoms of schizophrenia? What does this suggest?

A

No, suggests there are multiple NT pathways involved in the disease, e.g. dopamine causes positive schizophrenia, glutamate causes cognitive etc.

52
Q

Define psychosis.

A

Cognitive and emotional impairment that is so severe that contact with reality is lost.

Psychosis is a symptom of schizophrenia.

53
Q

What is another name for both a) typical and b) atypical anti-psychotic drugs?

A

a) First generation

b) Second generation

2nd Year: Drugs and the Mind (12 decks)

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