Schizophrenia Flashcards
Why are men more susceptible than women
Oestrogen plays a role in regulating dopamine receptor sensitivity
Name some contributing factors
Urban areas, living away from the equator, perinatal complications, cannabis use, advancing paternal age
What are the susceptibility genes?
Neuregulin and Dysbindin
Influence neurodevelopment and synaptic function
Whats the difference between positive and negative symptoms
Positive (acute) - thought insertion/disorder, auditory hallucinations, delusions. MORE THAN 1 MONTH
Negative (chronic) - mood, loss of drive, poor self-care, poverty of speech
What is the difference between working and semantic memory
Working - temporary storage, language, learning and reasoning
Semantic - Long term, ideas and concepts, common knowledge (dementia)
What are the 3 different types of schizophrenia
1) Paranoid - auditory delusions and hallucinations
2) Disorganised - thought disorder, odd behaviour inappropriate mood
3) Catatonic - Can be caused by the treatment, unable to move or speak, rigid
What is the role of dopamine in schizophrenia
Excess dopamine/ dopamine receptors
Antipsychotics are D2 receptor antagonists
(dopamine agonists like levodopa may cause symptoms)
Changes glutamate transmission downstream
What do imaging studies show
Abnormalities in cerebral blood flow and metabolism, particularly in frontal cortex, hippocampus, thalamus, cerebellum.
Enlargement of lateral ventricles, decrease in size of brain
No gliosis, affected white matter, neuronal and synaptic organisation.
How do antipsychotics work?
inhibit D2 receptors, reverse excess dopamine activity in mesolimbic system. Tail of medication if improvement noted.
Describe these ATYPICAL drugs
1) Risperidone
2) Olanzapine
3) Amisulpride
4) Quetiapine
5) Aripiprazole
DON’T PRODUCE EXTRAPYRAMIDAL SIDE-EFFECTS
1) Depot injection - good for +ve symptoms
2) Sedative, may cause metabolic syndrome
3) Some efficacy against -ve symptoms
4) Very sedating - good for bipolar
5) Dopamine partial agonist, stabilises.
What are the main side effects of atypical drugs
Weight gain
Hyperglycaemia and type 2 diabetes - drug induced hyperglycaemia and insulin resistance
Metabolic syndrome
Clozapine:
when is it used
what are the advantages/disadvantages
Used when failed response of other antipsychotics
Reduces suicide risk
Agranulocytosis, regular blood tests mandatory
Describe these side effects of typical drugs
1) Acute Dystonia
2) Parkinsonism
3) Akathisia
4) Tardive Dyskinesia
5) Neuroleptic malignant syndrome
6) Prolonged QT interval
1) `Contractions of muscles in neck, jaw eyes
IV cholinergics
2) decreased facial movements, stiffness. reduce dose
3) restlessness, lower dose or give propranolol
4) grimacing movements, lower dose/ propranolol
5) raised serum creatinine kinase, metabolic acidosis etc
6) arrhythmia, inhibition of specific cardiac K+ channels
