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Schizophrenia Flashcards

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1
Q

What were the first rank symptoms of schizophrenia proposed by Schneider?

A
  1. Delusion
  2. Thought disorder
  3. Passitivity
  4. Auditory hallucinations
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2
Q

What are delusions?

A

A belief that is maintained despiteb contradictions to reality/rationale.

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3
Q

What are thought disorders?

A
  1. Thought insertion
  2. Thought withdrawal
  3. Thought broadcasting
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4
Q

What is passitivity?

A

Thought that ones actions are being controlled by a 3rd party

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5
Q

What are auditpory hallucinations?

A
  1. Thought echo (thoughts are audible)
  2. 3rd person voice (discussing about the patient)
  3. Running commentary
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6
Q

What are the catogories of symptoms for Schizophrenia?

A
  1. Positive symptoms: Additional behaviours that are caused by the condition.
  2. Negative symptoms: Normal behaviours thar are lost as a consequence of condition.
  3. Disorganised symptoms: Characteristic disorganised behaviour.
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7
Q

What are the positive symptoms of Schizophrenia?

A
  1. Delusion of persecution
  2. Thought insertion
  3. Thought broadcasting
  4. Grandiose (exaggerated) beliefs
  5. Delusions of reference
  6. Perceptual hallucinations (hearing voices):
    - Arguing
    - Critical
    - Discussion
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8
Q

What are the negative symptoms of Schizophrenia?

A
  1. Lack of motivation
  2. Little interest in social interactions
  3. Loss of pleasure
  4. Reduced expression of emotions
  5. Reduced speech output
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9
Q

What are the disorganised symptoms of Schizophrenia?

A
  1. Problems organising ideas
  2. Loose association/derailment
  3. Bizarre behaviours
  4. Movement disorders (catatonia)
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10
Q

What are the criteria for diagnosing schizophrenia based on DSM5?

A
  1. 2 or more of symptoms for > 1 month, with one of the key symptoms:
    - Delusion (key)
    - Hallucinations (key)
    - Disorganised speech (key)
    - Catatonic behabiour
    - Negative symptoms
  2. Social/occupational decline
  3. Suffering at least 6 months from positive/negative symptoms
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11
Q

What is the prevalence of schizophrenia?

A
  1. Prevalence = ~1%
  2. More common in men compared to women
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12
Q

What is a high “Expressed emotion” family?

A
  • Low warmth
  • High over-involvement
  • High hostility
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13
Q

What is the relationship between high EE families and schizophrenia?

A

High EE families are associated with increased rate of relapse in schizophrenic patients

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14
Q

What is the relationship between local environment and schizophrenia?

A

There are higher rates of schizophrenia in urban areas compared to rural areas. This could be due to the high degree of social isolation and low availability of community support.

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15
Q

What is the relation between social class and schizophrenia?

A

There’s no clear evidence to suggest that social class has any relations with schizophrenia.

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16
Q

What is the relationship between genetics and schizophrenia?

A

Schizophrenia is highly heritable:

  • Monozygotic twin studies (~50% heritability)
  • Adopted children whose birth parents have schizophrenia are more likely to get schizophrenia
17
Q

What genetic defects are associated with schizophrenia?

A
  • Dysbindin
  • Neuregulin
  • DISC1
  • NDMA glutamate receptors
18
Q

What are the changes to brain structure observed with schizophrenia?

A
  • Decreased grey matter volume
  • Increased size of ventricles
19
Q

What is the dopamine theory of schizophrenia?

A

Schizophrenia is caused by high levels of dopamine activity in the brain (either due to increased expression of dopamine and/or dopamine receptors)

20
Q

What evidence supports dopamine theory of schizophrenia?

A
  1. Antipsychotic drugs used to treat schizophrenia (e.g. chlorpromazine) causes Parkinson-like symptoms and so must inhibit action of dopamine.
  2. Amphetamines increase dopamine in brain and exacerbates symptoms in schizophrenic patients.
  3. Efficacy of anti-psychotics are related to their ability to block the dopamine D2 receptor.
  4. There is increased density of D2 receptors in patients with schizophrenia
21
Q

What is the evidence against dopamine theory of schizophrenia?

A

Anti-psychotics don’t treat negative symptoms of schizophrenia, which seem to be caused by low levels of dopamine activity in the frontal cortex.

22
Q

What is the revised dopamine theory of schizophrenia?

A
  1. Excess dopamine in subcortical areas → D2 over-stimulation → Positive symptoms
  2. Inadequate dopamine in frontal cortex → D1 unser-stimulation → Negative symptoms
23
Q

How do abdormalities in dopamine activity cause psychological symptoms of schizophrenia?

A

Increased levels of subcortical dopamine causes ‘aberrant salience’ whereby seemingly unimportant objects in the environment are assigned significance. Psychosis results from an attempt by the individual to justify assigned significance to these objects.

24
Q

What are the problems with the revised dopamine theory?

A
  1. Antipsychtics seem to act on dopamine receptors immediately yet they only take effect after some time.
  2. Dosage of antipsychotic drugs neeeded reduce dopamine levels to below normal in order to produce effect (evidence by Parkinson-like symptoms).
  3. New antipsychotics act via more than one NT (e.g. serotonin), supporting fact that condition with such widespread symptoms is caused by more than one NT system.
25
Q

What evidence is there to support involvement of glutamate in schizophrenia?

A
  1. Schizophrenia is strongly associated with mutations in NDMA gene.
  2. NDMA receptor antagonists produce psychotic symptoms.
  3. Drugs affecting glutamate are effective at treating schizophrenia.
26
Q

What are the mechanism of action of 1st generation anti-psychotics?

A

Dopamine D2 receptor antagonists

27
Q

What are the side effects of 1st generation anti-psychotics?

A

Extrapyramidal side effects:

  1. Dystonia
  2. Restlessness
  3. Parkinson-like symptoms
  4. Slow movements
  5. Dyskinesia
28
Q

What is the mechanism of action of 2nd generation anti-psychotics?

A
  • Serotonin 5HT2A receptor antagonist
  • Dopamine receptor antagonist
29
Q

What are the side effects of 2nd generation anti-psychotics?

A
  • Metabolic side effects:
    1. Weight gain
    2. Type II diabetes
    3. Glucose metabolism defects
  • Immunosuppression
30
Q

What are examples of 1st generation anti-psychotics?

A
  • Chlorpromazine
  • Haloperidol
  • Trifluoperazine
31
Q

What are examples of 2nd generation anti-psychotics?

A
  • Clozapine
  • Olanzapine
  • Ziprasidone
32
Q

What are classical treatments for schizophrenia?

A
  1. Insulin coma: High dose of insulin injected to induce hypoglycaemic coma which is then revered with glucose.
  2. Prefronal lobotomy: Destruction of tracts connecting frontal lobe with other areas of the brain.

Psychology (12 decks)

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