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BB2 > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

What is schizophrenia?

A

Chronic mental disorder characterised by a triad of core symptoms

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2
Q

What are the 3 core symptoms of schizophrenia?

A
  • positive symptoms
  • negative symptoms
  • cognitive symptoms
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3
Q

What types of symptoms are ‘positive’?

A 
Hallucinations
delusions
agitation
Disorganised thinking
(psychotic symptoms)
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4
Q

What types of symptoms are negative?

A

(remove of normal processes/decreased emotions)

  • introversion
  • apathy
  • low self-esteem
  • personal neglect
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5
Q

What types of symptoms are cognitive?

A

Poor memory
Attention deficit
Executive dysfunction

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6
Q

How is schizophrenia diagnosed?

A

At least 2 DSM-5 symptoms

  • delusions
  • hallucinations
  • disorganised speech
  • disorganised/catatonic behaviour
  • negative symptoms

(at least 1 symptoms must be delusions/hallucinations or disorganised speech)

  • continuous signs of disturbance must persist for 6 months with 1 month of active symptoms with deterioration problems
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7
Q

What is catatonic behaviour?

A

Variety of abnormal motor postures

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8
Q

How is schizophrenia classified?

A

DMS-IV

  • paranoid (prominent hallucinations/delusions)
  • disorganised (behaviour without purpose)
  • catatonic (unusual movements between active and still)
  • undifferentiated
  • residual (history of psychosis but only negative symptoms)
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9
Q

What other ways can you test/classify schizophrenia?

A

Frontal Cortical Dysfunction Testing

- via Wisconsin Card Sorting Test

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10
Q

Which genes are associated with schizophrenia?

A
  • dysbindin
  • COMT
  • DISC 1
  • BDNF
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11
Q

What are the main structural changes in schizophrenia?

A
  • increased rate of gray matter loss (larger ventricles and smaller temporal lobes)
  • hypofrontality (decreased frontal activation)
  • overall brain volume loss
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12
Q

How does schizophrenia start?

A
  • decreased synaptic spines/dendritic complexity in cortex

- abnormalities in formation/maturation of circuits

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13
Q

How are corticolimbic circuits and dopaminergic systems affected?

A
  • hypofrontaltiy - excessive striatal dopamine release
  • explains psychotic symptoms
  • hyperactivity in the mesolimbic pathway
  • hypoactivity in the mesocortical pathway
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14
Q

What is brain connectivity altered?

A
  • mainly of default brain network = increased synchrony when subjects rest/allow mind to wander
  • explains psychotic symptoms
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15
Q

Which receptors are D1 type?

A

D1 and D5

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16
Q

Which receptors are D2 type?

A

D2, D3, D4

17
Q

Which receptors are main targets for schizophrenia?

A

D2

Antagonise it

18
Q

Which drugs are typical atnipsychotics? (remember 2 or 3 from each category)

A 
Chlorpromazine - 1st discovered
Thioridazine
Fluphenazine
Haloperidol
Flupenthixol
19
Q

What are the adverse effects of anti-pyshcotics?

A
  • extrapyramidal effects (acute dystonias, parkinsonism, tardive dyskinesia)
  • weight gain
  • QT interval prolonged
  • sudden death
  • hyperprolactinaemia
20
Q

Which drugs are atypical antipsychotics?

A
  • risperidone
  • olanzapine
  • clozapine
  • quetiapine
  • paliperidone
  • aripiprazole
21
Q

What do atypical antipsychotics do apart from antagonise D2 receptors?

A

Antagonise activity at 5-HT2 receptors

22
Q

What does clozapine do?

A

Blocks D4 receptor with high affinity

23
Q

What does aripiprazole do?

A
  • Combining antagonist/partial agonist effect on different D2 receptors
24
Q

What are the adverse effects of atypical antipyschotics?

A
  • weight gain
  • dyslipidaemia
  • T2D
  • cardiovascular disease
25
Q

How may atypical anti-psychotics be better than psychotics?

A
  • less tardive dyskinesia
  • less cardiac toxicity as less QT prolongation
  • less hyperprolactinaemia
26
Q

In drug resistance which is the drug of choice?

A

Clozapine

But risk of agranulocytosis so blood monitoring is essential

27
Q

What are the general side effects of antipsychotics?

A

Have affinity for alpha-1 noradrenergic, serotonin, 5-HT2, dopamine D1, histamine H1 receptors so:

extrapyramidal effects
hyperprolactinaemia
weight gain
allergic/toxic reactions
anticholinergic effects
postural hypotension
28
Q

What are the extrapyramidal effects?

A
  • acute dystonias
  • parkinsonism
  • tardive dyskinesia
29
Q

What are some rare complications of antipsychotics?

A
  • neuroleptic malignant syndrome

- irreversible complications (tardive dyskinesia)

30
Q

What is neuroleptic malignant syndrome?

A
  • rare but potentially lethal
  • medical emergency
  • hyperpyrexia, tremor, confusion, autonomic instability
31
Q

What is tardive dyskinesia?

A
  • involuntary movements of lips/jaw/face/constant chewing

- if taken typical antipsychotics for longer than years/few months

32
Q

What are some non-pharmacological approaches?

A

Cognitive behavioural therapy
Family therapy
- do not replace pharmacological treatment

33
Q

What are some new approaches to schizophrenia treatment?

A
  • associated with decreased glutamatergic transmission so possible potentiate NMDA receptor activity

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