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Schizophrenia Flashcards

1
Q

What is schizophrenia?

A
  • A type of major psychoses (madness).
  • It has an early onset, prevalent and is a disabling and manic illness.
  • It is considered a mental state that is out of touch with reality.
  • Abnormalities of perception, thought and ideas
  • Profound alteration in behaviour
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2
Q

Prevalence of Schizophrenia

A
  • Affects up to 1% of population which is relatively high
  • No significance influence of culture, ethnicity, background or socioeconomic group
  • However, present in urban areas.
  • No differences between sexes unlike depression
  • Before the illness can be recognised, therefore is often a phase in late teenage years associated with isolation, and social withdrawal.
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3
Q

Phases of schizophrenia

A
  • The prodrome
  • The active/acute phase
  • Remission
  • Relapse
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4
Q

What is the prodrome phase of schizophrenia?

A
  • Late teens/early twenties often mistaken for depression or anxiety
  • Can be triggered by stress
  • Negative symptoms
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5
Q

What is the active/acute phase in schizophrenia?

A
  • Onset of positive symptoms
  • Differentiation of what is and isn’t real is not present
  • Hallucinations and delusions
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6
Q

What is the remission phase in schizophrenia?

A
  • Treatment and returning back to normal

- Schizophreniform is positive symptoms for at least a month but under 6 months before relapse

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7
Q

What are the three catergories of Schizophrenic symptoms?

A

Positive
Negative
Cognitive
2 or more symptoms must be persist for at least 6 months

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8
Q

What are the positive schizophrenic symptoms?

A
  • Increase in abnormal behaviour
  • Visual and auditory (See and hear things)
  • Somatosensation - feel things that aren’t there
  • Delusions - disorted speech
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9
Q

What are the negative schizophrenic symptoms?

A
  • Decrease in normal behaviour
  • Social withdrawal
  • Lack of enjoyment and emotion
  • Poverty of speech
  • Emotional flatness
  • Anhedonia - no pleasure in anything
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10
Q

What are the cognitive schizophrenic symptoms?

A
  • Cognitive defect (can’t process thoughts)

- Impaired memory, attention and comprehension

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11
Q

Hallucinations

A
  • Perception experiences without stimulus
  • Auditory/hearing voices
  • Patients may engage with the dialogue with the voices or obey their commands
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12
Q

Delusions

A
  • A fixed unshakable belief

- Often paranoid or persecutory

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13
Q

Potential causes of schizophrenia

A
  • Nature

- Nurture

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14
Q

Nature causes of schizophrenia

A

Genetics

  • Tends to run in families, not directly inherited but can be linked in the family tree e.g. great uncle has it or another distant family member
  • Twin studies have shown 50% chance of getting schizophrenia if you have an identical twin that has it
  • If it was only caused by genetic factors, there would be a 100% chance between identical twins
  • This means that SCZ genes only predisposes you to the disease so other factors must be present
  • COMT, DISC1 and GRM3 are some of the genes that predispose someone to the disease
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15
Q

What are the genes that predispose someone to schizophrenia?

A

COMT, DISC1 and GRM3

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16
Q

Nurture causes of schizophrenia

A
  • Pregnancy or birth complications, including low birth weight, premature birth and Asphyxia during birth
  • Season of birth -> influenza
  • If the mother was in the 1st and/or 2nd trimester in the winter and got the flu, the risk of the baby developing schizophrenia when they are older is higher
  • This is why pregnant women are advised to be vaccinated against seasonal flu
  • General stress: moving, early love bereavement, loss of job, relationships etc
  • Cannabis use in early life as well as amphetamine, cocaine and LSD.
17
Q

Pathophysiology of Schizophrenia

A
  • Dopamine hypothesis
  • Brain structure differences
  • Hypofrontality
  • NMDA receptor hypofunction
  • Oxidative stress
  • Neuroinflammation
18
Q

What are the three stages in the dopamine hypothesis?

A
  • Hyperactivity of the mesolimbic pathway
  • Hypoactivity of the mesocorticol
  • Decreased tuberohypophyseal
19
Q

How does hyperactivity of the mesolimbic pathway affect dopamine?

A
  • Hyperactivity of the mesolimbic pathway which is linked to the reward symptom.
  • Schizophrenia associated with abnormally high dopaminergic transmission
  • Assumed because substances which cause overstimulation of dopamine receptors have similar symptoms to schizophrenia
  • Amphetamine and Cocaine have SCZ symptoms and they block the uptake of dopamine
  • The blocking of the D2 receptors in the mesolimbic pathway is associated with the antipsychotic effects and decrease in positive symptoms
20
Q

How does hypoactivity of the mesocortical pathway affect dopamine?

A
  • Associated with negative symptoms due to loss of cognitive control, motivation and emotion
  • Therefore, dopamine levels in the mesolimbic need to be decreased and need to be increased in the mesocortical system
21
Q

How does decreased tuberohypophyseal pathway affect schizophrenia?

A
  • Therefore, no prolactin release inhibition and therefore men and women get enlargement of breasts.
22
Q

Brain structure abnormalities in Schizophrenic patients

A

Overall, the brain of a SCZ patient is smaller. There is reduction in grey matter. There is also enlarged lateral ventricles and a smaller hippocampus

23
Q

What is hypo-frontality?

A

Reduced blood flow to the frontal cortex showing hypoactivity of the frontal cortex and therefore there is distorted cognitive function in the SCZ patients

24
Q

Glutamate hypothesis and schizophrenia

A
  • Low number of NMDA receptors in the prefrontal cortex of SCZ patients
  • NMDA antagonists are ketamine and phencyclidine which causes hallucinations and thought disorders
  • NMDA low levels enhance mesolimbic DAegic activity
  • Theory is that low levels of glutamate and DA exert excitatory and inhibitory effects on GABAergic striatal neurons projecting to the thalamus and sensory cortex.
  • Too much or too little action will disable the gate and allow unwanted sensory information to the cortex.
  • Low glutamate is thought to be linked to negative symptoms
25
Q

Serotonin hypothesis

A
  • Increased serotonin levels are linked with SCZ episodes

- Agonists of serotonin lead hallucinations serotonin activates the DA pathways

26
Q

What is the overall hypothesis of dopamine?

A
  • Over stimulation of mesolimbic D2 receptors
  • Under stimulation of mesocortical D1 receptors
  • Under stimulation of glutamate NMDA receptors
  • Over stimulation of serotonin receptors
27
Q

Typical antipsychotics

A
  • Antagonise D2 receptors
  • Takes longer to work
  • Mainly used for positive symptoms
  • As with most schizophrenic drugs, severe side effects
28
Q

Types of typical antipsychotics

A
  • Chlorpromazine
  • Fluphenazine
  • Haloperidol
  • Flupentixol
29
Q

Atypical antipsychotics

A
  • Antagonise D2 and 5-HT2a receptors
  • Better for negative symptoms
  • Fewer side effects as less potent D2 antagonists
  • Activation of 5HT2a causes hallucinations so help reduce hallucination which is a use for positive symptom
30
Q

Examples of Atypical antipsychiotics

A
  • Clozapine
  • Olanzapine
  • Risperidone
  • Aripiprazole
31
Q

Overall effect of Antipsychiotics

A
  • Binding to D2 receptors causes blockage in the mesolimbic pathway leading to antipsychotic effects and reduces reward/pleasure
  • Binding to D2 receptors in the nigrostriatal pathway leading to movement disorders due to movement control such as Parkinsonism
  • Binding to D2 receptors in the tubero-hypophyseal pathway leads to increased prolactin production due to no inhibition and therefore breast enlargement
  • Binding to muscarinic receptors leads to blurred mouth, blurred vision and constipation, as well as urinary retention
  • Binding to the adrenoceptors leads to hypotension and other CVS problems
  • Binding to other receptors can lead to weight gain, sedation

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