Schizophrenia

Question 1

Schizophrenia occurs is how much of the population?(1)

Answer 1

It occurs in about 1% of the population.(1)

Question 2

What is the age of symptomatic onset?(1)

Answer 2

The age of symptomatic onset is from late adolescence to early adulthood (approximately 18 – 24 years).(1)

Question 3

a. What role does gender play?(1)
b. What is the reason for the above ?(1)
c. What can we conclude about females being affected?(1)

Answer 3

a.When looking at the role gender plays it seems
like males are affected earlier and the condition seems worse among males.

b.This can be due to the fact that the condition presents sooner.

c.We can then conclude that females are to be less
severely affected and may be affected by Schizophrenia later than males.

Question 4

a. How long will the person have schizophrenia?(1)
b. Is it curable?(1)
c. How is life expectancy affected after diagnosis?(1)

Answer 4

a.Schizophrenia is a
lifelong disorder.

b.Remember discontinuous variation? When you have it – you have it. You
cannot return to a state where you do not have Schizophrenia anymore.

c.Life-expectancy is
reduced by 10 years when diagnosed.

Question 5

What are some symptoms the person may experience?(5)

Answer 5

some of the symptoms that a person
may experience:
 Hearing voices
 Delusions
 Hallucinations
 Decreased emotional reactivity
 Loss of motivation/pleasure

Question 6

a. What impact does this condition have on a persons everyday life?
b. How do most people diagnosed usually die?

Answer 6

a. this condition has a big impact on the person’s everyday life.
b. Most of the people diagnosed with Schizophrenia usually die by suicide.

Question 7

What was previously thought about scizophrenia?(1)

Answer 7

Previously it was thought that Schizophrenia is a consequence of pathological maternal-child
interactions and deviant family communication.

Question 8

List the 3 possible triggers that are thought to cause the onset of Schizophrenia.(3)

Answer 8

Possible triggers that are thought to cause the onset of Schizophrenia:
 Childhood trauma
 Trauma during the developmental years
 BUT, that needs to be accompanied with a genetic predisposition

Question 9

a. What is schizophrenia(1) and how heritable is it?(1)
b. what is it characterised by?(3)
c. Are these the same types of schizophrenia?

Answer 9

Schizophrenia is a brain disease with a high degree of heritability.

b. It is characterized by 3 independent symptom clusters:
.Positive symptoms,
• Negative symptoms,
• Cognitive impairment.

c.These are all different types of Schizophrenia, but they all can have symptoms associated with
the different clusters.

Question 10

a. What does positive mean?(2)
b. What does the negative symptom cluster mean?(2)
c. Which symptom cluster is the most dramatic?(2)

Answer 10

a.This does not mean positive as in GOOD, but positive as in PLUS. In other words, something
gets added.

b.The negative symptom cluster, in turn is not negative. It is symptoms that are
subtracted.

c.The positive symptom cluster is the most dramatic. The stereotype of Schizophrenia we have in
our heads is the positive symptom cluster.

Question 11

Manifestation of psychosis

a. Hallucinations
- What are they?(1)
- Give 3 examples?(1)

b. Delusions
- What are they?(1)
- Give the 2 types of delusions and an example of each?(4)
- What is nb to remember?

c.List 5 ways in which their cognitive processes can be affected.(5)

Answer 11

a.Hallucinations
• Sensory experiences in absence of external stimuli
o You hear voices
o Things you see
o Can be any of your senses (e.g. a person that taste blood in their mouth
the whole time)

b.Delusions
• Fixed belief about something, that remains intact even when presented with
contradictory external evidence:
o Mundane - e.g. “my family placed cameras in my house to watch me”
o Bizarre - e.g. “aliens are controlling my thoughts with an implanted a
microchip”
-Remember That belief is their reality.
So you see, these are ADDED – belief system, hallucinations, voices, etc.

• Cognitive processes
o impaired,
o disorganized,
o loose associations,
o illogical reasoning,
o inconsistent emotional states

Question 12

a. What kind of medication are people in the symptom cluster most responsive to?(1)
b. Why do they have worse outcomes?(1)

Answer 12

a. Within this symptom cluster, people are most responsive to any kind of medication.
b. They however have worse outcomes, because of their illogical reasoning and false belief systems they stop taking their medication fairly easy.

Question 13

Negative symptoms

a. What does negative refer to?(1)
b. What is it similar to?(1)
c. How does it differ from normal depression?(2)
d. Why do people hurt themselves?(1)
e. Why are symptoms grouped together?(2)

Answer 13

a.As mentioned previously, negative refers to a loss/deficit.

b. It is similar to being depressed, but it is
much worse.

c.Normal depression will show fluctuations and medication will relieve some of this.
This is more an extreme and constant form of depression.

d.Often people will hurt themselves,
because they feel almost like they cannot feel anything.

e.Positive and negative symptoms can co-occur, e.g. voices in your head, but they lose the ability
to speak properly with cognitive impairment.
Thus - the grouping of symptoms together.

Question 14

a. What are characteristics of cognitive impairment?

b. Discuss delayed word recall(1)

Answer 14

a.See all characteristics of cognitive impairment on the slides.

b. Delayed word recall – this can look like Alzheimer’s disease when investigating the brain.
The shrinkage observed in the brain is similar.

Question 15

Why are negative symptoms and cognitive impairment difficult to treat?

Answer 15

Negative symptoms and cognitive impairment are difficult to treat, but if treatment is identified that
works for an individual – it is the best predictor of a functional outcome.

Question 16

What does it mean when we say someone has paranoid schizophrenia?

Answer 16

It is important to remember
that when we say someone has paranoid schizophrenia, it does not mean they only have positive
symptoms. They may have the negative symptoms and cognitive impairment to an extent.

Question 17

Endophenotype

a. What is it?(1)
b. Who is it observed in?(1)
c. What is this an indication of?(1)
d. How did they come to this conclusion?(1)
e. What studies were these identified by?(3) Does everyone who ticks these boxes have chance of developing schizophrenia?(1)
f. When is endophenotype applicable?(2)
g. What is risk comprised of?

Answer 17

Endophenotype
a.This is the most basic form when we try to simplify the phenotype of Schizophrenia.

b. It is something that we observe in children – from a very early on with first-degree relatives with this disorder.
c. This is basically an indication that maybe later on the child may develop Schizophrenia.
d. Retrospective and prospective studies are how they came to this conclusion.

e.Identified by these studies:
o Subtle abnormalities in cognitive function and attention
o Social oddness
o Motor clumsiness
We all know some people that tick all these boxes. Does that mean they have a chance of
developing Schizophrenia? NO

f. (Endophenotype is only applicable if individuals have first-
degree relatives diagnosed with Schizophrenia)
Individuals with either a mother or father diagnosed with Schizophrenia AND they show these
three things – watch them closely.

g.Genetic predisposition + 3 mentioned characteristics = risk

Question 18

a. How does having a look at the endophenotype help?
b. A diagnosis cannot be made until when?
c. Why does being on different medications help?

Answer 18

a.During the developmental years individuals can be very vulnerable and can present symptomatic
features. That would not be enough to make a proper diagnosis. Having a look at the
endophenotype helps, because that is something that all individuals have in common.

b. A diagnosis
cannot be made until an individual has been on specific medication and observed what worked
and did not work.

c.Being on different medications helps to rule out other psychological conditions
till a definite diagnosis can be presented.

Question 19

COMPLEX GENETICS

A. What do twin studies highlight?(1)

b. What are perinatal influences?(1)List 3 of them(3)
c. Discuss three GWAS ifluences(2)(2)(2)

Answer 19

All of the previous information makes us think – there are many causes that contribute towards
the phenotype of Schizophrenia.

a.Twin studies highlight the importance of genetic predisposition.

b.Perinatal influences (the period just before and after birth)
o 2
nd trimester viral infection (also indicators of autism and ADHD)
o anoxia (oxygen absence) at birth
o not specific to Schizophrenia

c.GWAS
o Chromosomes 1, 2, 15, 22 (these are only some regions of interest)
o Copy number variant  number of copies of a DNA region differs in the probands relative
to the controls
o Similar to Huntington’s disease – where you have a triplet repeat that has to exceed a
certain number of repeats in order for you to develop Huntington’s disease. This is similar
to Huntington’s in the sense that this may be a risk indication.

Question 20

The dopamine hypothesis

a. How many neurotransmitters are involved?(1)
b. What does most of psychoactive medication work on?(1)
c. What could be causing schizophrenia?(1) What does this lead us to?
d. Which neurotransmitters compensate for each other(3)
e. What do we need to investigate?
f. Why are postmortem findings of dopamine inconsistent? How does dying impact our brain?

Answer 20

The Dopamine hypothesis
a.Multiple neurotransmitters may be involved.

b.Most of our psycho-active medication works in on the Dopaminergic system.

c.It might possibly be a defective system that causes Schizophrenia, but we
do not know this for sure. What we do know is that stimulating this system helps us to give relief
to symptoms of Schizophrenia. .This leads us to the Dopamine hypothesis.

d.Dopamine, Noradrenaline and Serotonin all compensate for each other.

e.We need to investigate
post-transcriptional modifications (DRD2, splice site, receptors either pre-synaptically or post-
synaptically).

f.Postmortem findings of dopamine is inconsistent, because for expression analysis on neurotransmitters we need brain tissue in deep parts of the brain (which is impossible to do
while alive). Dying changes our brain’s biology and deems transcriptional profiles to change. See
receptor interactions.