Schizophrenia

Question 1

Origin and original meaning

Answer 1

Described by Bleuler in 1911

name meaning “divided mind”

Question 2

Morbidity rate (how many people are affected at any one time)

Answer 2

1-1.5%, 400.000 hospitalised

Question 3

2 basic symptoms described by Kraepelin 1919/21

Answer 3

1) positive symptoms: additional uncommon behaviour
2) negative symptoms: common behaviour is not present
- later a third category cognitive symptoms was introduced
- Schizophrenia is thought to be not a single disorder but rather a group of various disorders with varying symptoms that are difficult to categorise

Question 4

Positive symptoms

Answer 4

1) delusions: totally unrealistic beliefs
2) hallucinations (usually auditory)
3) bizarre/unconventional behaviour
4) formal thought disorder: disorganisation of thought

Question 5

Negative symptoms

Answer 5

similar symptoms to depression (e.g. absence of motivation, social withdrawal, poor judgement)

Question 6

Genetic causes?

Answer 6

monozygotic twins have a 50% concordance rate and while neurological abnormalities are visible in one twin, they do not necessarily display the particular behaviour

Question 7

The dopamine hypothesis

Answer 7

people with schizophrenia have abnormally high dopamine levels

• drugs that block dopamine receptors can somewhat control the symptoms to various degrees
• L-dopa, a dopamine precursor, produces a transient psychotic state with schizophrenia-like symptoms in control subjects

Question 8

Problems of neuroleptic therapy (therapy with drugs that block dopamine receptors)

Answer 8

1) very slow effect (often weeks)

2) response and success varies

Question 9

Clozapine effect

Answer 9

blocks dopamine and serotonin receptors with greater success in controlling schizophrenia
-> suggests a dopamine-serotonin interaction

Question 10

refinement of new drugs

Answer 10

instead of only blocking the receptor D2, they additionally block D4 and serotonin receptors

Question 11

The glutamate hypothesis

Answer 11

PCP (Phencyclidine), which blocks glutamate receptors and ion channels, produces schizophrenia-like symptoms (hallucinations and paranoia as well as negative symptoms like social withdrawal)

Question 12

Gross structural abnormalities (correlated)

Answer 12

1) enlarged ventricles
2) cortical atrophy
3) cerebellar atrophy

Question 13

Microstructural changes

Answer 13

1) disorganisation of pyramidal neurons in the hippocampus

2) loss of neurons in medial-temporal lobe structures

Question 14

hypofrontality

Answer 14

lower blood flow in the frontal cortex

Question 15

performance change of the prefrontal cortex

Answer 15

lower activity during related tasks