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Year 2 - Theme 3 > Schizophrenia and its causes symposium > Flashcards

Schizophrenia and its causes symposium Flashcards

1
Q

Symptoms of psychosis

A
  • Delusions
  • Hallucinations
  • Disorganised speech
  • Catatonia
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2
Q

Cognitive effects of schizophrenia

A
  • Attention
  • Memory
  • Executive functions(eg abstraction)
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3
Q

Negative symptoms of schizophrenia

A
  • Affective flatterning
  • Alogia
  • Avolition
  • Anhedonia
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4
Q

Mood symptoms of schizophrenia

A
  • Dysphoria
  • Suicidality
  • Helplessness
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5
Q

How are relatives of schizophrenic patients affected

A
  • Increased risk of psychosis

- Increase in rate of schizotypal relatives

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6
Q

%risk - parent

A

5

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7
Q

%risk - sibling

A

10

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8
Q

%risk child

A

13

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9
Q

%risk child of 2 affected parents

A

46

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10
Q

Obstetric complications that increase risk

A
  • Premature birth
  • Low birth weight
  • Perinatal hypoxia
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11
Q

Effect of migration on risk

A
  • Increases risk of psychosis
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12
Q

Macro neurodevelopmental abnormalities reported in schizophrenia

A

Ventricular enlargement

widening cortical sulci

cortical grey matter loss

loss of asymmetry

↓limbic structure and thalamic volume

Progressive deficits in some, not all

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13
Q

Micro neurodevelopmental abnormalities reported in schizophrenia

A 
Cortical glial loss 
Increase in neurone density
Aberrant neurone migration 
Synaptic loss 
Decrease in dendritic complexity
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14
Q

Neuropsychology abnormalities in schizophrenia

A 
Deficits in     
Attention
Arousal (too much)
Working memory 
Executive function
Eye movement (saccadic, smooth pursuit) 
Social cognition (recognising facial emotions / social cues)
Theory of mind 
Loss of functional asymmetry
Receptive language function          
Subtle motor function, Speech, IQ
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15
Q

Where is dopamine synthesis and storage increased in schizophrenia

A
  • Striatal dopamine synthesis and storage increased in schizophrenia
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16
Q

What is associated with the increased dopamine secretion in the striatum in schizophrenia

A
  • Reduced glutamate function in frontal lobes
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17
Q

What symptoms are reduced frontal glutamate levels associated with

A
  • Negative symptoms
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18
Q

What symptoms are increased striatal dopamine levels associated with

A
  • Positive symptoms
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19
Q

What is glutamate dysfunction particularly associated with in schizophrenia

A
  • Cognitive symptoms
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20
Q

What does hypoactivity in PFC in schizophrenia lead to

A
  • Increased DA release in Nacc

look at pathway diagram in notes

21
Q

Drugs associated with psychosis influence via dopamine, serotonin and glutamate function

A 
L-Dopa                
Amphetamine            
LSD
Cannabis 
Cocaine
Ketamine
MDMA         
PCP  
other novel psychoactives
			etc
22
Q

Most likely environmental determinant of transition to psychosis in 2018

23
Q

Affective psychosis

A
  • Bipolar disorder
  • Depressive psychosis
  • Schizoaffective disorder
24
Q

‘Organic’ psychosis(just know a few examples)

A

Epilepsy (temporal lobe)
Infections: encephalitis, subacute sclerosing panencephalitis, neurosyphillis, HIV
Cerebral trauma
Cerebrovascular disease
Demyelination: MS, Schilder’s disease, metachromatic dystrophy
Neurodevelopmental disorders: velocardiofacial syndrome
Endocrine: thyroid disorders (hyper and hypo), Cushing’s syndrome,
Metabolic: hepatic failure, uraemia
Immunological: SLE, Autoantibodies to brain receptors NMDA
Drugs
Toxins eg. lead
Dementias
Personality disorder

25
Q

Target of antipsychotic drugs in psychosis treatment

A
  • Dopamine dysregulation
26
Q

Alternative treatment for psychosis

27
Q

Which drug has the greatest efficacy in resistant cases of psychosis

A
  • Clozapine

- Treatment benefit usually clinically evident by 2 weeks

28
Q

D2 dopamine antagonist effects

A
  • Parkinsonism
  • Tardive dyskinesia
  • Raised prolactin
29
Q

Alpha-1 norepinephrine antagonist effect

A
  • Postural hypotension
30
Q

H1 histamine antagonist effect

A
  • Sedation

- Weight gain

31
Q

M1 cholinergic antagonism

A

Constipation, Urinary retention,
Blurred vision, Confusion etc
(clozapine only): Saliva overproduction

Also cardiac conduction delay in some

32
Q

Typical antipsychotics

A
  • Haloperidol

- Chlopromazine

33
Q

Atypical antipsychotics

A 
· Amisulpride 
	· Aripiprazole 
	· Clozapine 
	· Risperidone 
	· Olanzapine 
	· Quetiapine 
	· Lurasidone
34
Q

Long acting injections(up to monthly administration) - antipsychotics

A

· Depixol
· Clopixol
· Piportil

· Paloperidone(risperidone) 
· Olanzapine 
· Aripiprazole
35
Q

Extrapyramidal side effects of typical antipsychotics

A

Parkinsonian symptoms
Dystonia
Akithisia
Tardive dyskinesia

36
Q

Cardiac side effects of typical antipsychotics

A
  • Hypotension
  • Arrhythmias
  • Temperature dysregulation
  • Neuroleptic malignant syndrome
37
Q

Anticholinergic side effects of typical antipsychotics

A
  • Weight gain(less than atypicals)

- Raised prolactin(galactorrhoea, decrease in sexual function, osteoporosis)

38
Q

Less frequent effects of typical(old) antipsychotics

A

Less frequently

  • Jaundice
  • Lens opacities
  • Skin discolouration
  • Blood dyscrasias
39
Q

Primary receptors affected by atypical(new) antipsychotics

A
  • Primary action not at D2 receptors, often more potent at 5HT2 receptors
40
Q

Atypical(new) antipsychotics that cause sedation

A
  • Olanzapine
  • Clozapine
  • Quetiapine
    (least for aripiprazole)
41
Q

Atypical(new) antipsychotics that cause metabolic effects

A
  • Weight gain, glucose intolerance, increase in triglycerides caused by olanzapine/clozapine more than othersl least for aripiprazole
42
Q

Atypical(new) antipsychotics that cause raised prolactin effects

A
  • Galactorrhoea, decrease in sexual function, osteoporosis(risperidone, amisulpride)
43
Q

Cardiac effects of atypical(new) antipsychotics

A
  • Hypotension(quetiapine) arrhythmias(less than typicals), neutropaenia with clozapine in 1% hence requires regular blood monitoring
44
Q

Nice regulations for antipsychotic use

A
  • Joint choice of drug with patient / carer / Dr
  • Use Clozapine if no response to 2 others (including 1 atypical)
  • Log acting (depot) injections useful in those who prefer them or to help covert non adherence
  • Develop advance directives
  • Avoid high dose or prescription of two antipsychotics together
45
Q

How is clozapine administered

A
  • Oral medication taken daily
46
Q

What is monitored in clozapine administration

A
  • Neutrophil count
  • Neutropaenia in approximately 1% of cases but progression slow so ceasing medication significantly reduces risk
  • Slow titration to optimal dose with mintoring of pulse, BP and neutrophil count
47
Q

Common side effects of clozapine

A
  • Sedation, weight gain, dribbling common

- Little parkinsonian effects or tardive dyskinesia

48
Q

Features of electroconvulsive treatment

A
  • Not a primary treatment of psychosis

- Very effective in psychosis associated with depression or with catatonia

49
Q

Features of metabolic syndrome

A

• Exacerbated by atypical antipsychotic drugs
• Appears more prevalent in schizophrenia pre treatment
than the general population
• Associated with higher rates of coronary heart disease,
cerebrovascular pathology and earlier death
• Hence routine screening, appropriate treatment and giving routine advice about diet & exercise in psychiatric practice

Year 2 - Theme 3 (9 decks)

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