Schizophrenia and Psychotic Disorders

Question 1

What is the mode of action of Midazolam?

Answer 1

Midazolam potentiates the inhibitory effects of GABA throughout the CNS, resulting in anxiolytic, sedative, hypnotic, anterograde amnesic, muscle relaxant, and antiepileptic effects.

Question 2

What are the indications for Midazolam?

Answer 2

Procedural sedation, induction of anaesthesia, sedation during ventilation, and premedication.

Question 3

What precaution should be taken in patients with respiratory disease or sleep apnoea when administering Midazolam?

Answer 3

Close monitoring is required as compromised respiratory drive may result in hypoventilation and hypoxaemia.

Question 4

How should Midazolam dosage be adjusted for elderly patients?

Answer 4

Reduce dose and monitor closely due to increased risk of oversedation, ataxia, confusion, falls, respiratory depression, and short-term memory impairment.

Question 5

What are some common adverse effects of Midazolam?

Answer 5

Hypotension, hiccup, and cough.

Question 6

What is the definition of schizophrenia?

Answer 6

Schizophrenia is a mental disorder characterized by abnormal social behavior and failure to understand what is real, with disturbances in speech, perception, cognition, and volition, and impaired functioning.

Question 7

What is the epidemiology of schizophrenia?

Answer 7

It affects 1% of the population, with an onset in males at 18-25 years and in females at 25-45 years. The male-to-female ratio is 4:1.

Question 8

Name three positive symptoms of schizophrenia.

Answer 8

Delusions
Hallucinations
Disordered thought + speech

Question 9

What are the stages of schizophrenia?

Answer 9

Prodromal, active, and residual stages.

Question 10

What is the Dopamine Hypothesis in relation to schizophrenia?

Answer 10

Symptoms of schizophrenia are largely attributed to disturbed and hyperactive dopamine signal transduction, due to the observation that most antipsychotics have dopamine receptor antagonist effects.

Question 11

Name the four main negative symptoms of Schizophrenia

Answer 11

Mesocortical pathway: VTA –> Cortex
Underactive pathway in schizophrenia (Decreased dopamine release from VTA)
1. Alogia (Poverty of speech/thought)
2. Flat/Blunted Affect
3. Avolition (decreased motivation to initiate activities)
4. Anhedonia (Reduced feelings of pleasure)

Question 12

What dopaminergic pathway is responsible for the positive symptoms of Schizophrenia?

Answer 12

Mesolimbic pathway: VTA –> Nucleus accumbens
Overactive pathway in schizophrenia (Increased dopamine release from VTA)
Responsible for positive symptoms (delusions, Hallucinations, disorganised thought, disorganised behaviour)