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Schizophrenia + Behavioral Dx/Neuroanatomy Flashcards

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1
Q

What are positive symptoms of schizophrenia?

A

hallucinations or delusions (phenomena that are added on to reality)

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2
Q

What are the diagnostic implications of deficits to the wakefulness/arousal/attention networks?

A

not localizable to discrete cortical/subcortical areas

can suggest: toxic drugs/metabolic disorders, brainstem lesions that disrupt origins, numerous cortical/white matter lesions that disrupt connectivity

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3
Q

What are the protein and lipid dynamics of antipsychotics?

A

highly protein bound (85-90%) and highly lipophilic

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4
Q

What is an example of a low-potency first-generation antipsychotic?

A

chlorpormazine

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5
Q

What are the emotional regulation and social-interpersonal skills neuroanatomical networks?

A

amygdala, orbitofrontal components of prefrontal cortex, cingulate gyrus

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6
Q

What are the normal behavioral manifestations of learning and memory networks?

A

learning new info; retention/recall of info/events; orientation to current location; time; people in the environment; knowledge of important current events

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7
Q

What is decisional capacity?

A

the ability to give or withhold informed consent for a specific procedure or to make a specific decision about their care

it relates to a specific decision and can wax and wane over time

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8
Q

What are the side effects of histamine blockade?

A

sedation

weight gain

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9
Q

What is a delusion?

A

a firmly-held, fixed (even in the presence of evidence), false belief that can be bizarre (violates laws of physics) or non-bizarre

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10
Q

What type of network is the executive functions network?

A

channel network

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11
Q

What are the clinical uses and side effects of aripiprazole?

A

a second-generation antipsychotic that is a partial agonist of D2 and 1A serotonin receptor and antagonist of 2A serotonin receptor

side effects: nausea, sedation, anxiety, akathisia

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12
Q

What clinical symptoms are associated with damage to language networks?

A

aphasia - errors in word selection or production; grammatical errors; alexia - errors in reading; agraphia - errors in writing

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13
Q

What is the neuroanatomical network of the wakefulness/arousal/attention network?

A

brainstem ascending reticular activating system (ARAS) - cholinergic, adrenergic, serotonergic, dopaminergic, GABAergic projection systems

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14
Q

What are disorganized symptoms of schizophrenia?

A

disorganized speech or behavior (symptoms that represent disordered versions of normal functions)

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15
Q

What are the normal behavioral manifestations of visuospatial perception networks?

A

object and spatial perception for recognition and navigation

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16
Q

What type of networks are language networks?

A

channel networks

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17
Q

What is the general metabolism of anti-psychotics?

A

usually 50% hepatically metabolized with the Cytochrome P450 system, 50% renally excreted

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18
Q

What is an example of a moderate potency first-generation antipsychotic?

A

perphenazine

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19
Q

What are the clinical uses and side effects of perphenazine?

A

a medium-potency antipsychotic

has some anti-muscarinic and anti-histaminic side effects and some extrapyramidal side effects

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20
Q

What types of networks are formed by the major neurotransmitter projection systems (ex. cholinergic, serotonergic)?

A

state networks (regionally concentrated groups of neurons with diffuse projections)

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21
Q

What is the difference between illness, disease, syndromes, and disorders?

A

Illness = person-based

Disease = system/pathology based

Syndrome = description based

Disorder = comparison based

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22
Q

What are the clinical uses and side effects of clozapine?

A

a second-generation antipsychotic (serotonin and dopamine blockade)

side effects: agranulocytosis (can be fatal), blocks alpha-1/histamine/muscarinic receptors

not associated with tardive dyskinesia

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23
Q

What is the organization of channel networks?

A

regional, distributed cortical areas that interconnect reciprocally with one another and also with shared subcortical areas to form “large-scale” distributed neural networks

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24
Q

What is tardive dyskinesia?

A

long term, often permanent, neurological impairment occuring after extensive use of first-generation antipsychotics

characterized by involuntary choreiform, writhing movements that may affect any striate muscle and results in permanent dysfunction of facial, truncal, esophageal, neck, or extremity motor function

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25
Q

What are the clinical uses and side effects of lurasidone?

A

strongest affinity for D2 and 2A/7 serotonin receptors, partial antagonist of 1A receptors

side effects: occasional akathisia

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26
Q

What is the difference between competence and decisional capacity?

A

competence is a legal term that is global and pertains to all decisions

competence is determined by a judge whereas decisional capacity is determined by medical professionals

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27
Q

What are the normal behavioral manifestations of the mood/motivation networks?

A

appropriate modulation of mood and affect; initiative

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28
Q

What lab studies/imaging orders are important for evaluation of a psychotic patient?

A

electrolytes, hematology, renal/hepatic/thyroid function, B12

syphillis test, HIV test

test for drugs of abuse or blood levels of psychiatric medications

EEG, CT/MRI, CSF studies

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29
Q

What is the neuroanatomical network for learning and memory?

A

“limbic system”: hippocampus, amygdala, dorsomedial nucleus of the thalamus, mammillary bodies of the hypothalamus, fornix (papez circuit)

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30
Q

Which antipsychotic has the greatest efficacy? What strategies are used to mitigate the potentially fatal side effect?

A

clozapine

potentially fatal side effect: agranulocytosis (neutropenia)

national registry is used to track when people had side effects and prevent them from being put back on the drug

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31
Q

What is a “petition” in the context of psychiatric hospitalization?

A

a document that asks for someone to be evaluated for psychiatric issues

when a patient is in a hospital with a valid petition, they cannot leave until a psychiatric evaluation is performed

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32
Q

Blockade of which dopamine pathway is responsible for the clinical efficacy of dopamine blockers?

A

mesolimbic dopamine pathway

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33
Q

What neurophysiological abnormalities may be associated with schizophrenia?

A

abnormal smooth pursuit eye movements, failure to attenuate startle responses, etc.

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34
Q

What is the effect of blocking dopamine on the nigrostriatal pathway?

A

extrapyramidal side effects (ex. tremor, slurred speech, distress)

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35
Q

What are the neuranatomical networks of language networks?

A

left hemisphere peri-Sylvian region in most people (some left-handers have it on the right side)

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36
Q

What type of network are wakefulness/arousal/attention networks?

A

state networks

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37
Q

What are examples of high potency first-generation antipsychotics?

A

fluphenazine, haloperidol

effective at low doses, less blockade of cholinergic, adrenergic, and histaminic receptors

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38
Q

What are the side effects of anticholinergic blockade?

A

memory and cognitive deficits

constipation

tachycardia

blurred vision

urinary retention

hyperthermia

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39
Q

What is an acute psychotic disorder?

A

psychosis with a duration of less than 30 days

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40
Q

What are neurologic “soft signs” associated with schizophrenia?

A

higher incidence of asteroeognosis, agraphesthesia, right/left confusion, problems in gait or fine motor control

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41
Q

What is the effect of dopamine blockade to the tuberoinfundibular dopamine pathway?

A

removes inhibition of prolactin, causing hyperporlactinemia (and thus galactorrhea, gynecomastia, amenorrhea, sexual dysfunction, and increased risk of osteoporosis)

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42
Q

What are dystonic reactions?

A

painful, acute involuntary muscle spasms associated with first-generation antipsychotics

reversible with anticholinergics

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43
Q

What are the clinical uses and side effects of fluphenazine?

A

a high-potency antipsychotic, available in depot form

few side effects other than extrapyramidal side effects

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44
Q

What other changes can be associated with schizophrenia that are not required for diagnosis?

A
  • cognitive deficits
  • neurophysiological abnormalities
  • structural brain abnormalities
  • functional brain abnormalities
  • mild physical changes
  • neurologic “soft signs”
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45
Q

What is the structure and function of the nigrostriatal dopamine pathway?

A

cell bodies in the ventral tegmental areas of the mesencephalon with projections to the basal ganglia that are involved in controlling movement

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46
Q

What type of networks are emotional regulation and social-interpersonal skills networks?

A

channel networks

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47
Q

What are the overarching purposes of diagnosis?

A

1) clinical utility
2) facilitation of resesarch

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48
Q

What treatment modality can be used for schizophrenia when adherence is an issue or if patients cannot swallow pills?

A

depot formulation - IM injections every 2-4 weeks

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49
Q

What type of network are mood/motivation networks?

A

state networks

50
Q

What is the effect of second-generation antipsychotics?

A

works like a first-generation drug with the addition of a serotonin blockade that reduces serotonin-mediated inhibition of dopamine in the medial prefrontal cortex (improved cognition and negative symptoms) and in the basal ganglia (reduced movement-related side effects)

51
Q

What general medical conditions can be associated with psychosis?

A

temporal lobe epilepsy, hypo- or hyperthyroidism, hypercalcemia, Huntington’s disease, Wilson’s disease, DiGeorge syndrome

52
Q

What are poor prognostic factors for schizophrenia?

A

earlier and more insidious onset, poor premorbid functioning, family history, primarily negative symptoms

53
Q

What are the criteria for involuntary admission?

A

Possible if because of a psychicatric disorder:

  • the patient is in danger of harming self or others
  • patient is unable to care for self such that they are likely to come to physical harm
  • patient cannot understand the need for treatment and is likley to suffer mental/emotional deterioration if untreated
54
Q

What is the structure and function of the tuberoinfundibular dopamine pathway?

A

located in the hypothalamus with projections into the anterior pituitary

controls prolactin secretion

55
Q

What are the side-effects of alpha-1 adrenergic blockade?

A

hypotension (including orthostatic hypotension)

dizziness

sedation

56
Q

What functional brain abnormalities can be associated with schizophrenia?

A

hypofrontality in fMRI

57
Q

What is drug-induced parkinsonism?

A

a side effect of antipsychotics that causes bradykinesia, tremor, rigidity, masked facies, festinating gait

treated with anticholinergics

58
Q

What is schizoprheniform disorder?

A

symptoms of schizophrenia with a duration greater than 30 days but less than 6 months

59
Q

What is the visuospatial perception neuronatomical network?

A

two main visual pathways from the visual cortex:

  • “what” pathway to ventral downstream visual processing areas of temporal lobe
  • “where” pathway to dorsal posterior parietal region for spatial location
60
Q

What is the structure of neuroanatomical state networks?

A

regionally concentrated groups of neurons that project fibers diffusely throughout the cerebral cortex

61
Q

What strucutural brain abnormalities may be associated with schizophrenia?

A

enlarged ventricles, fronto-temporo-limbic volume deficits (esp. hippocamus), thalamic volume deficits, lower overall white matter tract integrity

62
Q

What is the structure of the mesolimbic dopamine pathway?

A

cell bodies in the ventral tegmental area of mesencephalon with projections to nuclei in the limbic system

63
Q

What are the neuroanatomical networks of the mood/motivation network?

A

transmitter projection systems; paralimbic, cingulate, orbitofrontal cortex

64
Q

What are the diagnostic criteria for schizophrenia?

A

1) two or more of the following symptoms,e ach present for a significant portion of time during a one-month period: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms (apathy, affective flattening, algogia, avolition, anhedonia, etc.)
2) marked impairment in role functioning
3) duration of the disturbance persists for at least 6 months

65
Q

What are the three main hypotheses for schizophrenia origin?

A

stress-diathesis model: person with specific vulnerability to illness may become symptomatic under environmental, biological, or psychological stress

genetic factors: genetics plays a significant but not completely explanatory role

viral hypothesis: rates of schizophrenia increase after fetal exposure to influenza or other infections

66
Q

What are the clinical uses and side effects of haloperidol/haldol?

A

commonly used high-potency antipsychotic, available in depot form

few side effects other than extrapyramidal side effects

67
Q

What are the indications for psychiatric hospitalization?

A

1) a psychiatric disorder is present;
2) outpatient care is risky or unlikely to succeed; and
3) inpatient care is likely to be of benefit

68
Q

What is a “certificate” in the context of psychiatric hospitalization?

A

a certificate compels involuntary admission to a psychiatric hospital

two certificates are necessary within the first 24 hours - one by any clinician, the other by a psychiatrist

once completed, case goes before a judge in mental health court who decides if patient remains hospitalized for involuntary treatment or is discharged

69
Q

What clinical symptoms are associated with damage to the mood/motivation networks?

A

depression, unstable mood, affective disorder, apathy, abulia

70
Q

What are the diagnostic implications of deficits to the emotional regulation and social-interpersonal skills networks?

A

focal lesions that inferfere with frontal network

frontotemporal dementia

meningiomas

anterior temporal lesions

neurodegenerative changes to amygdala

71
Q

What is the special function of second-generation antipsychotics/

A

they block serotonin receptors in addition to blocking dopamine receptors

72
Q

What type of networks are learning/memory networks?

A

channel networks

73
Q

What clinical symptoms are associated with damage to visuospatial perception pathways?

A

object agnosia, Balint’s syndrome, spatial disorientation

74
Q

What is the effect of dopamine blockade to the mesocortical dopamine pathway?

A

modulation and possible worsening of negative and cognitive symptoms of schizophrenia

75
Q

What are the diagnostic implications of deficits to the mood/motivation network?

A

most are not localizable to discrete cortical/subcortical areas

can be associated with focal lesions of frontal lobes

76
Q

What is the working model of schizophrenia pathophysiology?

A

(1) genes/toxins/nutrition/perinatal hypoxia/pschological experiences exert an influence on (2) neuron formation, migration, synaptogenesis, synaptic pruning, apoptosis, and plasticity such that (3) there are functional anatomical disruptions leading to (4) impairment in one or more fundamental cognitive processes, which leads to (5) impairment in one or more second-order cognitive processes leading to (6) symptoms of schizophrenia

77
Q

What are good prognostic factors for schizophrenia?

A

later and more acute onset of illness, good premorbid functioning, no family history of schizophrenia, and primarily positive symptoms

78
Q

What are the diagnostic implications of deficits to the learning/memory networks?

A

primary symptom of Alzheimer’s disease

focal strokes in memory areas

temporolimbic epilepsy

79
Q

What is the main difference between schizophrenia diagnosis in the DSM-IV vs. DSM-5?

A

DSM-IV recognized five subtypes, DSM-5 eliminated the subtypes because of lack of stability over time and lack of biological correlates

80
Q

What is the efficacy of antipsychotics for negative symptoms of schizophrenia?

A

atypical agents are better at treating these symptoms

first generation antipsychotics can make these symptoms worse

81
Q

What is the effect of blocking dopamine in the mesolimbic pathway?

A

decreased hallucinations and delusions

responsible for the clinical efficacy of dopamine blockers

82
Q

What is the executive functions neuroanatomical network?

A

frontal network: dorsolateral, dorsomedial, and orbitofrontal components of prefrontal cortex

83
Q

What is reliability?

A

A feature of diagnosis that is present when two doctors, faced with the same patients, consistently make the same diagnosis

84
Q

What are the normal behavioral manifestations of channel networks?

A

speaking, understanding conversation, reading, writing

85
Q

What are the diagnostic implications of deficits to language networks?

A

can suggest damage to Broca’s or Wernicke’s area depending on symptoms

damage to pulvinar nucleus of thalamus

damage to basal ganglia

usually caused by focal lesions or degenerations

86
Q

What is the time course of absorption of antipsychotics?

A

oral: plasma level peaks in 2-4 hours
liquid: quicker than 2-4 hours

IM injections: 30-60 minutes

87
Q

What is the functional difference between state networks and channel networks?

A

state networks set the tone of general information processing

channel networks are dedicated to specific types of information processing (ex. communicating wtih language, storing memories)

88
Q

What are the clinical uses and side effects of trifuoperazine?

A

a medium-potency antipsychotic

some anti-muscarinic and anti-histaminic side effects, some extrapyramidal side effects

89
Q

What are the normal behavioral manifestations of emotional regulation and social-interpersonal skills networks?

A

social appropriateness, insight, and emotional concordance

90
Q

What are the normal behavioral manifestations of the executive functions network?

A

judgement, insight, reasoning, “executive functions” (planning, sequencing, organizing, rapid decision-making)

91
Q

What clinical symptoms are associated with damage to the learning/memory networks?

A

amnesia, inability to discriminate familiar and unfamiliar info; getting lost in familiar environments, repetitive questions/conversations

92
Q

Which subtype of antipsychotic is most associated with QT prolongation/cardiotoxicity?

A

piperadine phenothiazines (ex. thioridazine)

93
Q

What is the general efficacy of antipsychotics for positive symtpoms?

A

all have similar efficacy exept clozapine, which has greater efficacy

94
Q

What clinical symptoms are associated with damage to the wakefulness/arousal/attention network?

A

coma, stupor, drowsiness, hyperalertness, overreaction to extraneous stimulation

95
Q

What are the clinical uses and side effects of olanzapine?

A

a second-generation antipsychotic that is active at many receptors

side effects: blockade of many receptors, weight gain, DM2, ketoacidosis

96
Q

What is a delusional disorder?

A

a disorder with later onset and female predominance characterized by non-bizarre delusions as the sole symptom

97
Q

What are the clinical symptoms of damage to the executive functions network?

A

impulsive/automatic behaviors; poor planning, forethought, judgement, decision-making

98
Q

What are the steps to achieving diagnostic validity for psychiatric disorders?

A

1) clinical description
2) delimitation from other disorders
3) follow-up study
4) family study
5) laboratory studies

99
Q

What are the clinical uses and side effects of ziprasidone?

A

a second-generation antipsychotic that is an antagonist of multiple types of serotonin and dopamine receptors

side effects: dizziness, nausea, postural hypotension, QT prolongation

100
Q

What type of networks are visuospatial perception networks?

A

channel networks

101
Q

What is neuroleptic malignant syndrome?

A

an uncommon yet potentially fatal adverse reaction to antipsychotics - marked by elevated temperature, autonomic instability, delirium, and rigid muscle tone

102
Q

What are the diagnostic implications of deficits to the executive functions network?

A

focal lesions in the prefrontal cortex or some other interference with frontal network (multifocal lesions)

frontotemporal dementia

frontal meningiomas

103
Q

What are the clinical uses and side effects of chlorpromazine?

A

low-potency antipsychotic

few extrapyramidal side effects, many side effects related to blockade of other receptors

104
Q

What is the general treatment strategy for schizophrenia?

A

try an initial treatment for 4-6 weeks at an adequate dose, if no response change to another medicaiton (do not pile on multiple medications)

105
Q

What cognitive deficits may be associated with schizophrenia?

A

inattention, poor working memory, poor executive functions

106
Q

Which of these is a correct statement regarding reliability and validity:

a) a dignosis can be valid but not reliable
b) poor validity implies poor reliability
c) establishing reliability is necessary but not sufficient for establishing validity
d) only a few mental disorder diagnoses have good reliability

A

c) establishing reliability is necessary but not sufficient for establishing validity

107
Q

What neurotransmitters are implicated in schizophrenia?

A

dopamine dysregulation in the mesolimbic dopamine tract

may also involve serotonin and glutamate

108
Q

What is akathisia?

A

an intense sense of inner restlessness or anxiety associated with antipsychotics

treated with anticholinergics or benzodiazpines

109
Q

What are the clinical uses and side effects of risperidone?

A

second-generation antipsychotic with more D2 blockade at high dosese, has a long acting intramuscular preparation

side effects: hyperprolactinemia, alpha-1 blockade (orthostatic hypotension)

110
Q

What is the structure of the mesocortical dopamine pathway?

A

cell bodies in the ventral tegmental area of the mesencephalon, projections to the cerebral cortex (especially in limbic and frontal cortex)

111
Q

What is the difference between categorical and dimensional diagnoses?

A

Categorical = defined by sets of rules and criteria or a glossary of descriptions

Dimensional = uses ratings on a variety of dimensions of scales, often with normative comparisons/cutoff points

112
Q

What are negative symptoms of schizophrenia?

A

apathy, affective flattening, avolition, anhedonia (symptoms that are detractions from normal functioning)

113
Q

What are the normal manifestations of the wakefullness/arousal/attention network?

A

maintenance of an awake, alert state; ability to sustain attention

this is a state network

114
Q

What is schizoaffective disorder?

A

schizophrenia + prominent mood symptoms

psychosis persists even when mood is in remission

115
Q

What are the clinical uses and side effects of qutiapine?

A

second-generation antipsychotic

side effects: orthostatic hypotension, somnolence, weight gain, new onset DM2/ketoacidosis, cataracts, blockade of other receptors

116
Q

What is a hallucination?

A

a false perception that can be auditory, visual, tactile, gustatory, or proprioceptory

117
Q

What are the diagnostic implications of deficits to the visuospatial perception network?

A

primary symptoms in some forms of neurodegenerative dementia

strokes in relevant processing regions

118
Q

What are the phases of schizophrenia?

A

a prodrome, an acute phase, and a residual phase

also frequently includes relapsing and remitting symptoms

119
Q

What is psychosis?

A

a disturbance in the perception or understanding of reality; not a diagnosis itself, but a sign (like fever, pain, etc.)

120
Q

Which of the following best fits categorical classification:

a) visual acuity
b) intelligence
c) compulsive behavior
d) blood pressure

A

c) compulsive behavior

121
Q

What is shared psychotic disorder?

A

A psychosis that occurs in the context of a close relationship when a previously healthy persion begins to share a delusion that originated with the psychotic partner

Psych (6 decks)

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