Schizophrenia I & II

Question 1

What part of the brain gets bigger in schizophrenia?

Answer 1

Ventricles

Question 2

What is schizophrenia?

Answer 2

Irrational divergence between behavior and thought content. Debilitating disease associated with genetics, and exacerbated by stress.

Question 3

What is the schizophrenic “downward drift”?

Answer 3

The average patient becomes worse over time

Question 4

What is schizophrenic psychosis?

Answer 4

Impairment in reality testing that may present as hallucinations, delusions, abnormalities in thought processes

Question 5

What is “loss of ego boundaries”?

Answer 5

Not knowing where one’s mind and body and and those of others begin

Question 6

What is Echolalia (Clanging)?

Answer 6

Repeating statements of others/rhyming words

Question 7

What is alogia?

Answer 7

Speaking few or no words

Question 8

What is a neologism?

Answer 8

Creating new words

Question 9

What are the major characteristics of schizophrenia?

Answer 9

At least one episode of psychosis with persistent disturbances of thought, behavior, appearance, speech and affect (emotion) as well as impairment in occupational and social functioning

Question 10

What are the criteria for schizophrenia Dx?

Answer 10

A. At least two of following Syx present of significant portion of time during 1-month period:
Delusions, Hallucinations, Grossly disorganized or catatonic behavior, negative Syx, Disorganized speech
B. Social/occupation dysfunction
C. Duration >= 6 months with at least 1 moth of Syx that meet “A”
D. Schzoaffective and Mood Disorder Exclusion: Syx can’t be due to another illness

Question 11

What are positive Syx of schizophrenia?

Answer 11

Delusions, Hallucinations, Agitation, Talkativness, Thought Disorders (Respond well to drugs)

Question 12

What are negative Syx of schizophrenia?

Answer 12

Lack of motivation, social withdrawal, flattened affect/emotion, cognitive disturbances, poor grooming, poor speech

Question 13

What are the 5 subtypes of Schizophrenia?

Answer 13

Undifferentiated (most common), Paranoid (delusions of persecution), Residual (At least one psychotic episode with subsequent negative Syx, mild positive Syx), Disorganized (Incoherent speech, bizarre behavior, poor grooming, inappropriate emotional responses

Question 14

What are the three phases of the course of schizophrenia?

Answer 14

Prodromal, Psychotic/Active, Residual

Question 15

What is the prodromal stage of schiz?

Answer 15

Prior to first psychotic break, avoidance of social activities, quiet/passive or irritable, sudden interest in religion/philosophy, physical complaints, anxiety/depression

Question 16

What is the psychotic/active stage of schiz?

Answer 16

Loss of touch with reality (positive Syx)

Question 17

What is the residual stage of schiz?

Answer 17

period betwixt psychotic episodes in touch with reality but doesn’t behave normally (negative Syx)

Question 18

What are neurologic abnormalities found in a schizophrenic brain?

Answer 18

Decreased use of glucose in frontal lobe, lateral and third ventricle enlargement, loss of symmetry, change in brain density, decreased alpha waves, increased theta and delta waves, abnormal eye movements

Question 19

What is the Dopamine Hypothesis of Schizophrenia?

Answer 19

Excessive dopaminergic activity in mesolimbic tract; Too much dopamine from the ventral tegmental area activates the mesolimbic pathway and causes positive symptoms

Question 20

What does serotonin hyperactivity cause?

Answer 20

Hallucinations and delusions

Question 21

What is the major excitatory neurotransmitter in the CNS?

Answer 21

Glutamate

Question 22

Describe the Glutamate Hypothesis (Positive Symptoms)

Answer 22

NMDARs that normally sit on GABA interneurons become abnormal. GABA inhibitiory interneurons are not stimulated by Glutamate and therefore do not inhibit Glutamate neurons going to the VTA. There is overstimulation of the VTA which produces Dopamine. Excess dopamine is pumped into the mesolimbic system causing positive psychotic events.

Question 23

Describe Glutamate Hypothesis for (Negative Symptoms)

Answer 23

Within the prefrontal cortex pathway, a glutamatergic neuron is unable to bind to the NMDA receptor on the GABA interneuron. The interneuron no longer puts the brake on a glutamate neuron which over stimulates a further downstream inhibitory neuron. This inhibitory neuron stops dopamine from going to frontal lobe!

Question 24

What is considered a brief psychotic disorder?

Answer 24

1-29 days of schizophrenia symptoms

Question 25

What is Schizophreniform disorder?

Answer 25

1-6 months of schizophrenic symptoms

Question 26

What is Schizoaffective disorder?

Answer 26

Schizophrenia + mania and/or depression

Question 27

What is delusional disorder?

Answer 27

Delusions but no other schizophrenia symptoms

Question 28

What is shared psychotic disorder?

Answer 28

One person is delusional and a second person develops same delusion

Question 29

How do effective antipsychotics work?

Answer 29

By blocking D2 receptors in the mesolimbic system

Question 30

What do atypical second generation antipsychotics block?

Answer 30

D2 receptors and 5HT2a receptors

Question 31

What is a problem with atypical antipsychotics?

Answer 31

Compliance rate is low due to unpleasant side effects

Question 32

What are benefits of atypical antipsychotics?

Answer 32

Fewer negative neurological effects such as parkinsonism or tardive kinesia

Question 33

What type of psychotherapy is useful for schizophrenia?

Answer 33

Cognitive-Behavioral Therapy