ScZ

Question 1

What are the diagnostic symptoms of ScZ according to the DSM 5?

Answer 1

Two or more of the following, each present for much of the time during a one-month period (unless symptoms are remitted)

• Delusions
• Hallucinations
• Disorganised Speech
• Grossly disorganised behaviour
• Negative Symptoms

Question 2

What is the Etiology of ScZ (Sullivan, 2005)?

Answer 2

• Social stressors in urban settings
• Cannabis abuse
• Miswiring of the brain during development
• Perinatal hypoxia

Question 3

What are the genetic risks (percentage) for ScZ?

Answer 3

Parents: 6%
Dizygotic twins: 17%
Monozygotic: 49%
non-twin siblings: 9%

Question 4

• ScZ patients have less synapses in cortical regions & enlarged ventricles
• Cortical vol reduction is due to neuronal size and reduced neuropil
• Pathophysiology reflects an abnormal activity in the PFC, hippocampus and subcortical structures. (????)

Answer 4

Harrison, (1999)

Question 5

Severity of disease depends on age of onset (????)

Answer 5

Rajji and colleagues (2009)

Question 6

What did Dierks and colleagues (1999) find?

Answer 6

fMRI study found

- BOLD singal in Herschls gyrus during auditory hallucinations

Question 7

What did Chen and colleagues (2015) find?

Answer 7

Severity of auditory hallucinations was correlated with the degree of reduction in the right Herschls gyrus

Question 8

• deficits of white and gray matter in left MTL (LMTL) and left STG (LSTG)
• other regions did tend to be implicated for ScZ
• 2 key regions for structural differences in ScZ compared to HCs
• suggests changes of gray matter in ScZ could be regionally specific (????)

Answer 8

Honea and colleagues (2005)

Question 9

• ScZ have significant gray matter volume loss in left STG
• suggests that changes of gray matter in Scz could be regionally and temporally specific
• but findings could be due to pharmacological and neuroradiological variables (e.g. anti-psychotics) (????)

Answer 9

(Vita et al., 2012)

Question 10

Using a phenomenological approach and interviewing ScZ’s could give a deeper understanding into the experiences of symptoms in ScZ (????)

Answer 10

(Ulhaas et al., 2007)

Question 11

Define cognitive deficits

Answer 11

Cognitive deficits is the dysfunction of connectivity and communication between areas of the brain.

Question 12

Uhlhaas & Singer, (2010) review find?

Answer 12

• Evidence suggests abnormalities in the synchronicity of oscillations may have central role in pathophysiology of ScZ
• Oscillations are fundamental for temporal relationships between neuronal responses which is relevant for memory, perception and consciousness
• beta and gamma frequency abnormalities are related to cog dysfunctions and core symptoms of ScZ
• Developmentally oscillations are involved in maturation of cortical networks

Question 13

Should we only focus on gamma/beta or alpha/theta bands or should we focus on the full spectrum and their potential dysfunctional interactions. (????)

Answer 13

Moran & Hong, (2011)

Question 14

Found a reduction in fronto-temporal activity may contribute to the attribution of self-generated events and non-self generated events. (????)

Answer 14

(Ford et al., 2002)

Question 15

What did Grent-‘t-Jong et al., (2016) find?

Answer 15

study measured high-frequency oscillations, using MEG (a robust and reliable tool) of 16 HC’s and 16 ScZ’s. They engaged in a visual task, and found whilst undertaking the task reduced gamma-band activity in ventral regions of the visual cortex.

Question 16

Side effects of anti-psychotics

Answer 16

loss of brain tissue, weight gain, diabetes, blurred vision, constipation, sexual problems due to hormone changes and more. (rethink.org, 2019)

Question 17

Ho and colleagues (2011) conducted a longitudinal study with secondary data and found

Answer 17

that progressive brain vol changes in ScZ aren’t due to the disease but may be due to long-term antipsychotic use. And so would need to re assess the risk-benefit of anti-psychotic treatment in terms of duration and dosage.

Question 18

• Clozapine is the only effective medication for treatment-resistant ScZ
• Side effects of cardiometabolic dysfunction
• small efficacy, but no first-line treatment suitable for all patients (????)

Answer 18

Lally and MacCabe (2015)

Question 19

ScZ affects 1% of world pop and leading cause of chronic disability in young adults (????)

Answer 19

Murray and colleagues (1996)

Question 20

• Anti-psychotics have more efficacy for treating +ve symptoms but not -ve
• Agents stimulating NMDARs have received attention but more clinical trials need to be researched

Answer 20

(Yang and Tsai, 2017)

Question 21

Cella and colleagues (2017) found

Answer 21

A small to moderate effect for Cognitive Remediation for negative symptoms, and negative symptoms were still reduced at follow-up.

Question 22

Wykes et al., (2011)

Answer 22

Cognitive remediation has desriable effects on global cognition and functioning, however symptom reduction was small.

Question 23

provides support for the hypothesis that hallucinations (positive symtoms) are related to cortical hyperexcitability. Which is manifested by an increase in gamma and beta band oscillations in modality-specific brain regions (????)

Answer 23

(Spencer et al., 2008)

Question 24

disorganization and negative symptoms have been related to both enhanced and reduced high-frequency oscillations (????;????)

Answer 24

(Spencer at al., 2004; Tillmann et al., 2008)

Question 25

Bowie and colleagues (2014)

Answer 25

• examined the efficacy and effectiveness of cognitive remediation in early-course and long-term schizophrenia.
• found CR treatment of cognitive impairments is feasible in both early-course and chronic schizophrenia
• better for treating cognitive functions when delivered early
• cognitive remediation should be considered a tool for early intervention in schizophrenia.

Question 26

Researched into the efficacy of anti-psychotics and found most patients discontinued their assigned treatment due to side effects, inefficacy and other reasons (????)

Answer 26

(Lieberman et al., 2005)

Question 27

What is the synaptic pruning hypothesis?

Answer 27

a big part of the reorganisaitn of the brain take place during adolescence. Improper synaptic pruning in this developmental period may lead to the onset of ScZ.

Question 28

Nature (2014) conducted a GWAS

Answer 28

ScZ have a variation of C4 within chromosome 6. C4 is responsible for the development and synaptic pruning. Which gives evidence for the synaptic pruning hypothesis of ScZ.

Question 29

Zuardi and colleagues (2012) conducted research into CBD

Answer 29

• found that CBD was as effective as an antipsychotic.

- suggests that CBD could be a therapeutic alternative for psychosis and idvs who have ScZ

Question 30

• Impairments in working memory (WM) and other cognitive functions are cardinal neuropsychological symptoms in ScZ. The PFC is important for mediating and executing these functions.
• the review suggests that abnormal prefrontal gamma band responses may contribute to WM and other cognitive deficits in ScZ. (????)

Answer 30

(Senkowski & Gallinat, 2015)

Question 31

• Hypo functioning of NMDA receptor has been known to implicate the pathophysiology of ScZ.
  Tested effects of ketamine on rest state in heathy participants
• Gamma power increased while beta band activity decreased (gamma power was within the thalamus, hippo, frontal and temporal cortex)
  Inhibition on NMDA-R = dysregulation of high-freq oscillations
• Ketamine induced neuronal dysregulation in the thalamo-coritcol areas, which could give understand of ScZ as a disinhibition of neural circuits

Answer 31

(Rivolta et al., 2015)

Question 32

• CRT is beneficial for chronic and severe ScZ
  Significant improvements in memory, attention, social cognition, independent living skills
• Development of CRT is promising as pharmacological treatments fail to bring changes in cognition and socio-affective processing

Answer 32

(Tripathi et al., 2018)