Session 12 - Schizophrenia

Question 1

What is the lifetime risk of paranoid Schizophrenia?

Answer 1

1%

Question 2

Lifetime risk of Schizophrenia with 1 parent who has it?

Answer 2

10%

2 - 45%

Question 3

What is a key features of Schizophrenia

Answer 3

Psychosis

Question 4

What is psychosis?

Answer 4

Lack of contact with reality

Question 5

Give three conditions other than Schizophrenia with psychotic features

Answer 5

mania
severe depression
delirium

Question 6

What are the symptoms of Schizophrenia broken up into?

Answer 6

Postive symptoms

Negative symptoms

Question 7

Give three positive symptoms of Schizophrenia

Answer 7

Delusions
Hallucinations (auditory)
Catatonia

Question 8

Give three negative symptoms

Answer 8

Anhedonia
Withdrawal from social contacts
Flattening of emotional response

Question 9

What is a delusion?

Answer 9

 A fixed false belief that is out of keeping with someone’s cultural or religious beliefs

Question 10

What is the dopamine theory for schizophrenia?

Answer 10

o Some evidence of increased dopamine function in schizophrenics
o Dopamine antagonists are the best treatment for schizophrenia
o Amphetamine causes symptoms similar to positive symptoms of schizophrenia
o But:
 Amphetamines do not cause negative symptoms
 Dopamine antagonists do not treat negative symptoms
 Changes in dopamine function may be a response to long term drug treatment

Question 11

Give four pathways which use dopamine and their functions

Answer 11

Main Dopamine Pathways
Mesolimbic – emotional response and behaviour
Meso-cortical – important in arousal and mood
Nigrostriatal – key pathway damaged in Parkinson’s disease
Tuberoinfundibular – in hypothalamus and pituitary gland

Question 12

What do we want to inhibit in schizophrenia?

Answer 12

Mesolimbic

Question 13

What are two types of anti-psychotics?

Answer 13

Typical and atypical

Question 14

What is the first line treatment for schizophrenia?

Answer 14

Atypical

Question 15

How do typical antipsychotics work

Answer 15

 Dopamine D2 Receptor Antagonist
 Sedation – Within hours
 Tranquilisation – Within hours
 Antipsychotic – Several days or weeks

Question 16

Give 6 ADRs of typcial antipsycjotics

Answer 16

 Extrapyramidal effects – Hours or days
 Neuroleptic malignant syndrome – Severe rigidity, hyperthermia, autonomic instability, cognitive changes (delirium). Associated with elevated plasma creatine phosphokinase (CPK). Extremely rare, but very serious ADR of all antipsychotics.
 Weight gain
 Postural hypotension
 Endocrine changes (e.g. prolactinaemia)
 Pigmentation

Question 17

What occurs in anti-psychotic toxicity?

Answer 17

	CNS depression
	Cardiac toxicity
	Risk of sudden death with high dose
	Prolonged QT interval  Torsades de points 
	Risk of sudden death with large dose

Question 18

How do atypical antipsychotiocs work?

Answer 18

 Higher affinity for 5-HT2A receptors than Dopamine D2 Receptors
 Sedation – Within hours
 Tranquilisation – Within hours
 Antipsychotic – Several days or weeks

Question 19

Why do antipsychotics cause weight gain?

Answer 19

Supressed full signals

Question 20

Give two main symptoms of atypical anti-psychotics

Answer 20

 Extrapyramidal side effects at high doses

Question 21

What occurs in anti-psychotic toxicity?

Answer 21

	CNS depression
	Cardiac toxicity
	Risk of sudden death with high dose
	Prolonged QT interval  Torsades de points 
	Risk of sudden death with large dose

Question 22

Why are atypical anti-psychotics first line?

Answer 22

Have less extrapyramidal side effects