SM_98b-99b: Schizophrenia and Antipsychotics Flashcards
____ is a firmly held, fixed false belief, that can be bizarre or non-bizarre
Delusion is a firmly held, fixed false belief, that can be bizarre or non-bizarre
____ can be auditory, visual, tactile, olfactory, gustatory, or proprioceptory
Hallucination xan be auditory, visual, tactile, olfactory, gustatory, or proprioceptory
____ is a disorder in the form of though which becomes evident in speech and behavior
Thought disorder is a disorder in the form of though which becomes evident in speech and behavior
Describe diagnostic criteria for schizophrenia
Schizophrenia
- Two or more of: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms (apathy / flat affect / alogia / avolition / anhedonia)
- Marked impairment in role functioning
- Duration for > 6 months
Positive symptoms of schizophrenia include ____ and ____
Positive symptoms of schizophrenia include delusions and hallucinations
(new things overlaid on an otherwise normal psyche)
Negative symptoms of schizophrenia include ____, ____, ____, and ____
Negative symptoms of schizophrenia include lack of facial expressions, alogia, apathy, and lack of spontaneous action
(behaviors removed from an otherwise normal psyche, deficits of non-verbal communication)
Disorganized symptoms of schizophrenia include disorganized ____ and ____ coming from disorganized ____
Disorganized symptoms of schizophrenia include disorganized behavior and language coming from disorganized thoughts
Describe pathological changes in schizophrenia
Pathological changes in schizophrenia
- Enlarged ventricles (non-specific)
- Volume and shape changes of thalamus
- Altered development and shape changes in schizophrenia
- Loss of integrity in white matter tracts especially in frontotemporal regions
In schizophrenia, there is a loss of integrity in white matter tracts, especially in ____ regions, leading to ____
In schizophrenia, there is a loss of integrity in white matter tracts, especially in frontotemporal regions, leading to network dysfunction
____ is startle response is independent of cognitive control and ____ attenuated in schizophrenia
Prepulse inhibition is startle response is independent of cognitive control and is NOT attenuated in schizophrenia
Prepulse inhibition is reversed by ____
Prepulse inhibition is reversed by antipsychotic medications
Describe cytology findings in schizophrenia
Cytology findings in schizophrenia
- Impaired neuronal migration
- Volume loss without reduced number of neurons
- Changes in interneurons and dendritic spines
- Alzheimer’s findings confirmed
No signs of degeneration (gliosis, plaques, etc)
____ region copy number variations serve as a model for schizophrenia due to their role in ____, ____, and ____
16p11.2 region copy number variations serve as a model for schizophrenia due to their role in differentiation, migration, and plasticity
People with schizophrenia may have a ____ predisposition
People with schizophrenia may have a genetic predisposition
Environmental factors implicated in schizophrenia act during ____ or ____
Environmental factors implicated in schizophrenia act during early neurogenesis or in the perinatal period
- Fetal hypoxia and birth trauma
- Maternal infections (influenza, rubella, etc)
- Winter birth months
- Low SES
- Stress (poverty, war, natural disasters)
Cannabis use is associated with ____
Cannabis use is associated with schizophrenia
____ is a medication that may be used to treat schizophrenia
Chlorpromazine is a medication that may be used to treat schizophrenia
- Immediate effects: decreased agitation, decreased emotional intensity (less affect), decreased interest in environment, causes sense of indifference
- Delayed effects: reduced hallucinations, reduced delusions, improvement in disordered thinking
Describe the mechanism of action of chlorpromazine
Chlorpromazine
- Reversed epinephrine: catecholamines (alpha-1)
- Anti-emetic effects: dopamine
- Caused catalepsy: dopamine
- Atropine-like effects: ACh
- Prevented bronchospasm: histamine
- Indifference: dopamine
_____ dopamine pathway spans from the VTA to the limbic system and is involved in emotion, motivation, and goal-oriented activity
Mesolimbic dopamine pathway spans from the VTA to the limbic system and is involved in emotion, motivation, and goal-oriented activity
Blockade of ____ dopamine pathway is clinically effective in treating schizophrenia
Blockade of mesolimbic dopamine pathway is clinically effective in treating schizophrenia
____ dopamine pathway spans from the VTA to basal ganglia and is involved in fine control of movement
Nigrostriatal dopamine pathway spans from the VTA to basal ganglia and is involved in fine control of movement
Blockade of ____ dopamine pathway leads to acute dystonias, Parkinsonism, and tardive dyskinesia
Blockade of nigrostriatal dopamine pathway leads to acute dystonias, Parkinsonism, and tardive dyskinesia
____ dopamine pathway spans from the VTA to frontal cortex
Mesocortical dopamine pathway spans from the VTA to frontal cortex
Blockade of ____ dopamine pathway may worsen cognitive symptoms of schizophrenia
Blockade of mesocortical dopamine pathway may worsen cognitive symptoms of schizophrenia
_____ dopamine pathway from hypothalamus to anterior pituitary
Tuberinfundibular dopamine pathway from hypothalamus to anterior pituitary
Blockade of ____ dopamine pathway removes inhibition of prolactin, leading to galactorrhea, gynecomastia, sexual dysfunction, and amenorrhea
Blockade of tuberoinfundibular dopamine pathway removes inhibition of prolactin, leading to galactorrhea, gynecomastia, sexual dysfunction, and amenorrhea
Efficacy of medication for schizophrenia correlates strongly with the degree of blockade of ____ receptors and is achieved at 65-70% occupancy
Efficacy of medication for schizophrenia correlates strongly with the degree of blockade of mesolimbic D2 dopamine receptors and is achieved at 65-70% occupancy
_____ has greater efficacy for positive symptoms of schizophrenia than other antipsychotics
Clozapine has greater efficacy for positive symptoms of schizophrenia than other antipsychotics
(some negative symptoms may be a side effect of blocking dopamine in the mesocortical pathway)
Antipsychotic blockade of a1 receptors can cause side effects of ____, ____, or ____
Antipsychotic blockade of a1 receptors can cause side effects of hypotension (including orthostatic hypotension), dizziness, and sedation
Antipsychotic blockade of histamine H1 receptors can cause side effects of ____ and ____
Antipsychotic blockade of histamine H1 receptors can cause side effects of sedation and weight gain
Antipsychotic blockade of muscarinic receptors can cause side effects of ____, ____, ____, ____, ____, ____, ____, and ____
Antipsychotic blockade of muscarinic receptors can cause side effects of memory / cognitive effects, xerostomia (dry mouth), constipation, tachycardia, blurred vision, urinary retention, hyperthermia, and precipiation of narrow-angle glaucoma
Describe mechanism of action of haloperidol
Haloperidol mechanism of action
- Anti-emetic effects: dopamine
- Caused cataplexy in rats: dopamine
- Indiference: dopamine
- Reversed amphetamines: dopamine
____ potency antipsychotics have greater affinity for the dopamine receptor and greater risk of dopamine-mediated side effects such as dystonias, parkinsonism, and akathesia
High potency antipsychotics have greater affinity for the dopamine receptor and greater risk of dopamine-mediated side effects such as dystonias, parkinsonism, and akathesia
- Akathesia: uncomfortable sense of inner restlessness
____ potency antipsychotics have lower affinity for the dopamine receptor and greater risk of cholinergic, adrenergic, and histaminic side effects
Low potency antipsychotics have lower affinity for the dopamine receptor and greater risk of cholinergic, adrenergic, and histaminic side effects
Dopamine hypothesis stipulates symptoms of schizophrenia are related to an ____ of ____ in the synapse but is over-simplistic
Dopamine hypothesis stipulates symptoms of schizophrenia are related to an excess of dopamine in the synapse but is over-simplistic
Describe mechanism of action of clozapine
Clozapine mechanism of action
- Reversed epinephrine: catecholamines (a1)
- Anti-emetic effects: dopamine
- Atropine-like effects: ACh
- Prevented bronchospasm: histamine
- Indifference: dopamine
_____ is an atypical antipsychotic because it has a lack of movement-related side effects and blocks serotonin and dopamine
Clozapine is an atypical antipsychotic because it has a lack of movement-related side effects and blocks serotonin and dopamine
____ has greater efficacy than any other antipsychotic but causes ____
Clozapine has greater efficacy than any other antipsychotic but causes agranulocytosis
Risperidone is an antipsychotic that acts by blocking ____ and ____ receptors
Risperidone is an antipsychotic that acts by blocking serotonin and dopamine receptors
Second-generation antipsychotics are called atypical because they ____ and ____
Second-generation antipsychotics are called atypical because they lack movement-related side effects and block serotonin and dopamine
Describe side effects of second-generation / atypical antipsychotics
Side effects of second-generation / atypical antipsychotics
____ and ____ induce schizophrenia-like effects and are NMDA antagonists
(effects reversed by NMDA agonists)
Ketamine and phencyclidine induce schizophrenia-like effects and are NMDA antagonists
Glutamate hypothesis states ____ may precipitate psychosis
Glutamate hypothesis states insufficient glutamate signaling on NMDA receptors may precipitate psychosis
(NMDA receptors module dopamine release)
____ presents as delusions, personality changes, mania, depression, and apathy resulting from Treponema pallidum
Neurosyphilis presents as delusions, personality changes, mania, depression, and apathy resulting from Treponema pallidum
