SM_98b-99b: Schizophrenia and Antipsychotics

Question 1

____ is a firmly held, fixed false belief, that can be bizarre or non-bizarre

Answer 1

Delusion is a firmly held, fixed false belief, that can be bizarre or non-bizarre

Question 2

____ can be auditory, visual, tactile, olfactory, gustatory, or proprioceptory

Answer 2

Hallucination xan be auditory, visual, tactile, olfactory, gustatory, or proprioceptory

Question 3

____ is a disorder in the form of though which becomes evident in speech and behavior

Answer 3

Thought disorder is a disorder in the form of though which becomes evident in speech and behavior

Question 4

Describe diagnostic criteria for schizophrenia

Answer 4

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

Question 5

Positive symptoms of schizophrenia include ____ and ____

Answer 5

Positive symptoms of schizophrenia include delusions and hallucinations

(new things overlaid on an otherwise normal psyche)

Question 6

Negative symptoms of schizophrenia include ____, ____, ____, and ____

Answer 6

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)

Question 7

Disorganized symptoms of schizophrenia include disorganized ____ and ____ coming from disorganized ____

Answer 7

Disorganized symptoms of schizophrenia include disorganized behavior and language coming from disorganized thoughts

Question 8

Describe pathological changes in schizophrenia

Answer 8

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

Question 9

In schizophrenia, there is a loss of integrity in white matter tracts, especially in ____ regions, leading to ____

Answer 9

In schizophrenia, there is a loss of integrity in white matter tracts, especially in frontotemporal regions, leading to network dysfunction

Question 10

____ is startle response is independent of cognitive control and ____ attenuated in schizophrenia

Answer 10

Prepulse inhibition is startle response is independent of cognitive control and is NOT attenuated in schizophrenia

Question 11

Prepulse inhibition is reversed by ____

Answer 11

Prepulse inhibition is reversed by antipsychotic medications

Question 12

Describe cytology findings in schizophrenia

Answer 12

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)

Question 13

____ region copy number variations serve as a model for schizophrenia due to their role in ____, ____, and ____

Answer 13

16p11.2 region copy number variations serve as a model for schizophrenia due to their role in differentiation, migration, and plasticity

Question 14

People with schizophrenia may have a ____ predisposition

Answer 14

People with schizophrenia may have a genetic predisposition

Question 15

Environmental factors implicated in schizophrenia act during ____ or ____

Answer 15

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)

Question 16

Cannabis use is associated with ____

Answer 16

Cannabis use is associated with schizophrenia

Question 17

____ is a medication that may be used to treat schizophrenia

Answer 17

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

Question 18

Describe the mechanism of action of chlorpromazine

Answer 18

Chlorpromazine

• Reversed epinephrine: catecholamines (alpha-1)
• Anti-emetic effects: dopamine
• Caused catalepsy: dopamine
• Atropine-like effects: ACh
• Prevented bronchospasm: histamine
• Indifference: dopamine

Question 19

_____ dopamine pathway spans from the VTA to the limbic system and is involved in emotion, motivation, and goal-oriented activity

Answer 19

Mesolimbic dopamine pathway spans from the VTA to the limbic system and is involved in emotion, motivation, and goal-oriented activity

Question 20

Blockade of ____ dopamine pathway is clinically effective in treating schizophrenia

Answer 20

Blockade of mesolimbic dopamine pathway is clinically effective in treating schizophrenia

Question 21

____ dopamine pathway spans from the VTA to basal ganglia and is involved in fine control of movement

Answer 21

Nigrostriatal dopamine pathway spans from the VTA to basal ganglia and is involved in fine control of movement

Question 22

Blockade of ____ dopamine pathway leads to acute dystonias, Parkinsonism, and tardive dyskinesia

Answer 22

Blockade of nigrostriatal dopamine pathway leads to acute dystonias, Parkinsonism, and tardive dyskinesia

Question 23

____ dopamine pathway spans from the VTA to frontal cortex

Answer 23

Mesocortical dopamine pathway spans from the VTA to frontal cortex

Question 24

Blockade of ____ dopamine pathway may worsen cognitive symptoms of schizophrenia

Answer 24

Blockade of mesocortical dopamine pathway may worsen cognitive symptoms of schizophrenia

Question 25

\_\_\_\_\_ dopamine pathway from hypothalamus to anterior pituitary

Answer 25

Tuberinfundibular dopamine pathway from hypothalamus to anterior pituitary

Question 26

Blockade of ____ dopamine pathway removes inhibition of prolactin, leading to galactorrhea, gynecomastia, sexual dysfunction, and amenorrhea

Answer 26

Blockade of tuberoinfundibular dopamine pathway removes inhibition of prolactin, leading to galactorrhea, gynecomastia, sexual dysfunction, and amenorrhea

Question 27

Efficacy of medication for schizophrenia correlates strongly with the degree of blockade of ____ receptors and is achieved at 65-70% occupancy

Answer 27

Efficacy of medication for schizophrenia correlates strongly with the degree of blockade of mesolimbic D2 dopamine receptors and is achieved at 65-70% occupancy

Question 28

\_\_\_\_\_ has greater efficacy for positive symptoms of schizophrenia than other antipsychotics

Answer 28

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)

Question 29

Antipsychotic blockade of a1 receptors can cause side effects of \_\_\_\_, \_\_\_\_, or \_\_\_\_

Answer 29

Antipsychotic blockade of a1 receptors can cause side effects of hypotension (including orthostatic hypotension), dizziness, and sedation

Question 30

Antipsychotic blockade of histamine H1 receptors can cause side effects of ____ and \_\_\_\_

Answer 30

Antipsychotic blockade of histamine H1 receptors can cause side effects of sedation and weight gain

Question 31

Antipsychotic blockade of muscarinic receptors can cause side effects of \_\_\_\_, \_\_\_\_, \_\_\_\_, \_\_\_\_, \_\_\_\_, \_\_\_\_, \_\_\_\_, and \_\_\_\_

Answer 31

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

Question 32

Describe mechanism of action of haloperidol

Answer 32

Haloperidol mechanism of action * Anti-emetic effects: dopamine * Caused cataplexy in rats: dopamine * Indiference: dopamine * Reversed amphetamines: dopamine

Question 33

\_\_\_\_ potency antipsychotics have greater affinity for the dopamine receptor and greater risk of dopamine-mediated side effects such as dystonias, parkinsonism, and akathesia

Answer 33

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

Question 34

\_\_\_\_ potency antipsychotics have lower affinity for the dopamine receptor and greater risk of cholinergic, adrenergic, and histaminic side effects

Answer 34

Low potency antipsychotics have lower affinity for the dopamine receptor and greater risk of cholinergic, adrenergic, and histaminic side effects

Question 35

Dopamine hypothesis stipulates symptoms of schizophrenia are related to an ____ of ____ in the synapse but is over-simplistic

Answer 35

Dopamine hypothesis stipulates symptoms of schizophrenia are related to an excess of dopamine in the synapse but is over-simplistic

Question 36

Describe mechanism of action of clozapine

Answer 36

Clozapine mechanism of action * Reversed epinephrine: catecholamines (a1) * Anti-emetic effects: dopamine * Atropine-like effects: ACh * Prevented bronchospasm: histamine * Indifference: dopamine

Question 37

\_\_\_\_\_ is an atypical antipsychotic because it has a lack of movement-related side effects and blocks serotonin and dopamine

Answer 37

Clozapine is an atypical antipsychotic because it has a lack of movement-related side effects and blocks serotonin and dopamine

Question 38

\_\_\_\_ has greater efficacy than any other antipsychotic but causes \_\_\_\_

Answer 38

Clozapine has greater efficacy than any other antipsychotic but causes agranulocytosis

Question 39

Risperidone is an antipsychotic that acts by blocking ____ and ____ receptors

Answer 39

Risperidone is an antipsychotic that acts by blocking serotonin and dopamine receptors

Question 40

Second-generation antipsychotics are called atypical because they ____ and \_\_\_\_

Answer 40

Second-generation antipsychotics are called atypical because they lack movement-related side effects and block serotonin and dopamine

Question 41

Describe side effects of second-generation / atypical antipsychotics

Answer 41

Side effects of second-generation / atypical antipsychotics

Question 42

\_\_\_\_ and ____ induce schizophrenia-like effects and are NMDA antagonists (effects reversed by NMDA agonists)

Answer 42

Ketamine and phencyclidine induce schizophrenia-like effects and are NMDA antagonists

Question 43

Glutamate hypothesis states ____ may precipitate psychosis

Answer 43

Glutamate hypothesis states insufficient glutamate signaling on NMDA receptors may precipitate psychosis (NMDA receptors module dopamine release)

Question 44

\_\_\_\_ presents as delusions, personality changes, mania, depression, and apathy resulting from Treponema pallidum

Answer 44

Neurosyphilis presents as delusions, personality changes, mania, depression, and apathy resulting from Treponema pallidum