10. Schizophrenia

Question 1

Schizophrenia is characterised by…

Answer 1

Distortions in thinking, perception, emotions, language, sense of self and behaviour.

Question 2

Number of people affected by schizophrenia worldwide

Answer 2

20 million

Question 3

Positive symptoms of schizophrenia

Answer 3

Delusions, hallucinations, thought disorder, inappropriate effect, disorganised speech

Question 4

Negative symptoms of schizophrenia

Answer 4

Alogia (poverty of speech), avolition and anhedonia (flat effect)

Question 5

Cognitive deficit symptoms

Answer 5

Impairment in attention, learning and working memory

Question 6

4 risk factors

Answer 6

1) Pre and peri-natal events
2) Having an older father
3) Sex - more frequent in men
4) Environment - disadvantaged areas

Question 7

Describe drug abuse as a risk factor

Answer 7

• Amphetamine, methamphetamine and cocaine can result in SZ
• Cannabis > transient psychotic symptoms

Question 8

Describe social adversity as a risk factor

Answer 8

• Childhood physical/sexual abuse, maltreatment and bullying can all be risky
• Increased rate of intrusive life events before onset

Question 9

How much of the variance does implicated loci account for?

Answer 9

3.5%

Question 10

Name 5 of the genetic risk factors

Answer 10

1) DRD2 - codes for D2 receptor
2) GRM3 - encodes for metabotropic glutamate receptor
3) GRIN2A - encodes for GluN2A
4) GRIA1 - encodes for GluA1
5) SRR - encodes serine racemase

Question 11

What occurs to brain volumes in SZ

Answer 11

Total white and grey matter reduces as well as volume compared to healthy controls.

Question 12

What occurs to ventricular volume in SZ

Answer 12

It increases

Question 13

What occurs to cortical thickness in SZ

Answer 13

The volume decreases and is localised to the bilateral insult and the ACC, hypothalamus, and left uncus and amygdala

Question 14

Describe the abnormal salience processing and emergence of hallucinations

Answer 14

Increased striatal DA uptake is seen in SZ patients - it is linked to prefrontal cortex activity

Question 15

Describe hallucinations in SZ

Answer 15

The activation of auditory and speech processing cortices have been linked to hearing voices

Question 16

What occurs to the social brain in SZ?

Answer 16

The medial PFC, tempo parietal junction and amygdala are key regions of the social brain, and are abnormal in schizophrenic patients.

Question 17

Describe working memory as a cognitive symptom

Answer 17

Quantitative abnormalities in the dorsolateral PFC cortex, rostral anterior cingulate cortex

Question 18

Describe episodic memory as a cognitive symptom

Answer 18

SZ patients show reduced dorsolateral prefrontal cortex activation and decreased activation of hippocampal formation

Question 19

What occurred in 1952?

Answer 19

Chlorpromazine effects on mental state were discovered

Question 20

What occurred in 1954?

Answer 20

The drug got FDA approval

Question 21

What occurred in 1964?

Answer 21

50 million people had been treated with chlorpromazine

Question 22

What occurred in 1964-1969?

Answer 22

First reports of efficacy in comparison to placebos - phenothiazines were equally effective.

Question 23

Define parkinonism

Answer 23

Parkinson-like motor symptoms

Question 24

Define tardive dyskinesia

Answer 24

Involuntary neurological movement disorder, with jerky or slow twisting movements

Question 25

What does SZ result from?

Answer 25

Overactivity in the mesolimbic DA system.

Question 26

What can exacerbate psychosis in SZ patients?

Answer 26

Drugs which drive dopamine release or increase dopamine transmission

Question 27

Name some evidence for the dopamine theory.

Answer 27

- All antipsychotic drugs block D2 receptors at clinically effective doses - There's an increase in D2 receptor density - There's a decrease in D1 density

Question 28

Issues with the dopamine hypothesis - negative symptoms

Answer 28

These do not respond to first generation antipsychotic treatment despite the D2 receptor antagonism.

Question 29

Expand on the clozapine atypical profile.

Answer 29

There is a low incidence of side effects including Parkinsonism, and no tardive dyskinesia.

Question 30

Expand on the clozapine receptor profile

Answer 30

- Low affinity for D2 receptors - High affinity for D4 receptors - High affinity for 5-HT2 receptors - High affinity for a2 - noradrenergic receptors - D1 receptor agonist effects

Question 31

What is the effect of antipsychotics on D2 receptors

Answer 31

All antipsychotics, typical and atypical, block dopamine receptors

Question 32

Define the dopamine serotonin hypothesis

Answer 32

When atypical antipsychotics have a bigger affinity for the 5-HT2 receptor, compared to the D2 receptor. A blockade of the 5-HT2 receptor antagonises the increased neuronal activity during a WM task.

Question 33

Mention antagonism at adrenoreceptors

Answer 33

Antagonism at adrenoreceptors is more pronounced for second generation APDs than for first generation APDs.