Chapter 19, Antipsychotics

Question 1

Schizophrenia DSM-5 definition

Answer 1

• Delusions of persecution and auditory
  hallucinations are common
• Grossly disorganized or abnormal motor
  behaviour
• Language, particularly speech, often
  disorganized or incoherent
• Negative symptoms: reduced emotional
  expression, lack of volition, social
  withdrawal, apathy,
• Cognitive defects

Question 2

Schizophrenia diagnosis requires

Answer 2

• Two or more of the following for at least 1 month
• Delusions*
• Hallucinations*
• Disorganized speech*
• Grossly disorganized or catatonic behaviour
• Negative symptoms, such as diminished emotional expression

Question 3

Positive symptoms of Schizophrenia

Answer 3

• hallucinations
• delusions (e.g., paranoia)
• thought disorders
• movement disorders
• depersonalization

Question 4

Negative symptoms of Schizophrenia

Answer 4

• flat affect
• lack of pleasure
• social withdrawal
• alogia (poverty of speech)
• loss of interest and motivation
  if positive symptoms are dominant
• tend to be older at onset
• respond well to antipsychotic medication

Question 5

Cognitive symptoms of schizophrenia

Answer 5

• disorganized thinking
• poor concentration
• poor memory
• difficulty expressing ideas
• difficulty integrating thoughts and feelings
  if negative symptoms are dominant
• sometimes mistaken for other disorders (e.g., depression)
• symptoms are resistant to current treatments

Question 6

Abnormalities of brain structure and function in schizophrenia

Answer 6

• cerebral atrophy and ventricle enlargement
• disorganized hippocampal cells
• abnormal myelination and organization of white matter tracts
• reduced function of PFC (hypofrontality) ( PET scans show less blood flow to the frontal cortex when performing cognitive tasks

Question 7

Inflammation and Schizophrenia

Answer 7

• blood levels of pro-inflammatory cytokines are elevated and anti-inflammatory cytokines are reduced; levels return to normal after successful antipsychotic drug treatment.
• prenatal inflammation may cause abnormal neurodevelopment that increases the risk for schizophrenia.

Question 8

The neurodevelopmental model of schizophrenia

Answer 8

Genetic vulnerability in combination with environmental
stressors alter the trajectory of brain development, ultimately
resulting in the symptoms observed in schizophrenia
* Negative and cognitive symptoms caused by reduced frontal lobe function
* Positive symptoms caused by excessive mesolimbic DA activity following
early mesocortical cell loss (which could be due to genetics or
environmental events)

Question 9

Dopamine hypothesis of schizophrenia

Answer 9

excess DA function results in the positive symptoms of schizophrenia
* There is overlap in symptoms between stimulant-induced psychosis
* Amphetamine-induced Psychosis can be treated with psychosis
* Amphetamines make symptoms worse in patients with schizophrenia

Question 10

DA imbalance hypothesis of schizophrenia

Answer 10

symptoms are due to reduced DA function in mesocortical neurons along with excess DA function in mesolimbic neurons