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Year 2 BB > 19. Schizophrenia > Flashcards

19. Schizophrenia Flashcards

1
Q

What are the different types of symptoms of schizophrenia and give specific examples

A

Positive symptoms - hallucinations, delusions, agitation, disorganised thinking
Negative symptoms - introversion, apathy, low self-esteem leading to personal neglect
Cognitive symptoms - poor memory, attention deficit, executive dysfunction

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2
Q

How is schizophrenia diagnosed?

A

No physical tests to diagnosed schizophrenia - clinical diagnosis
Two or more of the following for a significant portion of time during a one month period:
Delusions
Hallucinations
Disorganised speech
Grossly disorganised or catatonic behaviour
Negative symptoms

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3
Q

What is the role of genetics in the development of schizophrenia?

A

The more you are related to somebody who has schizophrenia, the higher your risk is of developing it
There is a very strong genetic component but it is not a monogenic disease so there is not a straight influence

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4
Q

Name some genes which are associated with the development of schizophrenia

A

BDNF - neurotrphic factor
COMT
DAOA
Neuregulin 1

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5
Q

What type of people tend to develop schizophrenia and at what age does it tend to develop?

A

Often emerges in patients with an intelligence well above average

Tend to develop signs of the disease averagely around 20

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6
Q

Which symptom type are the drugs to treat schizophrenia generally effective against?

A

Generally used to treat the positive symptoms - do not currently have sufficient treatment to treat the negative and cognitive symptoms

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7
Q

Name the different types of schizophrenia

A 
Paranoid
Disorganised
Catatonic
Undifferentiated
Residual
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8
Q

Are there structural changes of the brain that occur in schizophrenia and if so, what are they?

A

Generally there is no structural change of the brain in Schiz - so it is hard to understand why there is a profound abnormality in these patients

NB. in some patients there may be a small level of shrinking of grey matter and a increasing size of the ventricles - these tend to happen in patients who have a poor outcome and who do not respond to medication

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9
Q

Why does schizophrenia tend to happen at the start of the 20s?

A

This is because this is the time when the brain reaches final maturation - especially the prefrontal cortex

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10
Q

What in the brain is most likely to be altered in schizophrenia (if not brain structure)?

A

Schizophrenia is most likely to effect connectivity in the brain - a disease of altered brain connectivity

Particularly in the mesolimbic pathway (hyperactivity) and the mesocortical pathway (hypoactivity)

Mesolimbic pathway - positive symptoms
Mesocortical pathway - negative and cognitive symptoms

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11
Q

What is the main neurotransmitter effected in schizophrenia?

A

Dopamine - there is a large imbalance of these neurotransmitters throughout different regions of the brain

Mesolimbic - hyperactivity due to reduced reuptake of dopamine
Mesocortical - hypoactivity

SO treat with drugs targeting the dopaminergic pathways and receptors

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12
Q

What are the different dopamine receptor and which do you want to target for schizophrenia?

A

D1 type - D1, D5
D2 type - D2, D3, D4

The D2 receptors are the major pharmacological target for the treatment of schizophrenia

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13
Q

What is the main drug used to treat schizophrenia?

A

Chlorpromazine aka. Largactil

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14
Q

DRUGS ARE IN DRUG BANK

A

DRUGS ARE IN DRUG BANK

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15
Q

What are the adverse effects of antipsychotic drugs?

A 
Parkinsonism
Weight gain
Dyslipidemia
Type 2 diabetes
Postural hypotension

These are generally due to the usage of atypicals

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16
Q

What is an effect of long term usage of anti-psychotics?

A

Tardive dyskinesia - involuntary movements of the lips, jaw, face, grimacing, constant chewing, tongue thrusting

17
Q

What are the non-pharmacological treatments to treat schizophrenia?

A

Cognitive behavioural therapy
Family therapy

BUT these should not replace the pharmacological treatment and should be used in conjunction

18
Q

What is the mesolimbic pathway and what is it’s role?

A

This is the dopaminergic pathway from the ventral tegmental area to the nucleus accumbens

There is dopaminergic release in the nucleus accumbens for rewarding stimuli

19
Q

Where is the ventral tegmental area?

A

Located in the midbrain

20
Q

Where is the nucleus accumbens?

A

Part of the basal ganglia - in the basal forebrain

21
Q

What is the mesocortical pathway and what is it’s role?

A

Dopaminergic pathway from the ventral tegmental area to the prefrontal cortex
Involved in cognitive control, motivation and emotional responses

22
Q

What are the three dopaminergic pathways of the CNS that we need to be aware of and what does dysfunction in them result in?

A

Mesolimbic - Schizophrenia
Mesocortical - Schizophrenia
Nigrostriatal - Parkinson’s disease

23
Q

What environmental factors can lead to the development of schizophrenia?

A 
Drug and substance abuse - can trigger schizophrenia if you have the genes that predispose you to the disease
Unemployment
Poor housing conditions
Low birthweight 
Childhood trauma
24
Q

What are the different targets for the pharmacological treatments of schizophrenia?

A

Typical antipsychotics - these mainly target D2 receptors BUT these also have an affinity for many other receptors e.g. D1, histamine H1

Atypical antipsychotics - used to mainly target 5-HT receptors (these are the first choice) - antagonistic effects at 5-HT so may potentially be able to also improve cognition

25
Q

What is the relation of schizophrenia to glutamate receptors?

A

Post mortem studies have shown that there is a hypoglutamaterigic state in the cortex and schiz is associated with decreased glutamatergic transmission

26
Q

What type of symptoms is catatonia?

A

Used to be considered a positive symptom and now considered a negative symptom - either is correct

27
Q

What are the differential diagnoses for schizophrenia?

A

Psychosis in other conditions

28
Q

What is clozapine and when is this used to treat schizophrenia?

A

Blocks D4 receptors with a high affinity - used if there is no response to any other medication

29
Q

How can non-compliance of schizoprenia medication be overcome?

A

Depot injection of the medication

Year 2 BB (36 decks)

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