Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Sem 3 Neuro > Case 8 > Flashcards

Case 8 Flashcards

1
Q

What does “affects” mean in psychiatry?

A

Mood states

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the International Classifications of Diseases (ICD-10) definition of Schizophrenia?

A

Severe enduring mental disorder.
Fundamental and characteristic distortions of PERCEPTION, THINKING and AFFECTS, that are inappropriate or blunted.
Clear consciousness and intellectual capacity are usually maintained.
COGNATIVE DEFICITS may evolve.

Accompanied by high levels of social dysfunction, inability to maintain employment, depression and suicide.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the three main symptom domains associated with Schizophrenia?

A 
Positive Symptoms (psychosis). 
Negative (deficit) symptoms. 
Cognitive impairments.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is “alogia”?

A

Poverty of speech.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is “anhedonia”?

A

Inability to feel pleasure in normally pleasurable activities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is “asociality”?

A

Lack of motivation to engage in social interaction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is “avolition”?

A

Decrease in motivation to initiate and perform self-directed purposeful activities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are positive symptoms of Schizophrenia? Give some examples.

A

They are known as additional symptoms of the disease.

Delusions
Hallucinations (mainly auditory)
Thought disorder (loosening of associations between thoughts) aka knights move thinking.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are negative (deficit) symptoms of Schizophrenia? Give some examples.

A

They are known as symptoms due to a lack of normal functioning. (Deficit of normal function)

Flat or blunted emotion. 
Alogia.
Anhedonia.
Asociality.
Avolition.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are cognitive impairments in Schizophrenia? Give examples.

A

They are impairments particularly of MEMORY and EXECUTIVE FUNCTIONS.

Example: planning and decision making impairments.

These prove to be the most debilitating.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a delusion?

Examples?

A

A fixed false belief, unshakable by superior evidence to the contrary, out of keeping with a persons cultural norms.

Often seen in SZ:
Someone is spying on me (reference)
Someone wants to do me hard (persecution)
Satan is controlling me (control)
Bizarre and impossible (i can photosynthesise)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are hallucinations?

Examples?

A

A perception, internally generated, in the absence of an external stimulus.

Involves any sensory modality: 
Auditory 
Visual 
Olfactory 
Tactile (somatosensory - temperature, pressure).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which hallucination is characteristic in Schizophrenia?

A

Auditory hallucinations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

According to the International Classifications of Diseases (ICD-10) how is Schizophrenia diagnosed? (in terms of ranks & months)

A

Need at least 1 “first rank” symptom for at least 1 month.

Or at least 2 “second rank” symptoms for at least 1 month.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the 4 “first rank” symptoms with regards to diagnosing Schizophrenia?

A
  1. Thought echo, insertion, withdrawal or broadcasting.
  2. Delusions of control, influence (body/limb movements) or delusions of thoughts/ actions/ sensations.
  3. Auditory hallucinations (running commentary, discussing patients between themselves for eg)
  4. Persistent delusions that are completely impossible.

Need at least 1 for 1 month.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the 4 “second rank” symptoms with regards to diagnosing Schizophrenia?

A
  1. Other persistent hallucinations in any other modality.
  2. Thought disorder (knights move for eg)
  3. Catatonic behaviour
  4. Negative symptoms not due to depression or medications.

Need at least 2 for 1 month.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the main 4 dopaminergic pathways?

A
  1. Nigrostriatal pathway
  2. Mesolimbic pathway
  3. Mesocortical pathway
  4. Tuberoinfundibular pathway
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which 3 dopaminergic pathways start from the cell body groups in the midbrain: Substantia Nigra pars compacta (SNc) and the Ventral tegmental area (VTA)?

A
  1. Nigrostriatal pathway
  2. Mesolimbic pathway
  3. Mesocortical pathway (continues from mesolimbic pathway).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the three anatomical divisions of the striatum?

A
  1. Caudate
  2. Putamen
  3. Ventral striatum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the three functional divisions of the striatum? and where are they positioned in relation to the anatomical devision of the striatum?

A
  1. Sensori-motor
  2. Associative
  3. Limbic

Sensory-motor and associative regions are located more laterally (dorsal) in the striatum. They also straddle the caudate and putamen.

The limbic region is more medial (ventral), and covers the ventral striatum.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe the Nigrostriatal pathway.

A

Starts from the Substantia nigra (SNpc) and goes to the caudate and putamen (i.e. striatum).

  1. SNc → Sensori-motor region (dorsal striatum).
  2. SNc → Associative region (middle striatum).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe the Mesolimbic pathway.

A

Starts from the Ventral tegmental area (VTA) and goes to the “limbic regions” of the brain, associated with reward.

This includes:
1. VTA → ventral striatum*
and also amygdala, hipocampus and medial pre-frontal cortex.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the Mesocortical pathway.

A

VTA → frontal cortex. Including the dorsolateral pre-frontal cortex (DLPFC).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe what you need to know about the Tuberoinfundibular pathway.

A

DA acts to inhibit prolactin release from the pituitary.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is dopamine release in the nigrostriatal pathway responsible for? How is it related to Parkinsonism?

A
  1. SNc → Sensori-motor region (dorsal striatum) is for involuntary motor control.
    Low dopamine here leads to Parkinsonism.
  2. SNc → Associative region (middle striatum) is for cognition, emotion, volition (will power).
    Low dopamine here leads to Parkinsonism.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is dopamine release in the mesolimbic pathway responsible for? What regions are part of the limbic system?

A

Limbic regions are responsible for memory, reward, motivation, and affects.

Limbic regions include: 
ventral striatum (nucleus accumbens), amygdala, hippocampus and medial pre-frontal cortex.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is dopamine release in the mesocortical pathway responsible for? Which regions are involved?

A

Cognitive function, motivation, and emotional response.

Frontal cortex and DLPFC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is dopamine release in the tuberoinfundibular pathway responsible for?

A

inhibits prolactin release from pituitary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What functional area does the SNc innervate and though which pathway?

A

Innervates the senseri-motor and associative region of the striatum.
Through the nigrostriatal pathway.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What functional area does the VTA innervate and through which pathway?

A

Innervates the ventral striatum through the mesolimbic pathway.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the associative striatum responsible for?

A

learning, habituation, memory, attention, motivation, emotion, volition.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the sensory-motor striatum responsible for?

A

Involuntary motor control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the limbic ventral striatum responsible for?

A

Reward

34
Q

What are the two main classifications of dopamine receptors?

A

D1 receptor family

D2 receptor family

35
Q

Which DA receptors do antipsychotics work at?

A

True D2 receptors

36
Q

Which DA can be either short or long?

A

True D2 receptors

37
Q

Which DA receptor is the most abundant?

A

D1 receptors

38
Q

Which receptors are part of the the D1 family classification?

A

True D1 and D5

39
Q

Which receptors are part of the the D2 family classification?

A

True D2 Long and Short
D3
D4

40
Q

What type of receptors are DA receptors?

A

GPCR’s

41
Q

What are the two DA abnormalities in Schizophrenia?

A
  1. Excessive DA in the striatum during illness exacerbations
  2. Inadequate DA in frontal cortex
42
Q

Which DA abnormality is correlated with positive symptoms?

A

Excessive DA in the striatum during illness exacerbations

43
Q

Which symptoms, positive or negative, respond well to antipsychotic drug treatment?

A

Positive symptoms.

44
Q

Which DA abnormality is correlated with negative symptoms?

A

Inadequate DA in frontal cortex

45
Q

Are DA abnormalities thought to be the primary problem in Schizophrenia?

A

No.

Thought to be a secondary/ knock on effect of a problem somewhere in the GABA/Glutamate system.

46
Q

Where is dopamine found to be elevated in an acute psychotic episode?

A

Associative striatum

47
Q

What is 18F-DOPA?

A

An analogue of DA precursor DOPA.

18F-DOPA can be used as a “brain tracer”.

48
Q

When does increased DA develop?

A

DA elevations where found up to 3 years before onset of schizophrenia.

49
Q

Were prior increases to DA correlated with severity of prodromal symptoms and cognitive impairment?

A

Yes

50
Q

What does ARMS stand for?

A

“At risk mental state”

51
Q

What does UHR stand for?

A

“Ultra high risk”

52
Q

In patients with Schizophrenia, where in the striatum was dopamine found to be normal (or even hypo-functional)?

A

Ventral/ Limbic striatum

53
Q

What are the glutamate receptors?

A

NMDA
AMPA
kainate
mGluR1-8

54
Q

What is the main hypo-functional receptor hypothesised in the glutamate-schizophrenia theory?

A

Hypo-functional NMDA receptos

55
Q

What is mGluR1-8 stand for?

A

Metabotropic Glutamate Receptor 1-8

56
Q

What type of receptors are glutamate receptors?

Specifically what type of receptor is an NMDA receptor?

A

They are all ion gated ligand channel.

Except mGluR1-8 (its in the name - metabotropic)

57
Q

Summarise the glutamate-schizophrenia theory in 4 steps.

A
  1. Decreased NMDA receptor function
  2. glutamate excito-toxicity
  3. impaired DA release
  4. disease progression
58
Q

What is thought to have caused hypo-functional NMDA receptors hypothesised in the glutamate-schizophrenia theory?

A

Mixture of genetic factors and the environment.

59
Q

Is the VTA affected by the excessive glutamate release from cortex?

A

NO
It can actually be more inhibited because not directly innervated by the glutamate neurones.
This can lead to VTA producing less DA in limbic and mesocortical pathways. i.e. less DA in cortex

60
Q

Where is DA low to cause cognitive impairments?

A

Pre-forntal Cortex

61
Q

Where do antipsychotics work? and how?

A

D2 receptor antagonism

62
Q

What is the antipsychotic effective threshold with regards to D2 antagonism? (percentage)

A

Antipsychotic drugs need to block at least 65% of D2 receptors in the associative striatum to be effective.

63
Q

What is the extrapyramidal side effects threshold with regards to D2 antagonism? (percentage)

A

78%

64
Q

Why are antipsychotic drugs taken at different doses if the effective threshold remains the same in the associative striatum?

A

Because different drugs have varying affinities to the D2 receptor.

65
Q

What else, other than the dose, can antipsychotic drug D2 affinity affect?

A

TIME or duration of drug action.

66
Q

Do D2 receptors need to blocked 24 hours a day to elicit their beneficial effects?

A

No

Only have to block the receptors for several hours, but the duration is undefined.

67
Q

With regards to antipsychotic drugs: is D2 antagonism defined to the associative striatum?

A

Nope.

They occupy D2 receptors in other, unwanted, regions and is currently unavoidable.

68
Q

Is other non-DA receptor occupancy necessary?

A

Nope.

69
Q

We know antipsychotics work on the nigrostriatal associative pathway by blocking D2 receptors. How does D2 antagonism in other areas give adverse effects? (Name the other areas & the related effects).

A
  1. Nigrostriatal motor pathway
    Parkinsonism and other extrapyramidal effects
  2. Mesolimbic pathway
    Worsening of negative system
  3. Mesocortical pathway
    May exacerbate low DA, leading to deterioration in cognitive function
  4. Tuberoinfundibular pathway
    Hyperprolactinaemia
70
Q

What is the hyperprolactinaemia threshold in antipsychotic drugs? Why is this more of a problem than extrapyramidal threshold?

A

72%

Literally slightly above the antipsychotic efficacy of 65%

71
Q

What is the extrapyramidal threshold in antipsychotic drugs? Why is this less of a problem than hyperprolactinaemia threshold?

A

78%

Bigger gap between antipsychotic efficacy of 65% (than hyperprolactinaemia).

72
Q

Are drugs with the higher or lower receptor affinity more likely to give side effects?

A

Drugs with lower affinity have lowest risk of giving side effects.

73
Q

What are the general symptoms and problems with hyperprolactinaemia?

A 
Sexual dysfunction 
Breast Pathology 
Hypogonadism 
Miscellaneous acne 
Reproductive dysfunction
74
Q

What other receptors do antipsychotics bind to?

A

Histamine
Muscarinic acetylcholine receptors, or mAChRs
Seretonin receptors
alpha-adrenergic

75
Q

With regards to receptor mediated adverse effects of antipsychotics: what effects result from M1 antagonism?

Remember acetyl-choline acts on M1 mACh receptors

A 
Dry mouth 
Sore throat
Blurred vision 
Tachycardia 
Urinary retention 
Abuse potential (give buzz)
76
Q

With regards to receptor mediated adverse effects of antipsychotics: what effects result from (sympathetic) alpha-adrenergic antagonism?

Remember adrenaline and noradrenaline act on the alpha receptors and cause blood flow contraction.

A

Postural hypotension and reflex tachycardia.

Small pupils

77
Q

With regards to receptor mediated adverse effects of antipsychotics: what effects result in cardiotoxicity?

Remember the heart is made up of muscle.

A 
M1 antagonism (muscle function antagonism) 
a-adrenergic antagonism (sympathetic antagonism)
78
Q

With regards to receptor mediated adverse effects of antipsychotics: what effects result in sedation?

Remember what receptor/s causes sedation.

A 
H1 antagonism (sedation)
a-adrenergic antagonism (sympathetic antagonism)
79
Q

With regards to receptor mediated adverse effects of antipsychotics: what effects result in weight gain?

A

Most evidence shows:
Seretonin receptors antagonism
H1 receptors antagonism
a-adrenergic antagonism

Effects on leptin

80
Q

Do antipsychotics work on both positive and negative symptoms?

A

No they do almost nothing to negative symptoms and cognitive impairments.

81
Q

Main worrying side effects of Clozapine? (Rare)

A

Agranulocytosis

Therefore blood tests needed

Sem 3 Neuro (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions