Chapter 16 - Schizophrenia

Question 1

What was an ancient treatment for psychosis? (Neolithic, > 7000 years ago)

Answer 1

Trephination

A hole is drilled into the skull to release spirits and treat headaches

Question 2

Before the 1900’s, what did people think psychosis was the result of?

Answer 2

Stress and strain of personal/ social interactions

Question 3

In 1911, what did Hideyo Noguchi do and what did he find?

Answer 3

Examined brains of psychotics

Found that the brains were damaged by syphillis

Question 4

True or false? Schizophrenia will persist for life only.

Answer 4

False. Can cycle in and out of remission.

Question 5

What are the early and later definitions of schizophrenia? (Know conventional symptoms)

Answer 5

Early: Paranoia, delusions, hallucinations, abnormal emotions, thought disturbances
Later: Dissociated thinking (lack of logic)

Question 6

What are five “types” of Schizophrenia?

Answer 6

1. Disorganized
2. Catatonic
3. Paranoid
4. Undifferentiated
5. Residual

Question 7

Is Schizophrenia a genetic disorder?

Answer 7

Shows strong genetic predisposition but identical twins do not have 100% concordance. (twin adoption study) (may be due to developmental/environmental difference)

Question 8

What signs does the schizophrenic twin usually exhibit?

Answer 8

Lower birth weight
More tearful, sensitive, vulnerable
Early neurological signs (eye movement)

Question 9

What happens with the ventricles in patients with Schizophrenia? What does this suggest?

Answer 9

Enlarged.

Cortical atrophy and neural degeneration. (Consequence, not root cause!)

Question 10

Early-onset schizophrenia in adolescence is characterized by a (loss/gain) in _____ matter.

Answer 10

Loss, gray

Question 11

With respect to the limbic system, what is observed with patients with Schizophrenia?

Answer 11

Smaller hippocampus and amygdala

Question 12

Schizophrenia patients have a (smaller/larger) cerebellar vermis?

Answer 12

Smaller

Question 13

During frontal cortex development, what may also be observed in patients? What is this consistent with?

Answer 13

Abnormal neuronal migration

Consistent with impaired performance on frontal lobe dependent tasks.

Question 14

In patients, frontal lobe neuronal complexity is (less/more)?

Answer 14

Less

Question 15

How is the hippocampus organized in patients?

Answer 15

Cells are disorganized, results in abnormal inputs and outputs

Question 16

In the hippocampus, what is correlated with severity of disease?

Answer 16

Degree of disorganization

Question 17

Using PET and fMRI, what has been observed in the frontal lobes of patients?

Answer 17

Lower metabolic activity, even at rest

Question 18

What is the effect of antipsychotics?

Answer 18

Increase frontal lobe activity

Question 19

What are the two main theories of Schizophrenia?

Answer 19

1. Dopamine hypothesis

2. Glutamate hypothesis

Question 20

Why is it difficult to study Schizophrenia and why?

Answer 20

Hard to separate cause from effect because Schizophrenia = heterogenous disease (could have different causes for different symptoms)

Question 21

[Dopamine hypothesis] With amphetamine psychosis, what is the dose required by amphetamine addicts and why?

Answer 21

3000 mg/day (5 mg for normal person keeps them awake!)

Due to drug tolerance

Question 22

[Dopamine hypothesis] With amphetamine psychosis, what is the dose required by amphetamine addicts and why?

Answer 22

3000 mg/day (5 mg for normal person keeps them awake!)

Due to drug tolerance

Question 23

[Dopamine hypothesis] What are the effects of using too much amphetamine?

Answer 23

Paranoia, delusions of persecution, auditory hallucinations, strange motor behaviour

Question 24

Amphetamines make schizophrenic symptoms (better/worse)?

Answer 24

Worse

Question 25

Amphetamines make schizophrenic symptoms (better/worse)?

Answer 25

Worse

Question 26

What do typical antipsychotics do and with which hypothesis does this support?

Answer 26

Block D2 receptors

Dopamine hypothesis

Question 27

In Parkinson’s patients, what drug can produce schizophrenic symptoms?

Answer 27

L-DOPA

Question 28

What does the ‘Dopamine Hypothesis’ suggest?

Answer 28

Schizophrenia may result from excessive synaptic dopamine or excessive postsynaptic sensitivity to dopamine

Question 29

What are the four main problems with the DA hypothesis?

Answer 29

1. DA antagonists don’t help all patients
2. Atypical antipsychotic drugs (works better!)
3. Dopamine metabolites in CSF, blood, urine (normal levels)
4. Therapeutic lag (DA receptors blocked quickly but symptoms reduced later)

Question 30

Atypical antipsychotic drugs have low activity of what and is it (more / less / just as) effective for positive symptoms? Negative symptoms?

Answer 30

Low D2 activity
Just as effective for positive symptoms
More effective for negative symptoms
(Note: can increase dopamine release, and L-DOPA combined with atypical works better!)

Question 31

What is the ‘Glutamate Hypothesis’?

Answer 31

Schizophrenia may be caused by decreased activity at NMDA receptor

Question 32

What acts as an NMDA antagonist?

Answer 32

Phencyclidine (PCP)

Question 33

What acts as an NMDA antagonist?

Answer 33

Phencyclidine (PCP)

Question 34

What can PCP induce?

Answer 34

Positive and negative symptoms similar to schizophrenia (psychomimetic)

Question 35

Prolonged administration (2 weeks) resulted in what in monkeys?

Answer 35

Decreased performance on prefrontal cortex dependent tasks

Question 36

What is the ‘Integrative Model’ for treatment?

Answer 36

Identify those with biological predispositions (brain abnormalities) and provide them with lower stress environments