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Flashcards in Mental health + Parkinsons Deck (84)
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1

How is schizophrenia seen in an MRI scan of the brain?

Ventricular dilation due to loss of brain tissue

2

What are the three main types of symptoms in schizophrenia?

Cognitive
Positive
Negative

3

State some positive symptoms of schizophrenia

Hallucinations
Delusions
Disorganised speech

4

State some negative symptoms of schizophrenia

Reduced motivation
Reduced emotion
Lack of interest
Lack of pleasure

5

State some cognitive symptoms of schizophrenia

Lack of attention
Lack of working and verbal memory

6

What are the four dopaminergic pathways in the brain?

Mesolimbic
Mesocortical
Nigrostriatal
Tuberoinfundibular

7

What is the mesolimbic pathway associated with?

Mediates pleasure, reward, motivation
Hyperactivity of dopamine mediates positive psychotic symptoms
D2 antagonists treat positive symptoms

8

What is the mesocortical pathway associated with?

Cognitive function, emotion
Decreased dopamine responsive for negative symtpoms

9

What is the nigrostriatal pathway associated with?

Motor control
Parkinsonian symptoms

10

What is the tuberoinfundibular pathway associated with?

Inhibition of prolactin release

11

Malfunction in which brain circuit are cognitive symptoms associated with?

Dorsolateral prefrontal cortex

12

What is the dopamine theory for schizophrenia?

Increased dopamine in subcortical pathways -> psychotic symptoms
Agonists of dopamine e.g. amphetamine induce psychotic symptoms

13

What is the glutamate theory of schizophrenia?

NMDA hypofunction is induced by genetic and non-genetic factors instilled in the brain in early development triggers psychosis in adulthood.
NMDA antagonist phencyclidine lead to positive, negative, cognitive and affective symptoms

14

Which of the two classes of antipsychotics causes most EPS?

Typicals

15

Name a typical antipsychotic

Haloperidol

16

Name an atypical antipsychotic

Clozapine

17

What are the major side effects of atypicals?

Weight gain
CVD
Diabetes

18

Which class of antipsychotics is ineffective at managing negative symptoms?

Typical

19

Which class of antipsychotics is associated with motor side effects and why?

Typicals because they have high affinity for dopamine D2 receptors not only in areas needed but else where so can affect motor function and cause tardive dyskinesia

20

What percentage of receptor occupancy is required for effective antipsychotic effect?

>65%

21

What is the effect of >78% D2 receptor occupancy?

EPS

22

What is the effect of over 70% D2 receptor occupancy?

Hyperprolactinaemia

23

Which antipsychotic is associated with most weight gain?

Olanzapine

24

What are the treatment options for a schizophrenic patient in the prodromal phase?

Offer CBT +/- family intervention. Do not offer antipsychotic

25

What are the treatment options for patient with first episode of schizophrenia?

Offer antispsychotic in conjunction with CBT after ruling out other causes of symptoms

26

How is a subsequent actue episode of schizophrenia treated?

Treated as first episode schizophrenia. May need to switch therapy e.g. from typical to atypical

27

What is "treatment resistant schizophrenia" defined as and how is it treated?

Schizophrenia resistant to treatment with two different antipsychotics, one of which being an atypical

28

What are the 4 different types of EPSE?

Pseudo-parkinsonism
Akathisia
Dystonia
Tardive dyskinesia

29

Which type of EPSE are anticholinergics not useful for?

Akathisia and tardive dyskinesia

30

What side effects are associated with clozapine?

VTE
Constipation
Sedation
Hypersalivation
Myocarditis and cardiomyopathy
neutropenia and agranulocytosis
Metabolic syndrome