Module 3: Neurodevelopment, Mental Health and Mental Illness Flashcards Preview

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Flashcards in Module 3: Neurodevelopment, Mental Health and Mental Illness Deck (158)
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1

What are the positive symptoms of schizophrenia?

- Delusions

- Hallucinations

- "voices"

- Disorganised speech

2

What are the negative symptoms of schizophrenia?

- Social withdrawal

- Apathy

- Emotional blunting

3

What are cognitive problems associated with schizophrenia?

Problems with

- Memory

- Attention

- Processing speed

4

What % of the population suffer from schizophrenia?

- 1% of population

5

What factors can cause schizophrenia?

- Genetics

- Paternal age

- Maternal famine or infection

- Hypoxia

- Season

- Urban dwelling

- Cannabis use

- Migration

6

What is the risk of developing schizophrenia in identical twins?

- 48%

7

What is the risk of developing schizophrenia in fraternal twins?

- 17%

8

What can be used to find common gene variants in schizophrenia?

- GWAS

9

What are the characteristics of the 108 loci associated with schizophrenia?

- 75% are protein coding genes/groups of genes, 40% are single genes

- 8% are within 20kb of a gene

- Notable associations with existing knowledge (aetiology/treatment) e.g. DRD2

- Main associations found in genes involved in glutamate neurotransmission and synaptic plasticity, GRM3, GRIN2A, GRIA1, SRR, voltage gated calcium channel subunits, CACNA1I, CACNA1C, CACNB2

10

What are the main findings of the Schizophrenia GWAS?

- Estimated that 8,300 independent, mostly common SNPs contribute to risk for schizophrenia and that these collectively account for at least 32% of the variance in liability

- Hits converge on genes that are expressed in brain and immune tissues

- MHC locus consistently strongest association
- The leucocyte antigenic system HL-A as a possible genetic marker of schizophrenia. Br J Psychiatry. 1974 125:25-7.

- Enriched for genes in glutamate signalling
pathway

- DRD2 implicated for the first time!

- Results consistent across sites showing ‘schizophrenia’ is good enough phenotype

11

What are some rare schizophrenia alleles?

- DISC1- a gene affected by a translocation that causes various forms of mental illness in some carriers

- 22q11 deletion syndrome- a deletion that can cause a variety of symptoms including various forms of mental illness in some carriers

12

What is 22q11 deletion syndrome?

- Velo-cardio-facial syndrome

- Hypoparathyroidism

- Underdeveloped thymus or absent thymus, which results in problems in the immune system

- Heart defects

- Cleft lip and/or palate


- Up to 1/3 VCFS patients may develop schizophrenia or other psychiatric illness

- Approximately 1% of patients with schizophrenia have 22qDS

- The schizophrenia in 22qDS is indistinguishable by symptoms, treatment response, neurocognitive profile, or MRI brain anomalies.

13

What are characteristics of rare schizophrenia-associated loci?

- Highly but not completely penetrant

- Not specific to schizophrenia

14

What are de Novo variants?

- Present in child but not in either parent

- Sufficiently rare (0-3 per exome) that could be possible to identify casual variants

- Very successful approach to identifying the cause of Mendelian diseases through sequencing

15

Describe de Novo variants in schizophrenia

- Examine “sporadic” cases
– Very difficult to find, depending how you define
them

- Compare frequency of de novos in cases vs.
controls

- Make assumptions about causality for those
present in cases

16

What have GWAS and rare variant studies have found?

- Studies of common (GWAS) and rare (sequencing ) variants have all started to implicate synaptic pathways in schizophrenia

- These pathways have also been implicated in
large scale studies of autism and epilepsy

- Maybe not surprising biologically?

- Less useful for drug development?

17

Describe the zinc transporter (ZnT3)

- Significantly decreased in schizophrenia
- impact on synaptic transmission

- Highly brain specific - present in SV sub-populations

- Suboptimal Zn nutrition during gestation in rate causes long-term effects on brain (Aimo et al 2010)

- Zn supplementation beneficial in unipolar depression (Nowak et al 2003)

18

What is the genetic association of the synaptic vesicle specific zinc transporter with schizophrenia?

- Significant allelic association was observed for four SNPs with disease status in our UK cohort.

- Genotypic associations were observed for all four SNPs tested, consistent with a dominant model for disease penetrance.

- Haplotype analysis further supported these associations with 4 SNP haplotype associated with risk for disease, after correcting for multiple comparisons.

19

What are different types of Cognitive Behavioural Therapy (CBT)?

- Cognitive Analytical Therapy

- Interpersonal psychotherapy

- Brief solution focussed therapy

- Psychodynamic psychotherapy

- EMDR

- Family therapy

- Dialectical Behavioural Therapy (DBT)

- Motivational interviewing

20

Why is language an issue regarding CBT?

- CBT and the associated lexicon were developed in HICs, whose language (e.g. English) differ (sometimes very substantially) from LIMCs

21

What is the hierarchy in patient-therapist relationship?

- Patient-therapist relationship in LAMICs is typically hierarchical

- Patients see the therapist as the expert and expect him/her to act as such- by showing authority and being directive

- A therapist attempting to be collaborative in such contexts may be unwittingly convey the impression of lack of expertise to the patient

22

How is distance a problem in therapist-patient relationships in LAMICs?

- The patient may travel very long distances at huge expenses and personal hazard to see a therapist

- It is not uncommon that the patient may never see the therapist again

23

Describe service organisation in CBT in LAMICs

- Referral pathways for CBT may not exist or if it is exists it is not understandable or accessible to clinician or the patient

- So the clinician seeing the patient may be the only one who can offer the patient CBT techniques (the patient may never be seen again)

24

What are the benefits of group intervention in CBT?

- More cost-effective

- Fits the collectivist culture in LAMICs

- Meta-analyses of CBT in depression and anxiety consistently find group therapy to be as effective as individual therapy

25

Why can CBT be delivered by lay/non-specialist workers?

- The principle of CBT is relatively easy to convey to non-specialist health workers and other non-health professionals such as teachers

- CBT lends itself readily to manualisation

- Several RCTs of CBT in LIMCs have shown good outcomes with treatments delivered by trained non-specialists using manuals developed and supervised by specialists

26

What are the benefits of behavioural techniques in CBT?

- Easier to explain- especially by less skilled clinicians

- Quicker to understand and relatively easier to use

- As effective as cognitive interventions or full CBT

27

What other factors are important to consider in CBT?

- More directive approach (hierarchial nature of patient-therapist relationship)

- Language (Adapt, translate into local languages, idioms and metaphors

- Incorporating existing helpful cultural/religious coping strategies

28

When is it logical to promote/encourage religious coping?

- If religious coping is helpful in a culture

- Religious practice/coping is high in that culture

29

What are the negative effects of religion on mental health?

- Guilt

- Promotion of anhedonia

- Promote stigma

- Harmful practices e.g. chaining and beating

- Reduced treatment adherence e.g. fasting

30

What are the positive effects of religion on mental health?

- Finding meaning in one's life

- More positive appraisal of negative events e.g. story of Job

- External attribution of negative events e.g. blame the Devil

- Promotion of positive affect e.g. count your blessings

- Social support e.g. reduced isolation

- Positive social guidance e.g. teaching of moderation

- Opportunity to give or serve - which improves positive affect

- Promoting or sustaining Hope in otherwise hopeless circumstances (which could reduce suicidality)