Neurobiology of Psychosis Flashcards

(73 cards)

1
Q

patient believes that their parents are trying to poison them because the government are controlling them. Which psychopathology term is most appropriate?

A

paranoid delusion

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2
Q

patient believes that news articles on the television about world leaders’ phones being tapped are actually talking about themselves as they holds important government information- what term describes this

A

ideas of reference

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3
Q

what is a functional hallucination

A

where the hallucination does not occur in the absence of a stimulus but are triggered by a stimulus in the same modality as the hallucination and can co occur with it

e.g. When Brian listens to the radio he can hear voices from elsewhere in the room telling him he must not think about the military information he has been given

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4
Q

what is heritability

A

proportion of observable differences in a trait between individuals in a population that is due to genetic differences

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5
Q

what is the inheritance of schizophrenia

A

multifactorial

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6
Q

does a childhood viral CNS infection increased risk of schizophrenia

A

yes by 50%

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7
Q

what does a brain look like in a patients with schizophrenia who has a poor prognosis

A

reduced frontal lobe volume
reduced frontal lobe grey matter
enlarged lateral ventricle volume

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8
Q

what brain abnormalities are seen in schizphrenia

A
reduction in gray matter in the: 
temporal cortex 
medial temporal lobe 
orbitofrontal cortex 
parietal cortex 
basal ganglia 

white matter- abnormal neural integration (increased fractional anisotrophy= reduced healthy white matter tracts)

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9
Q

what causes gray matter abnormalities in schizophrenia

A
reduced arborisation (branching)
same number of neurones just abnormal connections in both gray and white matter
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10
Q

what is the dopamine hypothesis of schizophrenia

A

drugs which release dopamine in the brain or D2 receptors agonists produce a psychotic state
in schizophrenia there is overactivity of dopamine pathways in the brain

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11
Q

how do amphetamines affect schizophrenia symptoms

A

can worsen them

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12
Q

antagonists of what are used to treat the symptoms of schizphrenia

A

dopamine receptor antagonists

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13
Q

what are the dopaminergic pathways, what do they do and what areas do they involve

A

nigrostriatal- extrapyramidal motor system (substantia nigra-> dorsal striatum)

mesolimbic/ cortical - motivation and reward systems (ventral tegmental area-> amygdala, hippocampus, frontal cortex, nucleus accumbens)

tuberoinfundibular- control of prolactin release

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14
Q

what are the two subtypes of dopamine receptors

A

D1 receptor family (D1 and 5)

D2 receptor family (D2,3,4)

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15
Q

what do D1 receptors do

A

stimulate cAMP

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16
Q

what do D2 receptors do

A

inhibit adenylyl cyclase
inhibit voltage activated Ca2+ channels
opens K+ channels

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17
Q

what type of dopamine receptor is most abundant

A

D1

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18
Q

where are D1 receptors found

A

neostriatum, cerebral cortec, olfactory tibercle, nucleus accumbens

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19
Q

where are D2 receptors found

A

neostriatum, olfactor tubercle, nucleus accumbens, pituitary gland

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20
Q

where are D3 receptors found

A

nucleus accumbens, island of calleja

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21
Q

where are D4 receptors found

A

midbrain, amygdala

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22
Q

where are D5 receptors found

A

hippocampus, hypothalamus

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23
Q

which dopamine receptors are found within the limbic ans striatal areas

A

D1 and 2

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24
Q

what neurobiology causes psychosis

A

subcortical dopamine hyperactivity

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25
what neurobiology caiuses negative and cognitive symptoms
mesocortical dopamine hypoactivity
26
what other neurotransmitters are suggested to be involved in schizophrenia
glutamate- altered NMDA receptor expression serotonin- reduced binding potential in frontal cortex
27
what genes cause brain pathology in schizphrenia
neuregulin- a signalling protein that mediates cell-cell interactions and plays critical roles in the growth and development of multiple organ systems dysbindin- essential foe adaptive neural plasticity DISC-1 - involves in neurite outgrowth and cortical development through its interaction with other proteins
28
what is a typical antipsychotic
works primarily though inhibition of D2 receptors
29
what symptoms are typical antipsychotics more likely to cause
extrapyramidal symptoms
30
name 2 typical antipsychotics
chlorpromazine | haloperidol
31
which side of synapse do antipsychotics work on
post synaptic receptors
32
what are atypical receptors
block both D2 and 5-HT2A receptors are less likely to induce extrapyramidal side effects better efficacy against negative symptoms effective in patients unresponsive to typical drugs
33
give examples of atypical antipsychotics
``` olanzapine risperidone quetiapine clozapine aripiprazole amisulpride ```
34
what does risperidone mainly block
5-HT2A
35
what does olanzapine mostly block
5-HT2A
36
what does haloperidol mostly block
D2
37
Why can antipsychotics cause extrapyramidal side effects
as block D2 receptors in the nigrostriatum (connects substantia nigra and dorsal striatum)
38
what is an acute dystonic reaction to antipsychotics
acute dystonia- muscle spasms- which takes hours to days
39
how is an acute dystonic reaction treated
acetycholine antagonists: prochlorperazine, procyclidine, orhphenadrine
40
how long till parkinsonism develops due to antipsychotics
days to months
41
what is akathisia
internal restlessness- feel the need to constantly move, fidget, wriggle or pace SE of antipsychotics, comes on after days- weeks
42
what is tardive dyskinesia
repetitive involuntary purposeless movements - grimacing, sticking tongue out, lip smacking, pursing lips, blinking possible SE of antipsychotics, takes years to develop, very hard to treat- try and prevent it happening
43
how do antipsychotics cause hyperprolactinaemia
secretion of prolactin from the pituitary is inder inhibitory control by dopamine from the hypothalamus
44
what does hyperprolactinaemia cause
sexual dysfunction, galactorrhoea/ gynaecomastia, amenorrhoea, infertility, (low oestrogen and testosterone) osteoporosis
45
what syndrome can 5-HT2 blockade cause (atypical antipsychotics)
metabolic syndrome
46
what dose histamine blockage cause
sedation | increased appetite
47
what are H1 receptors
histamine receptors
48
why are new antihistamines not sedative
as do not cross BBB
49
what can blockage of alpha aderergic receptors cause
postural hypotension (interupts baroreflex)
50
what system targets muscarinic receptors
parasympathetic
51
what are the anticholineric side effects (muscarinic blockage)
``` blurred vision dry mouth constipation urinary retention sedation confusion ```
52
what SEs do you avoid if taking a typical antipsychotic
weight gain, cardiovascular risk, sedation
53
what SEs do you avoid if taking an atypical antipsychotic
extrapyramidal | sexual SEs
54
which blockage will cause parkinsonism
dopamine receptors (D2)
55
which blockage will cause metabolic syndrome
serotonin
56
which blockage is most likely to cause falls
alpha adrenergic, histamine
57
which blockage is most likely to cause sedation
histamine
58
which antipsychotic is least likely to cause a recurrence of parkinsonism: ``` Risperidone Olanzapine Chlorpromazine Quetiapine Zuclopentixol ```
quetiapine (doesnt block D1/2)
59
haloperidol antagonises dopamine receptors in the pituitary gland, what SEs will this cause
sexual dysfunction ect (think hyperprolactinoma)
60
what does clozapine mostly block
histamine 5-HT2A alpha adenergic muscarininc actylcholine
61
what drug causes agranulocytosis
clozapine
62
how often should you do blood tests when prescribing clozapine
weekly for first 6 months fortnightly for next six months every four weeks thereafter for one month after stopping drug
63
what symptom should make you worried when taking clozapine
sore throat
64
what cardiac problem do you get when taking clozapine
myocarditis
65
what can result from a D2 blockade
``` extra pyramidal SEs: acute dystonic reaction parkinsonism akathisia tardive dyskinesia ``` hyperprolactinaemia
66
main SEs of clozapine
weight gain, sedation, hypersalivation, risk of agranulocytosis
67
which antipsychotic for avoidance of EPSE
atypicals
68
which antipsychotic are less sedating
haloperidol | risperdone
69
which antipsychotic are more sedating
olanzipine | chlorpomazine
70
which antipsychotic avoid weight gain
haloperidol | aripiprazole
71
which antipsychotic for treatment resistant schizophrenia
clozapine
72
which antipsychotic can be given as IM depot
risperidone
73
which antipsychotic can be used for anxiety
olanzipine