PBL 6 Flashcards
What does olazapine mean
an antipsychotic drug that is used to treat schizophrenia.
what is the definition of schizophrenia
major mental illness that affects how one thinks, feels and perceives.
- it can significantly impair functioning and has both acute and chronic effects on cognition
what is the hallmark symptom of schizophrenia
o Psychosis is the hallmark symptom.
i.e. experiencing auditory hallucinations (voices)/delusions (fixed false beliefs).
when does the onset of scizophrenia usually occur
• Onset: usually adolescence/early adult life.
o Onset can be insidious/acute (possibly after emotional event).
How do you classify schizophrenia
These types were:
• Paranoid (prominent hallucinations/delusions).
• Disorganized (behaviour without purpose).
• Catatonic (unusual movements between being very active/still).
• Undifferentiated (have signs of different types and doesn’t fit into one).
• Residual (history of psychosis but only negative symptoms).
- these have since been removed as they are not helpful in treatment
how do you diagnose schizophrenia
you have to have at least two of the following
Delusions
• Of control, influence or passivity.
• Persistent delusions of any other kind (i.e. superhuman powers/abilities).
Hallucinations: voices commentating.
• Persistent hallucinations in any modality.
Disturbance in Thought/Speech
• Echo, insertion or withdrawal.
• Breaks in train of thought resulting in incoherent/irrelevant speech.
Catatonic Behaviour
• Variety of abnormal motor postures.
o Mutism, stupor.
Negative Symptoms
• Marked apathy, low self-esteem, introversion, personal neglect.
or you can have one very clear symptom of delusion, hallucination, disorganised speech
- these symptoms have to be ongoing for 6 months or nearly present for most of the time during a period of 1 or more month
- have to have exclusion of mood disorder, substance misuse
what are the three types of symptoms of schizophrenia`
- positive
- negative
- cognitive
describe what the they types of systems are and give examples
- Positive Symptoms: hallucinations, delusions, agitation, disorganized thinking (psychotic symptoms).
- Negative Symptoms: introversion, apathy, low self-esteem, personal neglect (decreased emotions).
- Cognititive Symptoms: poor memory, attention deficit, executive dysfunction (making decisions).
what symptoms has a major outcome on schizophrenia
(!) Cognitive deficits have a major impact on the outcome of schizophrenia and social reinsertion of patients.
• As few as 10% of patients with schizophrenia work full time/20% can work part time.
how can you test for a cognitive dysfunction
Frontal Cortical Dysfunction Testing: Wisconsin Card Sorting Test.
what does the patient in this case present with
- Auditory Hallucinations: 2nd person command auditory hallucinations.
- Delusions: paranoid persecutory delusional beliefs.
- Isolated/social withdrawal and self-absorbed: significant change in aspects of her personal behaviour.
describe the epidemiology of schizophrenia
• Most common type of psychotic disorder (general population occurrence around 1%).
• Constant prevalence throughout the world with no difference between males vs females
o Although onset is earlier in males.
describe the pathophysiology of schizophrenia
• Associated with decreased synaptic spines/decreased dendritic complexity in the cortex.
o Creates abnormalities in formation/maturation of brain circuits
what provides evidence that there is a genetic factor for schizophrenia
there is a concordance rate in monozygotic twins of 50%
what is the biggest risk factor for developing schziophrenia
having a close relative with psychosis and schizophrenia
what genes have been associated with schizophrenia
o Dysbindin: may affect D2 receptors levels/glutamate and GABA transmission
o Neuregulin: neuroplasticity.
o DISC 1: neurodevelopment and signalling in Corticolimbic areas.
o DAOA: glutamatergic transmission
o COMT: dopaminergic transmission.
o BDNF: neurotrophic factor
o RGS4: G-protein coupled receptor signalling.
what environmental factors can lead to schizophrenia development
• Events that occur during gestation may be critical. Higher risk if:
o Born in winters.
o After viral epidemics.
• Other risk factors include:
o Excessive cannabis use in adolescence.
describe the structural and functional changes that are seen in schizophrenia
• Increased rate of gray matter loss
o Larger ventricles and smaller mesial temporal lobes.
• Event-related potentials (ERPs) (increased reactions to stimulation).
• Hypofrontality (decreased frontal activation)
o Leads to excessive striatal dopamine release (explains psychotic symptoms).
- Overall brain volume loss
- Altered brain connectivity
what is treatment for schizophrenia based upon
Treatment is based on the “dopamine theory of schizophrenia”.
• Believed to be an imbalance between dopaminergic projections.
o Hyperactivity in the mesolimbic pathway.
o Hypoactivity in the mesocortical pathway.
what is the major pharmacological target of all drugs used to treat schizophrenia
Dopamine D2 receptors are major pharmacological target of all drugs used to treat schizophrenia:
- acts as antagonists.
name two types of drugs used to treat schizophrenia
- Typical Neuroleptics/First Generation Antipsychotics
- Atypical Neuroleptics/Second Generation Antipsychotics
name examples of the typical antipsychotics
- Chlorpromazine
- Thioridazine
- Fluphenazine
- Haloperidol
- Flupenthixol.
describe how typical antipsychotics work
- Block dopamine receptors as well as acting as antagonists at other receptors (e.g. muscarinic cholinergic, histamine H1 and alpha2-adrenergic receptors).
- Lack of selectivity of action
what was the first neuroleptic drug
• Chlorpromazine was the first neuroleptic drug.
