Psychosis and Antipsychotics Flashcards Preview

MOHD4: Exam 5 > Psychosis and Antipsychotics > Flashcards

Flashcards in Psychosis and Antipsychotics Deck (58):
1

22q11 deletions

alter expression of genes via decrease of DGCR8 protein expression

2

Which of these illnessess does not have psychosis??

Brain tumors
Dementias
Endocrine disorders
Depression
Seizures
Infections
Substance intoxication/withdrawal
Delirium

Depression

3

Region hyperactivated in hallucinations

secondary auditory association cortex
(located in superior temporal gyrus)

4

Hallucinations result from increased activity from _______ and decreased activity from ________

Increased from emotional regulation/attention,
Decreased from monitoring/volitional functions

5

Structures involved in delusions

fronto-striatal circuits, parietal cortices, amygdala, cerebellum

6

Symptoms include:
Delusions
Hallucinations
Disorganized speech
Disorganized/catatonic behavior
Negative symptoms (flat, alogia, avolition)

Schizophrenia
(at least two symptoms,
at least 1 from the first three
for most of at least 1 month)

7

Genetics involved in schizophrenia

KCNH2
DTNBP1
NRG1
DISC1
RGS4

8

Structural abnormalities in schizophrenia include:
Enlarged ventricles
Reduced total brain volume
Enlarged occipital lobes
Smaller frontal/temp/par lobes

All but enlarged occipital lobe

9

Which of these cells are altered in schizophrenia pathology?
Pyramidal
Chandelier
Neurons
Oligodendrocytes
Astrocytes

All but astrocytes

10

Which neurotransmitters have dysfunction in schizophrenia?

DA, glut, GABA, 5-HT, ACh

11

What is the increased risk if a sibling has schizophrenia?

9% if sibling only,
16% if one parent + sibling

12

What is the heritability estimate of schizophrenia?

80%

13

What is the increased risk of schizophrenia in offspring?

13% if one parent,
46% if both parents

14

What are examples of common variants in schizophrenia?

SNPs
Tandem repeats

Account for ~30% of risk variance
8300+ variants
100 different genes

15

What are examples of rare varients in schizophrenia?

mutations
Unique CNVs (100+ w/ schiz ass'n)
- 22q11 via DGCR8 decrease
- DISC1 translocation (1/11)

16

Target of antipsychotic drugs

D2 receptor

D2 side effects:
• Extrapyramidal symptoms: Nigrostriatal pathway, parkinsonism, dystonia, akathisia, tardive dyskinesia after chronic use
• Worse negative/cognitive symptoms: mesocortical pathway
• Hyperprolactinemia, galactorrhea, amenorrhea, gynecomastia (esp risperidone)

17

Increases catecholamine via receptor blockade in the presence of MAO inhibition

Chlopromazine

18

Classifications of antipsychotics

Chemical
First/Second generation
High/low potency

19

Included in chemical class of phenothiazines

• Aliphatic: chlorpromazine
• Piperidine: thioridazine
• Piperazine: fluphenazine, perphenazine

20

First generation antipsychotics

chlorpromazine, haloperidol, fluphenazine, perphenazine, thioridazine, trifluoperazine

21

Additional effects of second-generation antipsychotics

5-HT2a antagonism, D2 receptor affinity

22

Low potency antipsychotics have ______ side effects related to D2 blockage, _______ side effects related to non-DA receptors

Decreased

Increased

23

Non-DA side effects of antipsychotics

Anticholinergic
Antihistamine
Alpha-1 adrenergic
QTc prolongation
Increased BP, lipids, blood sugar
Neuroleptic malignant syndrome

24

Side effects include agranulocytosis, seizure (high dose), constipation, sialorrhea, myocarditis, orthostatic hypotension + tachycardia

Clozapine

25

Shown to be more efficacious than other antipsychotics

Clozapine

26

Longest time to d/c in CATIE study

olanzapine

27

FDA approved uses of antipsychotics

schizophrenia
schizoaffective disorder
bipolar disorder
major depressive disorder
Tourette's syndrome

28

Moderate potency antipsychotics

perphenazine, loxapine

29

High potency antipsychotics

haloperidol, fluphenazine

30

Low potency antipsychotics

chlorpromazine

31

Catatonia

decreased reactivity to environment (negativism, rigid posturing, mutism, stupor)

32

Which major NT systems involved in psychosis?

DA, glut, GABA, 5-HT

33

Basal magnocellular corticopedal pathway involves...

GABA and ACh pathways

34

Acute fluctuating disturbance in attention, awareness, cognition

Delirium

35

Monitoring/volitional structures decreased during auditory hallucinations:

dlPFC, Cerebellum, DACingulate cortex

36

Emotional regulation and attention structures upregulated during auditory hallucinations:

OFC, VACingulate cortex, subcortical structures

37

Hyperactive in auditory hallucinations

Secondary auditory association cortex

38

Delusion of passivity means

someone/somthing external is controlling you

39

Thought broadcasting means

Others can hear your thoughts

40

Misinterpreting messages from the external world

Reference

41

Thought withdrawal means

Thoughts are being taken from your mind

42

Circuits involved in delusions

Salience/reference
Agency/others
Fear/paranoia

43

Abberrations in how brain circuits specify hierarchia predictions, how they compute and response

Delusions

44

the state or quality by which it stands out relative to its neighbors

Saliance

45

Symptom domains in Schizophrenia include

Delusions
Hallucinations
Disorganized speech
Disorganized or catatonic behavior
Negative symptoms (affect, alogia, avolition)

+ Common cognitive deficits

46

Structures commonly involved in all delusions

prefrontal cortex, midbrain


Other structures: fronto-striatal circuits, parietal cortices, amygdala, cerebellum, anterior cingulate, medial PFC

47

Alterations in glut affect GABA signalling, increase in glut in PFC, overinhibition of DA.

True --> too little DA results in negative symptoms

48

Alterations in glut affect GABA signalling, hyperactivity in NAcc and increase in DA.

True --> positive symptoms in schizophrenia

49

Hereditibility in schizophrenia

up to 80%. Some environmental involvement.

50

22q11 deletion

alters expression of multiple genes of DGCR8 (microRNA processing complex --> impact other areas of the genome)

51

DISC1 (disruption of schizophrenia 1)

translocation between 1/11 gene, disrupts gene, produces altered protein, interaction with many pathways (Wint, Dynein, Endopeptidate, Inflammatory, Immune) --> neurodevelopment

Found in Family in Scotland, produces other mental disorders

52

Schiz with shorter time period

schizophreniform disorder

53

Schiz with low mood

schizoaffective disorder

54

Schizophrenia is a chronic illness

True

55

Potency is inverse to efficacy.

False - potency has NO relationship to efficacy.

56

Likely to cause hyperprolactinemia, galactorrhea, amenorrhea, gynecomastia

Risperidone
(+ other D2 blockades)

57

Antihistamine effects:

Weight gain
EPS clonazapine, olanzapine

58

Clozapine scary SE

agranulocytosis (+ seizures, constipation, myocarditis, orthostatic hypotension, tachycardia)

Use only for treatment resistant schizophrenia