Schizophrenia

Question 1

What structural changes take place

Answer 1

Enlarging of ventricles
Decrease in grey matter
decrease in white matter

Question 2

What is lost in whit matter and what does it Cause

Answer 2

Oligodendrocytes
Loss of myelin sheath and neuronal insulation
signals can transduce and signal

Question 3

Are neurons lost in schozophrenia

Answer 3

No
Same number
just loss of function

Question 4

What causes the neurons to become dysfunctional

Answer 4

Loss of myelin sheath –> oligodendrocytes
Dendritic pruning

Question 5

What are the 2 hypothesis for pathophysiology of schozi

Answer 5

Dopamine
Glutamate

Question 6

What are the 4 pathways in the pathophysiology

Answer 6

mesolimbic
neocortical
nigrostriatal
Tubular infundibular

Question 7

What pathway is responsible for positive synptoms

Answer 7

Mesolimbic

Question 8

What pathway is responsible for negative symptoms

Answer 8

Mesocortical

Question 9

What function does the mesocortical pathway have

Answer 9

cognitive

Question 10

What function does the mesolimbic pathway have

Answer 10

Behavioural
reward pathway

Question 11

What function does the nigral striatal pathway have

Answer 11

Motor coordination

Question 12

Where do the mesolimbic and mesocortical pathway both start from

Answer 12

VTA
venteral tegmental area

Question 13

what pathway is associated with prolactin production

Answer 13

Tuberinfundibular

Question 14

Where are the 5-HT2a receptors found

Answer 14

Nigrostriatal pathway

Question 15

Summarise why a decrease in glutamate can cause schizophrenia

Answer 15

Decreased glutaminergic signalling
decreased NMDA activity
Decreased GABA production as no glutamate to stimulate release
Decrease in GABA = Increase in mesolimbic activity
induced psychosis symptoms

Question 16

What are the 4 drug targets used in treatment

Answer 16

D2 ANTAGONIST
5-HT2a ANTAGONIST
alpha-2 ANTAGONIST
Mu ANTAGONIST

Question 17

How do D2 Antagonists help

Answer 17

Reduces dopamine levels

Mesolimbic –> block reward pathway, decrease in positive symptoms
mesocortical –> No impact as already D2 deficient
Nigrostriatal –> motor symptoms such as pseudoparkinsons
Tubular infundibular –> Increase in prolactin production as dopamine usually inhibits this

Question 18

How do 5-HT2a Antagonists help

Answer 18

5-HT2a usually inhibits dopamine
inhibiting 5-HT2a means dopamine can be released in nigrostriatal and reduce motor symptoms –. decrease in epse

Increases dopamine and glutamate in mesocortical pathway –> reduced -ve symptoms

Question 19

What is a consequence of alpha-2 antagonist

Answer 19

Hypotension due to vessels not being able to constrict

Question 20

How do muscarinic antagonists affect the body

Answer 20

Inhibit acetylcholine in nigrostriatal pathway
balances out the reduction in dopamine with a reduction in acetylcholine
reduces epses
such as cholinergic burden

Question 21

What are some of the positive symptoms

Answer 21

Hallucinations –> visual, auditory
Delusions –> grandeur, superiority
Disorganised speech

Question 22

What are some of the negative symptoms

Answer 22

Low mood
lack of enjoyment
lack of emotion
self neglect
lack of apathy

Question 23

What diagnosis tools do we use

Answer 23

DSM-5
ICD-11

Question 24

Give some examples of SGA

Answer 24

Olanzapine
quietiapine
Aripiprazole
Clozapine
Rispiradone

Question 25

Give examples of FGA

Answer 25

Haloperidol flupentixol chlorpromazine

Question 26

What is better to give when a patient is experiencing depressed symptoms

Answer 26

SGA as they have 5-HT2a antagonistic activity that can help reduce negative symptoms in the mesocortical pathway

Question 27

What are the advantages of depot injections

Answer 27

Slow release of medicine --> good for poor adherence Remains in system for longer Smooth release profile

Question 28

What are the disadvantages of the depot injection

Answer 28

Negative stigma Preperation required Dose titration hard

Question 29

What can we give for rapid tranquillisation

Answer 29

IV lorazapam IM haloperidol + IM promethazine

Question 30

What medication is locensed for resistant schizophrenia

Answer 30

Clozapine

Question 31

What tests do we do before starting clozapine

Answer 31

Blood plasma levels

Question 32

Why do we need to do blood levels before starting clozapine

Answer 32

Neutropenia Aranulocytosis

Question 33

How can we temporarily reduce EPSEs

Answer 33

Procyclidine

Question 34

What type of medication are metabolic side effects more common

Answer 34

SGA

Question 35

What are some common ADR that can occur

Answer 35

Sexual dysfunction cardiac disease Anticholinergic

Question 36

what are the extra-pyramidical side effects

Answer 36

Dystonia parkinsonism tardive dyskinesia

Question 37

What is dystonia

Answer 37

muscle spasms

Question 38

What is the treatment for dystonia

Answer 38

Anticholinergics IV procyclidine

Question 39

What is parkinsonism

Answer 39

tremor rigidity bradykinesia

Question 40

What is akathisia

Answer 40

Inner restlessness

Question 41

What medication is akathisia most common with

Answer 41

Aripiprazole

Question 42

What is tardive dyskinesia

Answer 42

muscle movements

Question 43

What are some metabolic side effects seen

Answer 43

Weight gain Dyslipidaemia increased glucose levels

Question 44

What needs to be monitored when starting an SGA

Answer 44

weight for 6 weeks, then 3 months, then 12 months Fasting BG HbA1c lipids

Question 45

What are some symptoms of hyperprolctinemia

Answer 45

sexual dysfunction menstrual cycle changes reduced bone density

Question 46

What anti-psychotic can we use for loss of libido

Answer 46

Aripiprazole

Question 47

What cardiac effects can antipsychotics have

Answer 47

Postural hypotension QT interval prolongation cardiomyopathy myocarditis torsades de pointes

Question 48

How do we monitor for myocarditis

Answer 48

Hypotension tachycardia fatigue chest pain