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Flashcards in Schizophrenia Deck (52):
1

delusions/hallucinations

flat affect, diminution of thought and speech, lack of goal-direction

disorganized speech/behavior, decreased cognition

positive sx
negative sx
cognitive sx

2

mediating systems of thought/perception
schizophrenia results from these 3

PFC
Temporal lobe (cortex, amygdala, HC)
DA (VTA-MCL)

3

extensively interconnected w cortical/subcortical regions that process sensory info
"the executive"

PFC
highly processed/complex info
EXECUTIVE FUNCTION

4

working/ST memory
planning/prioritizing/multitask
behavioral flexibility

affective/emotional states (reigns in amygdala)

decreased activity in which disorder?

dorsolateral PFC

orbitofrontal PFC (mediofrontal)

schizophrenia

5

delayed response task: test of working memory supports what?
lesion here?

PFC regulates executive fxn
lesion here results in inability to switch strategies or change behavior (monkey keeps reaching for same side)
WI card sort test

6

perseveration

unable to show behavioral flexibility
pts w/PFC damage or schizo

7

neocortex+amygdala+HC+paraHC gyri

convergence of info from ALL sensory modalities

regulates info processing, sensory perception, emotion-laden memory

temporal lobe

8

seizure causing altered mental states including hallucinations, déjà vu, “out of body” experiences, all in absence of motor convulsions

Temporal lobe epilepsy

9

which lobe is activated during hallucinations? and is abnormal in schizophrenic brains?

temporal

10

reward+reinforcement
VTA to PFC, accumbens, temporal lobe
(projections to entire brain)

mesocortical limbic pathway

11

psychosis (3 sx)

hallucinations
paranoia
attention abnormalities

12

results of DA antagonists
which receptors?

D2 receptors
antipsychotics (reverse sx)

13

efficacy of antipsychotics is correlated with what?

affinity for D2 receptors

14

haloperidol has the greatest impact on what type of sx?

positive
not much effect on negative sx

15

atypical antipsychotics do what?

not only antagonize D2 receptors, but also other receptors and also IMPROVE NEGATIVE SX

16

there are not good treatments for what type of schizo sx?

cognitive

17

where's the lesion?
thought disorder
emotional blunting/lability
psychosis

dlPFC
ofPFC
temporal, DA

18

what is reduced in schizophrenic brains?
name what changes occur in 1)ventricles 2)temporal lobe 3)cytoarchitecture

grey matter in PFC
ventricular enlargement
temporal lobe reduction
temporal/frontal changes

19

psychopathologic mechanism for schizo?

hypoactivity of PFC --> disinhibition of VTA --> hyperactivity of dopamine in MCL pathway

20

DA does what to the PFC?

inhibits

21

risk factors for suicide in schizos?

male
depression
hopelessness
substance use
unemployment
social isolation

22

epidemiology

1%
M=F
15-25 in men
27 in women

23

schizophrenia is a d/o of?

thought and perception

24

amygdala, hippo, parahippo gyrus are found in which lobe?

temporal

25

2 DA pathways:
nigrostriatal
MCL

NS: cell bodies in SN, projects to forebrain
MCL: cell bodies in CTA and projects to limbic and cortical areas (incl PFC and temporal)

26

3 drugs that are DA agonists and can produce paranoia and hallucinations

L-DOPA, amphetamines, cocaine

27

antipsychotic MOA?

DA antagonists

28

PCP MOA?

antagonist at the glutaminergic NMDA receptor

29

glycine effect?

promotes glu binding to NMDA --> improves negative and cognitive sx

30

cognitive dysmetria hypothesis: 5 components of the neural network disrupted in schizo that causes sx

PFC
AC
thalamus
temporal cortex
cerebellum

31

in schizo, DA hyperactivity where?

ventral striatum (--> MCL)

32

risk factors of schizo

risk factor for relapse?

IU injury
maternal influenza
maternal starvation (2nd tri)
cannabis during adolescence
low SES "downward drift"

families w/high expressed emotion

33

schizo ddx

temporal lobe epilepsy
wilson's, parkinson's, huntington's
Vitamin B12
neurosyphilis
lupus
heavy metal poisoning
deletion in 22q --> DiGeorge

34

substance-induced psychotic d/o agents?

stimulants
hallucinogens
antiparkinsonian's
anticholinergics
alcohol/BZD/barb w/d

35

if hx of autism/communication d/o, then what additionally is needed for schizo dx?

prominent delusions/hallucinations

36

majority of morbidity comes from these symptoms:

negative

37

three chars of alogia

diminution of thought
lack of speech content
reduced speech

38

name 3 main cognitive sx that show "disorganization of thought processes" (criteria A3 and A4)

loosening of associations
illogical thought processes
incomprehensible speech

39

soft signs aka: what are they?

EPS
poor coordination
right/left confusion
gait impairment

40

tell me about schizoaffective d/o
prognosis?
tx?

A) either MDE or manic episode concurrent with schizo Criterion A (MDE must include "depressed mood")
B) delusions/halluc for 2+ wks in absence of a mood episode
C) Mood sx present for the majority of the illness

Better prognosis than schizo, but worse than MDD or bipolar

tx: antipsychotic w/antidepressant OR mood stabilizer

41

tell me about delusional d/o

A) delusions w/duration of 1+ month
B) Schizo Crit A never been met (hallucinations, if present, not prominent and assoc w/delusion theme)
C) Functioning not impaired, behavior not odd outside of delusions themselves
D) if mood/MDE occurs, brief
E) r/o body dysmorphic d/o and OCD

women>men; mid-late life

42

schizophreniform and
brief psychotic d/o

SPh: A, D, E of schizo but btw 1-6 months
BP: < 1mo

43

prodromal sx of schizo active phase

social w/d
loss of interest
deterioration in hygiene
unusual behavior outbursts of anger

must have meds to bring active phase to end

44

predictors of poor outcomes

lower IQ
male gender
age of onset
neg/cog sx
structural brain abnormalities
long prodrome
absence of mood sx
presence of obessions/compulsions
soft signs
family hx
live in industrialized nation

45

does early intervention (meds/psychosocial) during the prodrome reduce conversion to schizo?

no

46

acute psychosis tx

atypicals
watch for wt gain/HTN/dyslipidemia/insulin resistance
monitor weight/circumference/lipid levels/glucose

47

med for tx-refractory schizo

clozapine
SE: seizures/cardiomyopathy/agranulocytosis

48

adverse effects of all antipsychotics?

QT prolongation
sudden cardiac death
caution in adolescents/elderly (dementia)

49

timeframe for NMS?

w/in 30d of new antipsychotic OR increase in dose
sx arise over several days

50

NMS sx?

SS sx?

mental status changes
muscle rigidity (elevated CK)
hyperthermia
ANS instability (tachy/tachypnea)

CLONUS/hyperreflexia/hyperthermia/tachy/altered mental state

51

antipsychotics mostly tx these symptoms, but not so much these sx...

what's the best tx?

positive
negative/cognitive

psychosocial rehab= meds + teaching (e.g. ACT program)

also family psychoeducation (reduces relapse)
cognitive therapy (changing delusional thoughts and response to)

52

which hormone regulates thought and perception?

DOPAMINE