Schizophrenia

Question 1

delusions/hallucinations

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

disorganized speech/behavior, decreased cognition

Answer 1

positive sx
negative sx
cognitive sx

Question 2

mediating systems of thought/perception

schizophrenia results from these 3

Answer 2

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

Question 3

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

Answer 3

PFC
highly processed/complex info
EXECUTIVE FUNCTION

Question 4

working/ST memory
planning/prioritizing/multitask
behavioral flexibility

affective/emotional states (reigns in amygdala)

decreased activity in which disorder?

Answer 4

dorsolateral PFC

orbitofrontal PFC (mediofrontal)

schizophrenia

Question 5

delayed response task: test of working memory supports what?

lesion here?

Answer 5

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

Question 6

perseveration

Answer 6

unable to show behavioral flexibility

pts w/PFC damage or schizo

Question 7

neocortex+amygdala+HC+paraHC gyri

convergence of info from ALL sensory modalities

regulates info processing, sensory perception, emotion-laden memory

Answer 7

temporal lobe

Question 8

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

Answer 8

Temporal lobe epilepsy

Question 9

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

Answer 9

temporal

Question 10

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

Answer 10

mesocortical limbic pathway

Question 11

psychosis (3 sx)

Answer 11

hallucinations
paranoia
attention abnormalities

Question 12

results of DA antagonists

which receptors?

Answer 12

D2 receptors

antipsychotics (reverse sx)

Question 13

efficacy of antipsychotics is correlated with what?

Answer 13

affinity for D2 receptors

Question 14

haloperidol has the greatest impact on what type of sx?

Answer 14

positive

not much effect on negative sx

Question 15

atypical antipsychotics do what?

Answer 15

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

Question 16

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

Answer 16

cognitive

Question 17

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

Answer 17

dlPFC
ofPFC
temporal, DA

Question 18

what is reduced in schizophrenic brains?

name what changes occur in 1)ventricles 2)temporal lobe 3)cytoarchitecture

Answer 18

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

Question 19

psychopathologic mechanism for schizo?

Answer 19

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

Question 20

DA does what to the PFC?

Answer 20

inhibits

Question 21

risk factors for suicide in schizos?

Answer 21

male
depression
hopelessness
substance use
unemployment
social isolation

Question 22

epidemiology

Answer 22

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

Question 23

schizophrenia is a d/o of?

Answer 23

thought and perception

Question 24

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

Answer 24

temporal

Question 25

2 DA pathways: nigrostriatal MCL

Answer 25

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

Question 26

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

Answer 26

L-DOPA, amphetamines, cocaine

Question 27

antipsychotic MOA?

Answer 27

DA antagonists

Question 28

PCP MOA?

Answer 28

antagonist at the glutaminergic NMDA receptor

Question 29

glycine effect?

Answer 29

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

Question 30

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

Answer 30

``` PFC AC thalamus temporal cortex cerebellum ```

Question 31

in schizo, DA hyperactivity where?

Answer 31

ventral striatum (--> MCL)

Question 32

risk factors of schizo risk factor for relapse?

Answer 32

``` IU injury maternal influenza maternal starvation (2nd tri) cannabis during adolescence low SES "downward drift" ``` families w/high expressed emotion

Question 33

schizo ddx

Answer 33

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

Question 34

substance-induced psychotic d/o agents?

Answer 34

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

Question 35

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

Answer 35

prominent delusions/hallucinations

Question 36

majority of morbidity comes from these symptoms:

Answer 36

negative

Question 37

three chars of alogia

Answer 37

diminution of thought lack of speech content reduced speech

Question 38

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

Answer 38

loosening of associations illogical thought processes incomprehensible speech

Question 39

soft signs aka: what are they?

Answer 39

EPS poor coordination right/left confusion gait impairment

Question 40

tell me about schizoaffective d/o prognosis? tx?

Answer 40

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

Question 41

tell me about delusional d/o

Answer 41

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

Question 42

schizophreniform and | brief psychotic d/o

Answer 42

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

Question 43

prodromal sx of schizo active phase

Answer 43

social w/d loss of interest deterioration in hygiene unusual behavior outbursts of anger must have meds to bring active phase to end

Question 44

predictors of poor outcomes

Answer 44

``` 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 ```

Question 45

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

Answer 45

no

Question 46

acute psychosis tx

Answer 46

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

Question 47

med for tx-refractory schizo

Answer 47

clozapine | SE: seizures/cardiomyopathy/agranulocytosis

Question 48

adverse effects of all antipsychotics?

Answer 48

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

Question 49

timeframe for NMS?

Answer 49

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

Question 50

NMS sx? SS sx?

Answer 50

``` mental status changes muscle rigidity (elevated CK) hyperthermia ANS instability (tachy/tachypnea) ``` CLONUS/hyperreflexia/hyperthermia/tachy/altered mental state

Question 51

antipsychotics mostly tx these symptoms, but not so much these sx... what's the best tx?

Answer 51

positive negative/cognitive psychosocial rehab= meds + teaching (e.g. ACT program) ``` also family psychoeducation (reduces relapse) cognitive therapy (changing delusional thoughts and response to) ```

Question 52

which hormone regulates thought and perception?

Answer 52

DOPAMINE