Flashcards in Schizophrenia Deck (43)
When are males and females more likely to develop schizophrenia?
Males - younger (<25 years)
Females - older (<35 years)
3 Genes known to be associated with schizophrenia
Neurogulin Dybindin DISC1
Environmental triggers known to be associated with schizophrenia (4)
perinatal complications Cannabis use Stressors Lower income background
5 robust brain findings in people with schizophrenia
1. larger lateral ventricles 2. reduced fronto-temporal lobe volume, amygdala and hippocampus 3. reduced activation of the prefrontal cortex on specific tasks 4. reduced white mattive volume 5. neurotransmitter differences - dopamine, serotonin, glutamate
Drugs affecting which neurotransmitter cause schizophrenia to get worse
What sort of drugs stimulate dopaminergic activity in the brain and may produce a psychotic state?
Which pathway is primarily affected in schizophrenia?
mesolimbic pathway and ventral tegmental area (VGA) --> the reward pathway
How is glutamate implicated in schizophrenia?
excitotoxicity - long term hyperactivity leads to excitotoxicity and long term deterioration that characterises the disease course
Where does glutamate particularly effect in the brain of schizophrenics?
What is the prodromal phase of schizophrenia?
a period preceding the first episode of psychosis by around 18 months, characterised by the gradual deterioration in functioning; odd ideas and behaviour, altered affect, social withdrawal, reduced interest in activities
What are Schneiders symptoms of first rank?
symptoms that are suggestive of schizophrenia in the absence of durg use or organic impairment but are not specific to SZ
3 Symptoms of first rank - Schizophrenia
Auditory hallucinations, passivity phenomena, delusional perception
What is the main feauture of positive symptoms of schizophrenia?
It adds a new feature that does not have a physiological counterpart i.e. it is normal to have varying levels of concentration through life, it is never normal to have hallucinations
Positive symptoms of schizophrenia
Hallucinations of any form, delusions, passivity phenomena, disordered form of thought, disorganised speech and behaviour, catatonic behaviour
What are passivity phenomena?
Made acts, thoughts, impulses and feelings such as thought insertion, thought withdrawal, thought broadcasting
What is catatonic behaviour?
strange, purposeless behaviour i.e. sudden excitement, waxy flexibility and negativity, mutism
What is the main feature of negative symptoms in schizophrenia?
reduction or removal of ability to do normal processes not due to depression or anti-psychotics
Negative symptoms of schizophrenia
reduced amount of speech, reduced amount of motivation and drive, reduced interest and pleasure, reduced social interaction, restricted range of affect
What are the general diagnostic criteria for schizophrenia?
At least 1 symptom of first rank and at least 2 others. Symptoms must have been present for at least 6 months and most of the time for 1 month. There must be marked impairment in functioning at work and home
Good prognostic indicators for Schizophrenia
Older age of onset, female sex, marked mood disturbance esp. elation, FHx or mood disorder, no history of drug use
Bad prognostic indicators for schizophrenia
insidious onset, poor pre-morbid adjustment, early onset, cognitive impairement, enlarged ventricles
Which anti-psychotic requires particular monitoring and why?
Clozapine - 6 monthly bloods - agranulocytosis
Examples of typical (1st Gen) antipsychotics
Which receptor do typical (1st gen) antipsychotics affect?
D2 receptor - neuroleptic (tranquilisers)
What is the main reason for stopping 1st gen anti-psychotics?
extrapyramidal side effects
What are extrapyramidal side effects?
tremor, dystonia, tardive dyskinaesia, parkinsonism, bradykinesia
Examples of atypical (2nd gen) antipsychotics
Risperidone, quetiapine, onlanzapine, clozapine
How do atypical antipsychotics work?
have a high 5HT2a to D2 receptor ratio; less likely to cause extrapyramidal effects and have a better efficacy against negative symptoms
Example of 3rd generation antipsychotic