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BMSc - Psychiatry > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

When is the average onset of SZ?

A

Teen/YA

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2
Q

Which hallucinations are mostly seen in SZ?

A

Auditory

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3
Q

What is a delusion?

A

Fixed, rigid belief that does not waver when pressed

Different from any cultural, religious, social background

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4
Q

What are the negative symptoms of SZ?

A 
Withdrawal
Poor attention
Anhedonia
Lethargy
Speech reduction
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5
Q

What is passivity phenomena?

A

Belief that not in full control of actions

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6
Q

What is the lifetime risk of SZ with 2 SZ parents?

A

45%

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7
Q

What is the concordance between MZ twins?

A

45%

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8
Q

What is the concordance between DZ twins?

A

18%

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9
Q

What is a good prognosis a/w?

A 
Being female 
Sudden onset
Married
Good premorbid state
FHx of mood disorder
No ventricular enlargement
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10
Q

How is white matter affected?

A

Decrease in size in corona radiata and corpus callosum

Kelly et al 2018

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11
Q

How is grey matter affected?

A

Affected between illness onset
Neuropil elimination
Progressive over disease

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12
Q

What is a neuropil?

A

Dense network of nerve fibres
With their branches and synapses
Also glial filaments.

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13
Q

Which structures have significant decrease in size?

A 
Hippocampus 
Amygdala 
Thalamus
Accumbens
Lateral vents
Palidum

Ven Erp TG et al 2016

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14
Q

How is imaging used to diagnose SZ?

A

Its not

One image on its own isn’t enough

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15
Q

How might AI be developed to diagnose SZ?

A

Uses a digital screening tool to phenotype patients and predict disease
Done by measuring the semantic density in patients own natural language

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16
Q

Explain the corollary discharge hypothesis

A

When motor command happens it sends an “efference copy” out which is processed as the predicted sensory input

Due to transmission issues, reduced white matter and demyelination, this does not match the actual sensory input in SZ - not then perceived as self-generated

(Stephan et al 2009)

17
Q

What is the corollary discharge system’s main function?

A

To differentiate between self-generated and external action

18
Q

Why may corollary discharge abnormalities cause auditory “hallucinations”?

A

Due to reduced white matter tracts there is reduced communication between Broca’s and Wernicke’s area.

Speech is then not recognised as self-generated

Evidence is limited for this

Stephean et al 2009

19
Q

What are the two different components to a sense of agency?

A

Feeling of agency

Judgement of agency

20
Q

Why may sense of agency be altered?

A

Dysfunction of communication between action and perception

Similar to abnormal corollary discharge

21
Q

What are the negative side effects of d2 blockade?

A

Parkinsonism

Dyskinesias

22
Q

Give examples of traditional antipsychotics

A

Haloperidol

Chlorpromazine

23
Q

Give examples of atypical antipsychotics

A

Clozapine, risperidone, quetiapine

24
Q

What is the major side effect of clozapine?

A

Agranulocytosis

25
Q

How do antipsychotics normalise salience?

A

Dampen salience acquisition (as needs d2) so that there can be re-learning of event value

26
Q

How does abnormal salience come about?

A

Dysregulated DA function leads SZ patients to draw the wrong meaning from things

27
Q

Summarise the Whitford et al Hypothesis of SZ Causation

A

Some kinda genetic trigger
Cause abnormally structured myelin to abnormally insulate
Leads to corollary discharge issues and abnormal agency
Treatable by DA block

28
Q

Explain what the genetic trigger does in the Whitford hypothesis

A

Causes abnormal expression of oligodendrocyte linked gene during pre-pubertal myelination of the association cortex

29
Q

Explain how an abnormal sense of agency comes about according to the Whitford hypothesis of SZ causation?

A

Myelin abnormally insultes the axon so signals get to the sensory cortex at different times and cant match up
Own actions not tagged as such and this leads to abnormal agency

30
Q

What did Roy et al 2007 find in purposely disrupted oligodendrocyte growth in mice?

A

Hyperdopaminergia

31
Q

Where are the biggest white matter abnormalities?

A

Corona radiate and corpus callosum

32
Q

How did Hauser et al 2011 display the enhanced agency in SZ?

A

Asked patients to produce a drum beat and then played more drum taps over it
Asked if what they head was self generated or not
SZ patients more likely to attribute the sound played to their own tapping action

33
Q

Why is there though to be increased salience in SZ?

A

Too much DA

mesolimbic DA needed to attribute importance to events/items

34
Q

How do antipsychotics work to combat salience?

A

Dampen down DA to basically make nothing salient

Then allows normal salience to re-form

35
Q

Which receptors is punishment avoidance related to?

A

D2

36
Q

Which receptors is reward-learning related to?

A

D1

BMSc - Psychiatry (12 decks)

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