schizophrenia and affective disorders

Question 1

what is schizophrenia?

Answer 1

affects approximately 1:300 people (≈24 million)

onset is most often during adolescence and 20s

considered to be a type of psychosis - a loss of contact with reality

Question 2

what did Bleuler (1911) say about schizophrenia?

Answer 2

a “split mind”, a break in reality

often had breakdown in associative thinking

thoughts, emotions and perceptions no longer worked together smoothly

“splitting” of mental faculties rather than unified conscious experience

Question 3

what are positive symptoms of schizophrenia?

Answer 3

something you gain

hallucinations

thought disorder

delusions (persecution, grandeur, control)

Question 4

what are negative symptoms of schizophrenia?

Answer 4

something you lose

flat emotional response

poverty of speech

lack of initiative and persistence

anhedonia (lack of interest)

social withdrawal

Question 5

what are cognitive symptoms of schizophrenia?

Answer 5

general symptoms

difficulty sustaining attention

low psychomotor speech

deficits in learning and memory

poor problem solving

poor abstract thinking

Question 6

what are neurology symptoms of schizophrenia?

Answer 6

ventricular enlargement

one of the earliest and most consistent findings in schizophrenia

ventricles of patients with schizophrenia are approximately 130% the size of normal controls

Question 7

what physical symptoms of schizophrenia are there with hair?

Answer 7

fine electric hair

two or more hair whorls

head circumference outside of normal range

Question 8

what physical symptoms of schizophrenia are there with eyes?

Answer 8

epicanthus (skin fold at inner corner of eye

hypertelorism (wide set eyes) - inner canthal distance, outer canthal distance, interpupillary distance

Question 9

what physical symptoms of schizophrenia are there with ears?

Answer 9

ear position (low-seated ears)

adherent ear lobes

malformed ears

asymmetrical ears

soft and pliable ears

Question 10

what physical symptoms of schizophrenia are there with the mouth?

Answer 10

high-steepled palate

furrowed tongue

tongue with smooth-rough spots

Question 11

what physical symptoms of schizophrenia are there with the hands?

Answer 11

curved fifth finger

single transverse palmar crease

Question 12

what physical symptoms of schizophrenia are there with the feet?

Answer 12

third toe longer than second toe

partial syndactylia (webbing) of two middle toes

gap between first and second toes

Question 13

what are the causes of schizophrenia?

Answer 13

not completely sure

clear link with genetics - polygenic trait

clear link with environmental factors

combined suggests genetic predisposition

Question 14

what is the heritability of SZ?

Answer 14

biggest chance between twins, not parents (suggest strong genetic link)

% drop drastically (polygenic in nature)

husband/wife higher than general population (suggests an environmental factor)

Question 15

what are the different types of monozygotic twins?

Answer 15

monochorionic = sharing single placenta

dichorionic = separate placentas

Question 16

what was Davis et al’s (1995) study into SZ in twins?

Answer 16

monochorionic concordance = 60%

dichorionic concordance = 10.7%

even pre-natal environmental is an environment

Question 17

what are other environmental factors that impact the development of SZ?

Answer 17

cannabis use

prenatal infection

birth month

childhood trauma

chronic stress

Question 18

what is the dopamine hypothesis?

Answer 18

people with SZ have overactivity in DA neurons (nearly double)

hypothesis originated from observations made in 50s and 60s using antipsychotic medications which antagonise DA receptors, alleviating psychotic symptoms of SZ individuals

DA agonists induce positive symptoms

Question 19

how do DA agonists induce positive symptoms?

Answer 19

activity of DA neurons in accumbens strongly reinforce behaviour

Fibiger (1991) - paranoid delusions caused by activity in amygdala (fear responses, learning emotional responses)

Snyder (1974) - SZs report elation at start of SZ episode

Question 20

what did Stahl (2018) say about treatment and pharmacology of SZ?

Answer 20

still an emerging picture

new evidence from drug research (psychedelics/hallucinogens/LSD/PCP)

Question 21

what is the NMDA theory of SZ?

Answer 21

glutamate hypoactivity in regions involved with cognition and executive functions (e.g. prefrontal cortex)

Question 22

what is the serotonin theory of SZ?

Answer 22

serotonin dysfunction may disrupt typical cognitive abilities prompting the SZ development

Question 23

what non-medication treatments are available for SZ?

Answer 23

CBT

art therapy

Question 24

what are affective disorders?

Answer 24

categorised as a mood disorder

identified by disruptions in emotions

Question 25

what are symptoms of affective disorders?

Answer 25

depression mania

Question 26

what are the depressive symptoms of affective disorders?

Answer 26

low energy levels anhedonia (lack of interest or enjoyment from life experiences) loss of appetite for food or sex sleeping problems constipation

Question 27

what are the manic symptoms of affective disorders?

Answer 27

euphoria delusional poor attention span lack of sleep grandeur

Question 28

what are the types of affective disorder?

Answer 28

bipolar disorder unipolar disorder (MDD) seasonal affective disorder (SAD) some cases of mania without depression but rare

Question 29

what is bipolar disorder?

Answer 29

alternating periods of mania and depression 1% of population afflicted at some point in this life equally frequent in men and women

Question 30

what is unipolar disorder (MDD)?

Answer 30

depression without the mania 2 or 3 times more likely in women than men

Question 31

what is seasonal affective disorder (SAD)?

Answer 31

depression typically associated with onset of winter months

Question 32

what are the neurology and physical symptoms of affective disorders?

Answer 32

currently unclear no consistent neurological markers across conditions

Question 33

what is the cause of affective disorders?

Answer 33

not completely sure clear link with genetics - polygenic trait clear link with environmental factors suggests genetic predisposition

Question 34

what was Gershon et al's (1976) research into heritability of affective disorders?

Answer 34

monozygotic concordance = 69% dizygotic concordance = 13% Price (1968) - concordance is the same whether twins are raised apart or together

Question 35

what was Rosenthal's (1971) study into heritability of affective disorders?

Answer 35

10 times more likely to suffer from affective disorders if a close relative also does

Question 36

what is the monoamine hypothesis?

Answer 36

monoamine neurons = neurotransmitter modulators suggests depression is caused by faulty activity on monoamine neurons deficiencies in serotonin - thought to play a role in modulating mood norepinephrine imbalance - plays a role in the body's stress response DA dysfunction - plays a role in reward and pleasure pathways iproniazid and tricyclic antidepressants

Question 37

what is iproniazod?

Answer 37

treats depression inhibits monoamine oxidase (a monoamine antagonist) increasing serotonin, DA and norepinephrine discovered as a side effect of TB treatment unpleasant side effects

Question 38

what are tricyclic antidepressants?

Answer 38

treats depression agonists of just serotonin and norepinephrine inhibits reuptake of neurotransmitter by terminal buttons

Question 39

what are SSRIs?

Answer 39

prozac, citalopram treats depression agonists of just serotonin inhibits reuptake of just 5HT

Question 40

what is reserpine?

Answer 40

causes depression general monoamine antagonist used to treat high blood pressure

Question 41

what non-medication treatments are available for affective disorders?

Answer 41

CBT - patients with more depressive symptoms art, music and talking therapies