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Neuropsychopharmacology > Week 2 - Schizophrenia & Psychoses > Flashcards

Week 2 - Schizophrenia & Psychoses Flashcards

1
Q

What are the ‘positive’ symptoms of schizophrenia?

A) Impaired memory and attention
B) Disturbances in motivation and pleasure
C) Delusions, hallucinations, thought disorders
D) Social withdrawal and decreased speech
E) All of the above

A

C) Delusions, hallucinations, thought disorders

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2
Q

What are the Deficit ‘negative’ symptoms of schizophrenia?

A) Delusions, hallucinations, thought disorders
B) Impaired memory and attention
C) Disturbances in motivation, experience of pleasure, social interactions, spontaneous speech, and mood expression
D) Affective symptoms such as depression and anxiety

A

Correct Answer: C) Disturbances in motivation, experience of pleasure, social interactions, spontaneous speech, and mood expression

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3
Q

What are the Cognitive impairment symptoms associated with schizophrenia?

A) Delusions, hallucinations, thought disorders
B) Impaired memory, intellectual functioning, executive function, and attention
C) Disturbances in motivation and pleasure
D) Affective symptoms such as depression and anxiety

A

Correct Answer: B) Impaired memory, intellectual functioning, executive function, and attention

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4
Q

What is sensorimotor gating, and how does it relate to schizophrenia?

A) Sensorimotor gating refers to the regulation of sensory and motor information processing in the brain, and individuals with schizophrenia typically exhibit deficits in this process, leading to inappropriate responses to environmental stimuli.

B) Sensorimotor gating refers to the ability to filter irrelevant sensory stimuli and focus attention on relevant information, and individuals with schizophrenia typically have heightened abilities in this regard, leading to hyperfocused attention.

C) Sensorimotor gating refers to the synchronization of sensory and motor responses in the brain, and individuals with schizophrenia typically exhibit deficits in this process, leading to delayed responses to environmental stimuli.

D) Sensorimotor gating refers to the ability to rapidly adapt to changes in the environment, and individuals with schizophrenia typically excel in this regard, demonstrating enhanced adaptive responses.

A

Correct Answer: A) Sensorimotor gating refers to the regulation of sensory and motor information processing in the brain, and individuals with schizophrenia typically exhibit deficits in this process, leading to inappropriate responses to environmental stimuli.

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5
Q

What is Prepulse Inhibition (PPI), and how is it related to schizophrenia?

A) The ability to rapidly adapt to changes in the environment, and individuals with schizophrenia typically excel in this regard, demonstrating enhanced adaptive responses.

B) The synchronization of sensory and motor responses in the brain, and individuals with schizophrenia typically exhibit deficits in this process, leading to delayed responses to environmental stimuli.

C) The regulation of sensory and motor information processing in the brain, and individuals with schizophrenia typically exhibit deficits in this process, leading to an inability to inhibit the startle response to a warning tone.

D) The ability to filter irrelevant sensory stimuli and focus attention on relevant information, and individuals with schizophrenia typically have heightened abilities in this regard, leading to hyperfocused attention.

A

Correct Answer: C) The regulation of sensory and motor information processing in the brain, and individuals with schizophrenia typically exhibit deficits in this process, leading to an inability to inhibit the startle response to a warning tone.

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6
Q

What is the proposed role of dopamine in individuals with schizophrenia regarding information processing?

A) Dopamine levels are reduced, leading to deficits in information processing
B) Dopamine levels are elevated, resulting in an overload of information processing without proper filtering
C) Dopamine levels remain stable and do not affect information processing
D) Dopamine levels fluctuate, leading to intermittent issues in information processing
E) All of the above

A

Correct Answer: B) Dopamine levels are elevated, resulting in an overload of information processing without proper filtering

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7
Q

What neurotransmitter is typically elevated in individuals with schizophrenia?

A) Serotonin
B) Dopamine
C) Acetylcholine
D) GABA

A

Correct Answer: B) Dopamine

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8
Q

In individuals with schizophrenia, where in the brain is there typically an excess of dopamine?

A) Prefrontal cortex
B) Hippocampus
C) Basal ganglia
D) Nucleus accumbens
E) Bother C and D

A

E) Bother C and D

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9
Q

Which neurotransmitters are considered the main players in the neurochemistry of schizophrenia?

A) Dopamine
B) Serotonin
C) Glutamate
D) GABA
E) All of the above

A

Correct Answer: E) All of the above

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10
Q

Which of the following drugs exacerbate or produce positive psychotic symptoms by increasing dopamine levels in the nucleus accumbens?

A) Amphetamine
B) Cocaine
C) Dopamine receptor agonists
D) All of the above

A

Correct Answer: D) All of the above

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11
Q

Which of the following types of drugs alleviate some of the symptoms of schizophrenia?

A) Dopamine receptor agonists
B) Serotonin reuptake inhibitors
C) Dopamine antagonists
D) Opioid agonists
E) All of the above

A

Correct Answer: C) Dopamine antagonists

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12
Q

Which neurotransmitter is primarily involved in psychosis?

A) Dopamine
B) Serotonin
C) Glutamate
D) GABA

A

Correct Answer: A) Dopamine

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13
Q

In what part of the brain do schizophrenics typically have a decreased amount of dopamine?

A) Nucleus accumbens
B) Prefrontal cortex
C) Amygdala
D) Hippocampus
E) Both B and D

A

Correct Answer: B) Prefrontal cortex

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14
Q

In schizophrenia, increased dopamine levels in the nucleus accumbens are associated with which type of symptoms?

A) Cognitive deficits
B) Negative symptoms
C) Positive symptoms
D) Affective symptoms

A

Correct Answer: C) Positive symptoms

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15
Q

Which brain regions are involved in the neurochemical dysregulation observed in schizophrenia?

A) Nucleus Accumbens, associated with increased dopamine levels leading to positive symptoms such as psychoses and euphoria at the beginning of the illness.
B) Prefrontal Cortex, characterized by hypofrontality and decreased dopamine levels, leading to cognitive deficits and negative symptoms.
C) Hippocampus, involved in memory formation and consolidation, showing structural changes in individuals with schizophrenia.
D) Amygdala, associated with emotional processing and regulation, showing alterations in connectivity in schizophrenia.
E) Both A and B

A

E) Both A and B

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16
Q

Which neurotransmitter pathway is primarily associated with positive psychotic symptoms in schizophrenia due to increased dopamine levels?

A) Mesolimbic dopamine pathway, involving the nucleus accumbens
B) Mesocortical dopamine pathway, involving the prefrontal cortex
C) Nigrostriatal dopamine pathway, involving the basal ganglia
D) Tuberoinfundibular dopamine pathway, involving the hypothalamus

A

Correct Answer: A) Mesolimbic dopamine pathway, involving the nucleus accumbens

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17
Q

Which neurotransmitter pathway is primarily associated with negative and cognitive symptoms in schizophrenia due to decreased dopamine levels?

A) Mesolimbic dopamine pathway, involving the nucleus accumbens
B) Mesocortical dopamine pathway, involving the prefrontal cortex
C) Nigrostriatal dopamine pathway, involving the basal ganglia
D) Tuberoinfundibular dopamine pathway, involving the hypothalamus

A

Correct Answer: B) Mesocortical dopamine pathway, involving the prefrontal cortex

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18
Q

Which dopamine system is primarily abnormal in schizophrenia?

A) Mesolimbic dopamine system
B) Nigrostriatal dopamine system
C) Mesocorticolimbic dopamine system
D) Tuberoinfundibular dopamine system

A

Correct Answer: C) Mesocorticolimbic dopamine system

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19
Q

Which receptor subtype is generally associated with the production of positive symptoms of schizophrenia through enhanced dopamine neurotransmission?

A) D1 receptors
B) D2 receptors
C) D3 receptors
D) D4 receptors

A

Correct Answer: B) D2 receptors

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20
Q

What is the primary action of First Generation Typical Antipsychotics, also known as “neuroleptics”?

A) Agonize dopamine receptors
B) Block serotonin receptors
C) Antagonize dopamine receptors
D) Enhance GABA transmission

A

Correct Answer: C) Antagonize dopamine receptors

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21
Q

What is the main action of First Generation Typical Antipsychotics, and what additional effects do they commonly have?

A) Main action is to agonize dopamine receptors; they also have antihistaminic, anticholinergic, and adrenaline-like effects.

B) Main action is to block serotonin receptors; they also have antihistaminic, anticholinergic, and adrenaline-like effects.

C) Main action is to antagonize dopamine receptors; they also have antihistaminic, anticholinergic, and adrenaline-like effects.

D) Main action is to enhance GABAergic transmission; they also have antihistaminic, anticholinergic, and adrenaline-like effects.

A

Correct Answer: C) Main action is to antagonize dopamine receptors; they also have antihistaminic, anticholinergic, and adrenaline-like effects.

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22
Q

Which medication, is considered one of the most widely used neuroleptics?

A) Risperidone
B) Haloperidol
C) Clozapine
D) Olanzapine
E) All of the above

A

Correct Answer: B) Haloperidol

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23
Q

Which statement accurately describes the action of typical neuroleptics on dopamine receptors, considering both the D1 and D2 receptor families?

A) They selectively block D1 receptors in the nucleus accumbens, reducing positive psychotic symptoms.

B) They selectively block D2 receptors in the nucleus accumbens, reducing positive psychotic symptoms.

C) They block both D1 and D2 receptors, leading to positive psychotic symptoms.

D) They antagonize both D1 and D2 receptors, reducing positive psychotic symptoms; however, antagonizing D1 receptors can affect normal movement.

A

Correct Answer: D) They antagonize both D1 and D2 receptors, reducing positive psychotic symptoms; however, antagonizing D1 receptors may affect normal movement.

24
Q

Which dopamine system is primarily responsible for movement and is implicated when dopamine levels are decreased?

A) Mesolimbic DA system

B) Nigrostriatal DA system

C) Mesocortical DA system

D) Tuberoinfundibular DA system

A

Correct Answer: B) Nigrostriatal DA system

25
Q

What is a significant issue associated with typical antipsychotic medications?

A) Increased activity in the nigrostriatal dopamine system leading to low blood pressure.

B) Both C and E

C) Blocking D1 and D2 receptors, leading to disruption in movement.

D) Reduced levels of dopamine in the mesolimbic dopamine system.

E) They don’t help with negative and cognitive symptoms

A

Correct Answer: B) Both C and E

26
Q

What percentage of D2 receptors typically needs to be blocked by antipsychotic medications to effectively alleviate symptoms and produce therapeutic effects?

A) 20%

B) 40%

C) 60%

D) 80%

A

Correct Answer: D) 80%

27
Q

What term describes a group of adverse effects associated with certain medications, particularly antipsychotic drugs, that affect the extrapyramidal system in the brain?

A) Neuroleptic malignant syndrome

B) Serotonin syndrome

C) Extrapyramidal side effects

D) Akathisia

A

Correct Answer: C) Extrapyramidal side effects

28
Q

Which of the following symptoms are associated with extrapyramidal side effects caused by certain medications, particularly antipsychotic drugs?

A) Diarrhea and nausea

B) Slurred speech and confusion

C) Visual hallucinations and delusions

D) Parkinson’s-like symptoms, acute dystonias, and dyskinesia. These include tremors, involuntary movement muscle rigidity, muscle spasms and protruding tongue.

A

D) Parkinson’s-like symptoms, acute dystonias, and dyskinesia. These include tremors, involuntary movement muscle rigidity, muscle spasms and protruding tongue.

29
Q

After the introduction of the first generation typical neuroleptics, what were the subsequent goals?

A) To develop antipsychotics that exclusively target the D2 receptor subtype.

B) To explore the involvement of other neurotransmitters beyond dopamine.

C) To reduce EPS, improve negative and cognitive symptoms, to explore the involvement of other neurotransmitters beyond dopamine and develop antipsychotics that were specific for D2 subtype

D) To enhance the potency of D2 antagonists for more effective treatment of psychosis.

A

Correct Answer: C) To reduce extrapyramidal side effects (EPS) and improve negative and cognitive symptoms associated with antipsychotic use.

30
Q

After the introduction of the first generation typical neuroleptics, what was the primary subsequent goal?”

A) To refine the formulation of typical neuroleptics for better efficacy and tolerability.

B) To explore the involvement of other neurotransmitters beyond dopamine, and develop antipsychotics specific for the D2 subtype.

C) To reduce extrapyramidal side effects (EPS) and improve negative and cognitive symptoms.

D) C and B

A

D) C and B

31
Q

Which of the following statements accurately describes the characteristics of next-generation typical antipsychotics?”

A) They are highly selective for D2 receptors, resulting in reduced extrapyramidal side effects but no improvement in negative or cognitive symptoms.

B) They exhibit broad binding affinity across multiple neurotransmitter systems, resulting in a wide range of side effects.

C) They primarily target serotonin receptors, leading to improved negative and cognitive symptoms.

D) They have a lower potency compared to first-generation typical antipsychotics, resulting in reduced efficacy in treating positive symptoms.

A

Correct Answer: A) They are highly selective for D2 receptors, resulting in reduced extrapyramidal side effects but no improvement in negative or cognitive symptoms.

32
Q

In schizophrenia, which of the following statements accurately describes the role of serotonin in the prefrontal cortex?”

A) Serotonin levels in the prefrontal cortex are significantly elevated, contributing to the manifestation of positive symptoms of schizophrenia.

B) Serotonin levels in the prefrontal cortex remain unchanged, indicating minimal involvement of serotonin in the disorder.

C) Serotonin receptor levels in the prefrontal cortex are unaltered, suggesting that serotonin does not play a role in the pathophysiology of schizophrenia.

D) Serotonin levels in the prefrontal cortex are unaltered, but there are alterations in serotonin receptor levels, implying a potential role of serotonin in the disorder.

A

Correct Answer: D) Serotonin levels in the prefrontal cortex are unaltered, but there are alterations in serotonin receptor levels, implying a potential role of serotonin in the disorder.

33
Q

How does hyperactivity of 5HT2A receptors in the prefrontal cortex contribute to the dopamine dysregulation observed in schizophrenia?”

A) Hyperactivity of 5HT2A receptors leads to decreased release of serotonin in the prefrontal cortex, which indirectly decreases dopamine levels in the nucleus accumbens.

B) Hyperactivity of 5HT2A receptors increases glutamate neuron activity in the prefrontal cortex, subsequently driving dopamine release in the nucleus accumbens/ventral striatum.

C) Hyperactivity of 5HT2A receptors inhibits glutamate neuron activity in the prefrontal cortex, resulting in reduced dopamine release in the nucleus accumbens/ventral striatum.

D) Hyperactivity of 5HT2A receptors directly stimulates dopamine release in the prefrontal cortex, leading to increased dopamine levels in the nucleus accumbens/ventral striatum.

A

Correct Answer: B) Hyperactivity of 5HT2A receptors increases glutamate neuron activity in the prefrontal cortex, subsequently driving dopamine release in the nucleus accumbens/ventral striatum.

34
Q

“What effect do drugs that act as agonists at 5HT2 receptors, such as LSD, have on schizophrenia symptoms?”

A) Drugs that agonize 5HT2 receptors exacerbate positive symptoms while alleviating negative symptoms of schizophrenia.

B) These drugs have no significant effect on schizophrenia symptoms, as their mechanism of action differs from neurotransmitter dysregulation in the disorder.

C) Agonists at 5HT2 receptors induce negative symptoms but alleviate positive symptoms of schizophrenia.

D) Drugs that act as agonists at 5HT2 receptors produce both positive and negative symptoms of schizophrenia.

A

Correct Answer: D) Drugs that act as agonists at 5HT2 receptors produce both positive and negative symptoms of schizophrenia.

35
Q

How do newer atypical antipsychotic medications, which act as 5-HT2 antagonists, impact the symptoms of schizophrenia?”

A) Antagonism of 5-HT2 receptors exacerbates both positive and negative symptoms of schizophrenia.

B) These medications alleviate positive symptoms but exacerbate negative symptoms of schizophrenia.

C) Atypical antipsychotics reduce negative symptoms of schizophrenia by acting as agonists at 5-HT2 receptors.

D) By acting as 5-HT2 antagonists, newer atypical antipsychotics help alleviate negative symptoms of schizophrenia.

A

Correct Answer: D) By acting as 5-HT2 antagonists, newer atypical antipsychotics help alleviate negative symptoms of schizophrenia.

36
Q

What is a notable side effect associated with the use of clozapine, an atypical antipsychotic?”

A) Elevated dopamine D4 receptors in the brain

B) Development of extrapyramidal side effects

C) Agranulocytosis, characterized by life-threatening suppression of white blood cells

D) Increased risk of developing positive symptoms of schizophrenia

A

Correct Answer: C) Agranulocytosis, characterized by life-threatening suppression of white blood cells

37
Q

What distinguishes clozapine, a dibenzazepine atypical antipsychotic, from typical neuroleptics?”

A) It selectively antagonizes dopamine D4 receptors without affecting D2 receptors.

B) Clozapine has a higher propensity for causing extrapyramidal side effects compared to typical neuroleptics.

C) Clozapine blocks both dopamine D4 and D2 receptors, along with 5-HT2, muscarinic, histamine, and adrenergic receptors, while attenuating both positive and negative symptoms without causing extrapyramidal side effects.

D) Unlike typical neuroleptics, clozapine does not affect histamine and adrenergic receptors, resulting in reduced sedation and orthostatic hypotension.

A

Correct Answer: C) Clozapine blocks both dopamine D4 and D2 receptors, along with 5-HT2, muscarinic, histamine, and adrenergic receptors, while attenuating both positive and negative symptoms without causing extrapyramidal side effects.

38
Q

Dibenzazepine/Clozapine

A

Blocks both D4 and D2

  • As well as 5-HT2, muscarinic, histamine & adrenergic receptors
  • No EPS
  • Attenuates both positive and negative symptoms
39
Q

When is clozapine typically considered as a treatment option for schizophrenia?

A) As a first-line treatment for all patients with schizophrenia

B) After trying at least two other antipsychotic medications from different classes and finding them to be ineffective or causing intolerable side effects

C) When patients exhibit mild symptoms of schizophrenia

D) When patients have not responded to any other medication for unrelated conditions

A

Correct Answer: B) After trying at least two other antipsychotic medications from different classes and finding them to be ineffective or causing intolerable side effects

  • This is because the serious side effects - Life-threatening suppression of white blood cells (immunity)
40
Q

Benzamides

A
  • Highly selective for D2 receptors
  • Less Extrapyramidal Side Effects
  • Still no effect on negative or cognitive symptom
41
Q

Haloperidol

A

Main action is to antagonise dopamine receptors
- Most widely used Neuroleptic and this is because it mostly lacks the antihistaminic (sedative),
anticholinergic & adrenaline-like effects that other neuroleptics can have
- no effect on negative or cognitive symptoms
- ESPS

42
Q

Which receptor antagonists are typically desired when developing antipsychotic medications to minimize side effects?

A) 5-HT1 and D1 receptors

B) 5-HT2 and D2 receptors

C) D1 and D2 receptors

D) 5-HT2 and D1 receptors

A

Correct Answer: B) 5-HT2 and D2 receptors

43
Q

Which antipsychotic medications exhibit multiple receptor antagonism, including D2, D4, 5-HT2, adrenergic, histamine, and muscarinic receptors?

A) Olanzapine

B) Quetiapine

C) Risperidone

D) Aripiprazole

E) Both A and B

A

E) Both A and B

44
Q

Which of the following medications are the most commonly prescribed antipsychotics?

A) Risperidone and Clozapine
B) Aripiprazole and Olanzapine
C) Haloperidol and Quetiapine
D) Quetiapine and Olanzapine
E) Both A and C

A

D) Quetiapine and Olanzapine

45
Q

Which type of antagonists do current antipsychotics primarily focus on?

A) Pure D2 antagonists

B) Pure 5-HT antagonists

C) Mixed 5-HT/D2 antagonists

D) Mixed 5-HT/D1 antagonists

A

Correct Answer: C) Mixed 5-HT/D2 antagonists

46
Q

What role does glycine play in the brain’s neurotransmission?

A) Inhibits the release of neurotransmitters at synapses.
B) Acts as an antagonist at NMDA receptors.
C) Enhances the activation of NMDA receptors by serving as a co-agonist with glutamate.
D) Increases the degradation of glutamate in the synaptic cleft.

A

Correct Answer: C) Enhances the activation of NMDA receptors by serving as a co-agonist with glutamate.

47
Q

What effect does PCP have on NMDA receptors?

A) It acts as an agonist, increasing their activity.
B) It has no effect on NMDA receptors.
C) It antagonizes NMDA receptors, blocking their activity.
D) It sensitizes NMDA receptors, making them more responsive to glutamate.

A

Correct Answer: C) It antagonizes NMDA receptors, blocking their activity.

48
Q

PCP Blocks NMDA Receptor =

A

Induces Psychosis.

PCP stops positive ions from entering the cell and Glutamate is made ineffective at opening up the channel. This process of blocking NMDA receptors produces psychosis.

49
Q

What is the primary function of glutamate in the central nervous system?

A) Inhibition of neural activity
B) Maintenance of sleep-wake cycles
C) Modulation of pain perception
D) Excitation of neural activity

A

Correct Answer: D) Excitation of neural activity

50
Q

NMDA Receptors Dysfunction (hyptoactive) in prefrontal cortex
|
↓
Less GABA Activation of Glutamate Neurons
|
↓
Imbalance between Excitatory and Inhibitory Signals
|
↓
Overactivity of Glutamate Neurons
|
↓
Increased Dopamine Release in Nucleus Accumbens
|
↓
Contribution to Schizophrenia Symptoms

A

The ultimate consequence of disrupted NMDA receptor function and altered GABAergic signaling is a shift in the balance of excitatory and inhibitory inputs within neural circuits. This imbalance can result in abnormal neural excitability contributing to the pathophysiology of conditions like schizophrenia.

51
Q

What is the mechanism of action for glycine and D-serine, two novel antipsychotics known as NMDA receptor modulators?

A) They inhibit dopamine reuptake in the synapse.

B) They block serotonin receptors in the brain.

C) They act as agonists at the glycine site to enhance NMDA receptor function.

D) They increase GABAergic neurotransmission in the prefrontal cortex.

A

Correct Answer: C) They act as agonists at the glycine site to enhance NMDA receptor function.

52
Q

Which of the following pharmacotherapies could potentially be used to address the reduced GABA cell function in the prefrontal cortex and its associated implications for dopamine cell firing?

A) Selective serotonin reuptake inhibitors (SSRIs)

B) Benzodiazepines

C) Nonsteroidal anti-inflammatory drugs (NSAIDs)

D) Antihistamines

A

Correct Answer: B) Benzodiazepines

53
Q

Antipsychotic treatments aim to: 4

A
  1. Reduce Dopamine effect at D2 receptors (D2 antagonist)
  2. Reduce Serotonin effect at 5-HT2 receptors (5-HT2 antagonist)
  3. Increase Glutamate neurotransmission (NMDA & AMPA receptors)
  4. Stabilise dopamine neurons (GABA-A agonists)
54
Q

Which brain regions are implicated in the current research on the neurobiology of schizophrenia?

A) Medulla oblongata and cerebellum

B) Occipital lobe and parietal lobe

C) Nucleus accumbens/striatum, prefrontal cortex, and hippocampus

D) Corpus callosum and basal ganglia

A

Correct Answer: C) Nucleus accumbens/striatum, prefrontal cortex, and hippocampus

55
Q

Which receptor subtypes are implicated in the neurobiology of schizophrenia?

A) Acetylcholine, norepinephrine, and histamine

B) Opioid, cannabinoid, and adenosine

C) Dopamine, serotonin, and glutamate

D) GABA, glycine, and nitric oxide

A

Correct Answer: C) Dopamine, serotonin, and glutamate

Neuropsychopharmacology (8 decks)

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