Schizophrenia

Question 1

Psychiatric disorders

Answer 1

Disorders of psychological function sufficiently severe(ernstig genoeg) to require treatment

Question 2

DSM-5

Answer 2

Diagnostic and Statistical Manual of the American Psychiatric Association

Question 3

2 main difficulties in diag­nosing particular psychiatric disorders

Answer 3

1. Patients suffering from the same disorder often display differ­ent symptoms, and
2. Patients suffering from different disorders often display many of the same symptoms.

Question 4

Schizophrenia means…

Answer 4

the splitting of psychic functions

Question 5

Waxy flexibility

Answer 5

Reacting like a mannequin, not resisting movement and holding new position until being moved again.

Question 6

Schizophrenia with catatonia

Answer 6

Schizophrenia characterized by long periods of immobility and waxy flexibility

Question 7

Echolalia

Answer 7

Vocalized repetition of some or all of what has just been heard

Question 8

Positive symptoms

Answer 8

Symptoms that seem to represent an excess of typical function

Question 9

Negative symptoms

Answer 9

Symptoms that seem to represent a reduction or loss of typical function

Question 10

Examples of positive symptoms

Answer 10

• Delusions. Delusions of being controlled (e.g., “Martians are making me steal”), delusions of persecution (e.g., “My mother is poisoning me”), or delusions of grandeur (e.g., “Steph Curry admires my jump shot”).
• Hallucinations. Imaginary voices making critical com­ments or telling patients what to do.
• Inappropriate affect. Failure to react with the appropri­ate emotion to positive or negative events.
• Disorganized speech or thought. Illogical thinking, peculiar associations among ideas, belief in supernatural forces.
• Odd behavior. Difficulty performing everyday tasks, lack of personal hygiene, talking in rhymes.

Question 11

Examples of negative symptoms

Answer 11

• Affective flattening –> Diminished emotional expression.
• Avolition –> Reduction or absence of motivation.
• Catatonia –> Remaining motionless, often in awkward positions for long periods.

Question 12

Series of studies that established schizophrenia’s genetic basis

Answer 12

1. Although only 1 percent of the population develops schizophrenia, the probability of schizophrenia occurring in a close biological relative (i.e., a parent, child, or sibling) of a patient with schizophrenia is about 10 percent, even if the patient with schizophrenia was adopted shortly after birth by a healthy family.
2. The concordance rates for schizophrenia are higher in monozygotic twins (45–50 percent) than in dizygotic twins (10–17 percent).
3. Adoption studies found that the risk of schizophrenia is increased by the presence of the disorder in biological parents but not by its presence in adoptive parents.

Question 13

Variety of early experiential factors have been implicated in the development of schizophrenia

Answer 13

• Birth complications, maternal stress, prenatal in­fections, socioeconomic factors, urban birth or residing in an urban setting, and childhood adversity.
• Such early experiences are thought to alter the typical course of neurodevelopment leading to schizophrenia in individuals who have a genetic susceptibility, presumably through epigenetic mech­anisms.

Question 14

Supporting neu­rodevelopmental theory of schizophrenia are:

Answer 14

1. The fact that schizophrenia and autism spectrum disorders share many of the same causal factors (e.g., genetic risk factors, environmental triggers)
2. The study of two 20th­-century famines(hongersnoden): Fetuses whose pregnant mothers suffered in those famines were more likely to develop schizophrenia as adults.

Question 15

Antipsychotic drug

Answer 15

A drug that is meant to treat certain symptoms of schizo­phrenia and bipolar disorders.

Question 16

Chlorpromazine

Answer 16

• Was developed by a French drug company as an antihistamine.
• In 1950, a surgeon noticed that chlorpromazine given prior to surgery to counteract swelling had calming effect on some of his patients, and he suggested that it might have a calm­ing effect on difficult­ to­ handle patients with psychosis.
• Discovery that chlorpromazine alleviates the symptoms of schizophrenia: Agitated patients with schizo­phrenia were calmed by chlorpromazine, and emotionally blunted patients with schizophrenia were activated by it.
• Chlorpromazine does not cure schizophrenia, but often reduces the severity of symptoms enough to allow institutionalized patients to be discharged.

Question 17

Psychosis

Answer 17

A loss of touch with reality

Question 18

Reserpine

Answer 18

• The active ingredient of the snakeroot plant which had long been used in India for the treatment of mental illness.
• Gave reserpine to his patients with schizophrenia and confirmed its antipsy­chotic action.
• No longer used in the treatment of schizophrenia because it produces a dangerous decline in blood pressure at the doses needed for successful treatment.

Question 19

Chemical structures of chlorpromazine and reserpine dissimilar, but antipsychotic effects similar in 2 major respects.

Answer 19

1. Antipsychotic effect of both drugs is manifested only after a patient has been medi­cated for 2 or 3 weeks.
2. The onset of this antipsychotic effect is usually associated with motor effects similar to the symptoms of Parkinson’s disease (e.g., muscular rigidity, a general decrease in voluntary movement). These similarities suggested to researchers that chlorpromazine and reserpine were acting through the same mechanism—one that was related to Parkinson’s disease.

Question 20

Dopamine theory of schizophrenia

Answer 20

The theory that schizophrenia is caused by too much dopamine and, conversely, that antipsychotic drugs exert their effects by decreasing dopamine levels.

Question 21

Lending instant support to the dopamine theory of

schizophrenia were two already well ­established facts.

Answer 21

1. The antipsychotic drug reserpine was known to deplete the brain of dopamine and other monoamines by breaking down the synaptic vesicles in which these neurotransmitters are stored.
2. Drugs such as amphetamine and cocaine, which can trigger episodes that resemble schizophrenia in healthy users, were known to increase the extracellular levels of dopamine and other monoamines in the brain.

Question 22

The major difficulty in studying and treating schizophre­nia is accurately defining it …

Answer 22

• Its symptoms are complex and diverse;
• Symptoms overlap greatly with those of other psychiatric disorders
• Symptoms frequently change during the progression of the disorder.
• Various neurologi­cal disorders (e.g., complex partial epilepsy; see Chapter 10) have symptoms that might suggest a di­agnosis of schizophrenia.

Question 23

Schizophrenia spectrum disorders

Answer 23

Because the cur­rent definition of schizophrenia overlaps with that of several different disorders, the DSM­5 prefers to use the label schizophrenia spectrum disorders to refer to schizophrenia and related disorders.

Question 24

Metabolites

Answer 24

Substances that are created by the breakdown of another substance in cells

Question 25

Chlorpromazine and reserpine antagonize transmission at dopamine synapses but they do it in different ways:

Answer 25

Reserpine by depleting(verminderen) the brain of dopamine and chlorpromazine by binding to dopamine receptors.

Question 26

Receptor blocker (at dopamine synapses)

Answer 26

It binds to dopamine receptors without activating them and, in so doing, keeps dopamine from activating them

Question 27

Haloperidol

Answer 27

One of the most potent anti­ psychotic drugs of its day, it had a relatively low affinity for dopamine receptors.

Question 28

Phenotiazines

Answer 28

All bind effectively to both D1 and D2 receptors

Question 29

Butyrophenones

Answer 29

All bind effectively to D2 receptors but not to D1 receptors.

Question 30

Typical antipsychotics (the first generation of antipsychotic drugs)

Answer 30

The degree to which typical antipsychotics bind to D2 receptors is highly correlated with their effectiveness in suppressing the symp­toms of schizophrenia.

Question 31

Spiroperidol( is a butyrophenone)

Answer 31

Had the greatest affinity for D2 receptors and the most potent antipsychotic effect

Question 32

D2 version of the dopamine theory of schizophrenia could not explain two general findings:

Answer 32

- Although typical antipsychotics block activity at D2 receptors within hours, their therapeutic effects are usually not apparent for several weeks. - Most antipsychotics are only effective in the treatment of schizophrenia’s positive symptoms, but not its negative symptoms.

Question 33

Current version of the dopamine theory

Answer 33

Ex­cessive activity at D2 receptors is one factor in the disorder but there are many other factors as well.

Question 34

Atypical antipsychotics(also known as second­ generation antipsychotics)

Answer 34

Drugs that are effective against schizophrenia but yet do not bind strongly to D2 receptors

Question 35

Clozapine

Answer 35

The first atypical anti­ psychotic to be approved for clinical use, has an affinity for D1 receptors, D4 receptors, and several serotonin and hista­mine receptors, but only a slight affinity for D2 receptors

Question 36

Diagnosis of schizophrenia

Answer 36

The frequent recurrence of any two of the symp­toms for 1 month is currently sufficient for the diagnosis of schizophrenia—provided that one of the symptoms is delusions, hallucinations, or disorganized speech.

Question 37

3 important things to be aware of in atypical antipsychotics

Answer 37

1. Some D2 receptor antagonists have no antipsychotic ac­tions 2. Drugs that enhance the effects of glycine or block the effects of glutamate are proving to be effective treatments for schizophrenia in preliminary tests; 3. There is growing appreciation of the role of glutama­tergic dysregulation in the development of schizophrenia

Question 38

Psychedelic drugs

Answer 38

- Drugs whose primary ac­tion is to alter perception, emotion, and cognition. - Classical hallucinogens --> LSD, psilocybin, and mescaline - Dissociative hallucinogens --> ketamine and phencyclidine - Cannabinoids

Question 39

Researchers have pursued two lines of research on | psychedelics..

Answer 39

1. Focused on those psychedelic drugs that produce effects similar to the symptoms of psychiatric disorders (e.g., il­lusions, hallucinations, paranoia, panic), and they used the drugs to model the disorders. 2. Focused on the feelings of boundlessness, unity, and bliss(geluk) reported by some users and attempted to use psychedelics in the treatment of psychiatric disorders.

Question 40

1990s renewal of inter­est in utilizing psychedelic drugs to study the mechanisms of schizophrenia and other psychiatric disorders. What stimulated this?

Answer 40

- The development of techniques for imaging the effects of drugs in the human brain - Increased under­standing of the mechanisms of psychedelic drug action

Question 41

1990s renewal of inter­est in utilizing psychedelic drugs led to two important conclusions

Answer 41

1. The effects of classical hallucinogens, such as LSD, mimic the positive symptoms of schizophrenia (e.g., hallucinations and dis­organized thought) by act­ing as agonists of particular serotonin receptors; 2. Dissociative hallucinogens (e.g., ketamine) mimic the negative symptoms of schizo­phrenia by acting as antago­nists of glutamate receptors

Question 42

Study of schizophrenia ­related genes and their ef­fects pointed to several processes that could play important roles in develop­ment of the disorder

Answer 42

Schizophrenia ­related genes have been shown to: - disrupt neural proliferation(vermenigvuldiging) and migration - pruning(vermindering) synaptic during neurodevelopment - Myelina­tion or transmission at glutama­tergic and GABAergic synapses

Question 43

One important general point about schizophrenia­ related genes has recently emerged.

Answer 43

Some genes that in­crease a person’s susceptibility to schizophrenia have also been linked to other psychiatric and neurological disorders.

Question 44

Many studies have assessed brain development in patients with, or at risk for, schizophrenia. Four important findings have emerged from various meta-analyses of those studies

Answer 44

- Individuals who have not been diagnosed with schizophrenia but are at risk for the disorder (e.g., because they have close relatives with schizophrenia) display volume reductions in some parts of the brain. - Extensive brain changes already exist when patients first seek medical treatment and receive their first brain scans. - Subsequent brain scans reveal that the brain changes continue to de­velop after the initial diagnosis. - Alterations to different areas of the brain develop at different rates

Question 45

Where do schizophrenia ­related volume reduc­tions develop and what are the results?

Answer 45

- Hippocampus, amygdala, thala­mus, and nucleus accumbens were found to be signifi­cantly smaller in those with schizophrenia. - In both gray and white matter, and they are most consistently observed in the temporal lobes - -> Reduced neuron size and reduced dendritic and axonal arborization