Schizophrenia Flashcards

Question

dopamine hypothesis

Answer 1

* Basically: Hyper-active dopamine neurotransmission underlies the manifestations of schizophrenia * Key evidence: * Antipsychotics block D2 * Clinical doses have high blocking potency * Dopamine enhancing drugs can induce psychotic symptoms (e.g. amphetamine, L-DOPA)

Answer 2

* DA hyperactivity does not explain negative symptoms * D2 blockers do not improve negative symptoms * Imaging studies (Positron Emission Tomography) have not replicated consistent patterns of DA activity disturbance * Newer (second generation) antipsychotic medications have powerful serotonin (5HT -2) receptor blocking activity in addition to D2 blocking activity * There must be some relationship between these neurotransmitters!

Answer 3

* Imbalance in DA function varying by brain region * Hyperactive subcortical-mesolimbic projections (too much dopamine lands on the D2 receptors causing overstimulation and positive psychotic symptoms) * Underactive mesocortical DA projections to the pre- frontal cortex (resulting in under-stimulation of D1 receptors and negative symptoms) * These two components may be related – DA deficiency in mesocortex may disinhibit mesolimbic DA

Answer 4

* NMDA is key to neuroplasticity * NMDA receptor hypofunction onto GABA interneurons, disinbition of glutamate neurons, stimulates dopaminergic neurons * NMDA receptor dysfunction in animal models show behaviours of psychosis and memory impairment * Low doses of ketamine cause negative symptoms and cognitive impairments * Use of NMDA receptor antagonist PCP results in delusions * 30% of the 130 genes related to schizophrenia risk encode some aspect of the glutamatergic synapse and affect NMDA transmission * No current medications to target NMDA receptor dysfunction

Answer 5

* There is no curative treatment for schizophrenia * Treatment focuses on: * Early identification * Symptom control * Skills development for patients and families * Relapse prevention * Reintegration of the patient into community * Recovery

Answer 6

* “First generation” and “second generation” categories * First generation are potent DA D2 receptor blockers * significant risk of extra-pyramidal (motor) side effects (acute dystonic reactions, parkinsonism, tardive dyskinesia * Second generation have a combination of D2 and 5HT -2 blocking effects * Lower frequency motor side effects * More metabolic side effects (increased BMI, lipid abnormalities, impaired glycemic regulation including diabetes mellitus)

Answer 7

First Generation * Chlorpromazine * Haloperidol * Flupenthixol * Fluphenazine * Loxapine Second Generation – Risperidone – Paliperidone – Quetiapine – Olanzapine – Clozapine* – Ziprasidone** – Lurasidone** – Aripiprazole** – Brexpiprazole** – Cariprazine** * clozapine is more efficacious than other antipsychotics, but 0.3 – 0.6% risk of agranulocytosis ** these agents have lower metabolic risk

Answer 8

* Antipsychotic medication is the mainstay * Supportive care and psychoeducation when ready * Possible hospitalization if imminent risk of: * Harm to self * Harm to others * Marked deterioration in self-care * Sometimes requires involuntary treatment using provisions of the Mental Health Act * Electroconvulsive therapy (ECT) is considered in acute catatonia or very resistant psychosis

Answer 9

* Antipsychotic medication is the mainstay * Non-adherence is common and problematic * Long-acting injectable antipsychotics enhance adherence (e.g. risperidone, paliperidone, aripiprazole, haloperidol) * Psychosocial treatments enhance overall treatment adherence, reduce distress and increase function [e.g. cognitive behavioral therapy (CBT), psychosocial rehabilitation, family therapy, social skills training] * Family therapy reduces relapse rates especially if there is high “expressed emotion” in the home

Answer 10

* A treatment approach and a philosophy of care * emphasizes jointly set (between patient/client and care provider) goals for recovery of function and successful living in the community * The term “ recovery” is not used to mean ”cure" or “remission” of illness, but rather to a re-formulation of one’s life aspirations, and living in the best way possible, within the limits imposed by illness * Optimism and hope for patients and their families is fostered

Answer 11

* Other Psychotic illnesses * Schizoaffective disorder * Delusional disorder * Schizophreniform disorder * Brief psychotic disorder * Schizophrenia spectrum illness * Schizotypal personality disorder * Borderline personality disorder

Answer 12

* Mood episode (major depression or mania) along with psychosis (criterion A for schizophrenia) BUT… * Delusions or hallucinations persist > 2 weeks in the absence of a major mood episode AND * Major mood episodes are present for the majority of the total duration of active illness

Answer 13

* One or more delusions that persist for more than a month * If criterion A for schizophrenia is met, this diagnosis is not used * The affected individual is not markedly impaired (outside of the impact of the delusion itself) * The delusion(s) are not restricted to periods of major mood episodes (depression or mania)

Answer 14

* Similar to criteria for schizophrenia (including criterion A) EXCEPT… * The duration of illness is between 1 month and <6 months (ie the full duration criteria for schizophrenia are not met) * A mood disorder has to be ruled out

Answer 15

* Psychotic symptoms (delusions, hallucinations, disorganized speech or grossly disorganized behavior) are present for at least a day but less than one month * (Note that the list of psychotic symptoms for this diagnosis includes all schizophrenia criterion A except negative symptoms) * Again, a mood disorder needs to be ruled out

Answer 16

* Listed in Schizophrenia Spectrum section but described in Personality Disorders section of DSM-5 * reflect the familial-genetic relationship of schizotypal PD with schizophrenia * Unusual thinking/ideas, ideas of reference but not florid psychotic symptoms

Answer 17

* DSM-5 diagnosis requires 5 or more of: * Ideas (not delusions) of reference * Odd beliefs or magical thinking * Unusual perceptual experiences (e.g. illusions) * Odd thinking/speech (e.g. vague, metaphorical) * Suspiciousness or paranoid ideation * Inappropriate or constricted affect * Odd, eccentric or peculiar behavior * Lack of close friends other than family * Social anxiety that relates to paranoid fears

Answer 18

* DSM-5: transient stress-related paranoid ideation * Short-lived “micropsychotic” episodes not prolonged psychosis, no thought disorder * In practice, voices that are berating or commanding self- harm are not uncommon **can have both schizo and borderline - not mutually exclusive

Answer 19

Drugs – Cannabis (longitudinal association as well) – Stimulants – Hallucinogens Medical illnesses – Delirium/dementia – Structural brain lesions (e.g. brain tumor, stroke) – Degenerative brain diseases (Huntington’s, Parkinson’s) – Epilepsy, esp. complex partial seizures – Endocrine (thyroid, adrenal, parathyroid) – Infectious (e.g. syphilis, HIV/AIDS) Medications – Steroids (e.g. prednisone, L-DOPA)

Answer 20

* Schizophrenia is a serious & persistent mental illness * positive symptoms (psychosis) * negative symptoms * deterioration in function * Schizophrenia needs to be distinguished from other psychiatric illnesses * extent and nature of psychotic symptoms, * duration of illness * presence of mood episodes * Medical illnesses and drugs of abuse need to be ruled out. * Schizophrenia cannot be cured, but can be managed with a combination of medication and non-medication strategies

Schizophrenia Flashcards

(44 cards)