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62 Cards in this Set
- Front
- Back
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What is schizophrenia not?
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A split personality disorder
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What can Psychosis occur from?
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Many etiologies
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What 2 NT's are clearly involved in some way in psychosis?
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Dopamine and Serotonin
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Who was the first to try to connect psychoses to the brain?
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Hippocrates
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What group of NT's modulates emotional function and is implicated in severe psychiatric illnesses?
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The monoamines
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Monoamines consist of:
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-Serotonin
-Norepinephrine -Dopamine |
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What is the symbol for Serotonin?
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5-HT
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How many dopamine receptors are there? Which do we know the most about?
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5 receptors - we know the most about the D2 receptor
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What are D2 agonists?
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Drugs of abuse
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In what disorders is Dopamine implicated?
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Movement (parkinsons)
Psychotic |
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What 3 disorders is NE impicated in?
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-Depressive
-Anxiety -Attention deficit |
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What is Serotonin important in?
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The LIMBIC system
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What is Psychosis?
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A disorder of thinking; a loss of control with reality
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What are 3 characteristics of psychoses?
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-Illogical thought processes
-Hallucinatory experiences -Behavioral abnormalities |
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5 disorders that may manifest psychotic symptoms:
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-Schizophrenia
-Schizoaffective disorder -Bipolar disorder -Depression -Dementia |
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What are the 2 main categories of symptoms in Schizophrenia?
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-Positive symptoms
-Negative symptoms |
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What is the difference between positive and negative symptoms?
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Pos: something is there that shouldn't be
Neg: something is lacking |
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3 Positive symptoms of Schizophrenia:
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-Hallucinations
-Paranoia -Delusional thinking |
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5 Negative symptoms of Schizophrenia:
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-Apathy
-Concrete thinking -Lack of motivation -Social isolation -Affective flattening |
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What causes the negative symptoms?
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Lack of prefrontal cortex activity
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How was schizophrenia treated in the USA in 1936?
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By psychosurgery - prefrontal lobotomy
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Does prefrontal lobotomy do anything good?
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No; just makes the person docile.
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How was Schizophrenia treated in Italy in 1938?
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With electroconvulsive shock therapy -ECT
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What does ECT do?
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Creates seizures
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Is ECT effective in treating schizophrenia?
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No; it is good for depression but not this.
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What became the method of treatment for schizophren in the USA in 1954?
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Phenothiazines
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What 2 psychotic disorders are among the top 10 leading causes of disability?
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-Schizophrenia
-Bipolar affective disorder |
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What is the approximate epidemiology of Schizophrenia in the US?
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Affects ~1% of the US population
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When is the onset of Schizo most common?
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Late adolescence or early adulthood
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What % of mental health facility beds and all hospital beds does schizo account for?
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40% of mental health beds
9% of all hospital beds |
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What is the cause of Schizo?
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Multifactorial
-Genetics -Environmental |
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What are some environmental factors associated with Schizo?
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-2nd trimester maternal viral infections
-Obstetric/perinatal complications |
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How does the onset of Schizo differ in males versus females?
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Males: onset in early 20's
Females: onset in mid-late twenties to forties (later) |
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What structural brain abnormalities are seen in Schizophrenia?
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-Cerebral atrophy
-Ventricle enlargement -Diffuse cerebral dysfunction |
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Where are specific functional abnormalities in particular?
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-Prefrontal
-Medial temporal |
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What is the problem with dopamine in Schizophrenia?
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Dopaminergic neurons fail to develop normal projections to the frontal cortex
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What brain pathway is overactive in Schizophrenia?
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The Dopaminergic Mesolimbic pathway
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What are dopaminergic neurons in the brainstem normally connected to?
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-Prefrontal cortex
-Limbic system |
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What does the prefrontal cortex normally do to the connection between DA neurons/limbic areas?
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Inhibit them
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What happens when DA projections to the prefrontal area are lost?
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The mesolimbic pathway is overactive... Schizophrenia
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What are the 4 pathways in the Dopamine system?
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1. Mesocortical
2. Mesolimbic 3. Tuberoinfundibular 4. Nigrostriatal |
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What does damage and loss of activity in the mesocortical pathway cause?
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Negative symptoms
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What does damage and overactivity of the mesolimbic pathway cause?
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Positive symptoms
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What is the nigrostriatal pathway implicated in?
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Parkinsons
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What is the function of the Tuberoinfundibular pathway?
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Inhibition of prolactin release
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Hyperdopaminergic pathways
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Positive symptoms
-Hallucinations -Delusions |
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Hypodopaminergic pathways
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Negative symptoms
-Flattened affect -Withdrawn -Problems learning/concentrating |
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What did the old drugs treat?
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Mostly the POSITIVE symptoms
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What did ALL first generation antipsychotics cause?
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Extrapyramidal symptoms (EPS)
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What is another bad side effect of first generation antipsychotics?
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Hyperoprolactinimea due to lack of inhibition of prolactin release
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What was a 1st generation drug?
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Chlorpromazine
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What was the mechanism of Chlorpromazine?
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D2 antagonist
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What was the good thing about Chlorpromazine?
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It caused a large reduction in mental health hospital pateints
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Why did Dopamine antagonism prevent positive symptoms?
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Because it blocked the overactivity of the mesolimbic pathway
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Why didn't Dopamine antagonism prevent negative symptoms?
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Because there was no change in the hypoactive mesocortical pathway.
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What is a 2nd generation antipsychotic?
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Clozapine
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Why was Clozapine banned?
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Because it caused Agranulocytosis in 1% of patients
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Then what happened?
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It was allowed because it is so good and reduces both pos and neg symptoms
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What is different about the mechanism of 2nd generation antipsychotics?
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They are antagonists of both D2 and 5HT2A receptors
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What is the latest generation of antipsychotics based on?
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Partial agonists of D2 and 5HT1A
Antagonists of 5HT2A |
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What are the 5HT receptors?
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Serotonin receptors
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How do partial agonists work?
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By sitting on their receptors and turning them on 30% but not 70%
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