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62 Cards in this Set

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