Neuropsychiatry: Week 2- Schizophrenia And The Psychoses

Front 1

Prevalence denotes...?

Back 1

The number of cases of a condition in a population

Front 2

Incidence indicates...?

Back 2

The rate of occurrence of a particular disorder in a given period of time.

Front 3

Generally speaking, the figure of _ case of schizophrenia per ___ life time incidence is a good estimate of the pool size.

Back 3

1, 100

Front 4

THE CONTINUUM VIEW OF SCHIZOPHRENIA: Despite often being discussed as if its a well defined, unitary concept, 'Psychosis' is a fairly _____ term used to classify a ___ of _______, and is not, in itself, a __________ _________.

Back 4

Vague, Set, Symptoms, Diagnostic Category

Front 5

THE CONTINUUM VIEW OF SCHIZOPHRENIA: Psychosis is traditionally linked to:
-
-
-

Back 5

Schizophrenia Spectrum Disorders
Affective Disorders
'Organic Syndrome' Disorders (Commonly Dementia)

Front 6

THE CONTINUUM VIEW OF SCHIZOPHRENIA: Psychosis may also arise after almost any sort of _______, _______ or _____

Back 6

Illness, Injury, Drug

Front 7

Does Psychosis equal schizophrenia?

Back 7

NO, though the diagnosis of Schizophrenia requires the presence of psychotic symptoms!

Front 8

List 2 Good and 2 Poor (as in it predicts a bad outcome) DEMOGRAPHIC Predictors of outcome:

Back 8

GOOD: Female & Married
POOR: Male & Single

Front 9

Family History of MOOD DISORDERS- Does this predict good or poor outcome?

What about family history of Schizophrenia?

Back 9

Good.

Schizophrenia predicts Poor outcome

Front 10

Good premorbid ____________, ______ onset,____ event at onset, and ______ treatment all predict GOOD outcome

Back 10

Adjustment, Acute, Life, Prompt

Front 11

_________ traits, _____ onset, Long duration of __________ psychosis, and onset under __ years old all predict POOR outcome

Back 11

Schizoid, Slow, Untreated, 17

Front 12

Out of the following symptoms, 1 is a predictor of good outcome and the rest predict poor outcome. Identify them,

Negative Symptoms
Obsessions
Affective Symptoms
Bizarre Delusions
Poor Insight

Back 12

Good outcome: Affective Symptoms

The rest predict poor outcome.

Front 13

Good response to treatment predicts good outcome, however, high expressed ________, ___________ misuse, and poor adherence to ____________ all predict poor outcomes.

Back 13

Emotions, Substance, Treatment

Front 14

HALLUCINATIONS are _______ experiences in the absence of any _________ from the ___________ (e.g., audible thoughts/ voices arguing or commenting)

Back 14

sensory
stimulation
environment

Front 15

DELUSIONS are holding a _______ that the rest of society would generally ________ with or view as ______________ of _________.

Back 15

belief
disagree
misinterpretations
reality

Front 16

BIZARRE BEHAVIOUR is defined as the practice of _______ or _____________ behaviours or __________ such as _____________, or saving ____ _________.

Back 16

unusual
uncharacteristic
rituals
aggressiveness
body parts

Front 17

THOUGHT DISORDERS are problems with the _____ of thought. Includes features such as:
- I_________
- N___________ (which is the generation of ...?)
- L___________ of A________
- C_____ A___________
- P________ of S_______
- P___________
-T______ B_________

Back 17

Form
- Incoherence
- Neologisms (generation of non-words)
- Loosening of Associations
- Clang Associations
- Poverty of Speech
- Perseveration
- Thought Blocking

Front 18

List the Positive Symptoms of Schizophrenia (4)

Back 18

Hallucinations
Delusions
Bizarre Behaviour
Thought Disorder

Front 19

DSM V Criteria for Schizophrenia:(5)

Back 19

1. Delusions
2. Hallucinations
3. Disorganised speech (derailment/incoherence)
4. Grossly disorganised or catatonic behaviour
5. Negative symptoms (diminished emotional expression/ avolition)

Front 20

Traditionally, Psychosis has been seen as a ______________ different state from normal mental functioning.
It is seen as a _______ or ___________ in nature.

This view additionally relies on:
________ factors such as intrusiveness, frequency, and comorbidity
________ and ________ factors such as coping, illness behaviour, societal tolerance, resultant disability

Back 20

Qualitatively
Disorder, Pathological
Symptom
Personal, Social

Front 21

Thought disorders are a problem with the _____ of thought. Includes such features as:
C
L
I
N
P
P
T

Back 21

Form

Clang associations
Loosening of association
Incoherence
Neologism
Poverty of speech
Perseveration
Thought blocking

Front 22

Negative symptoms of schizophrenia:
F
A
A
A
A

Back 22

Flattening of affect
Alogia
Avolition
Anhedonia
Attention Deficit

Front 23

Define FLATTENING OF AFFECT: (2 points)

Back 23

- Virtually no stimulus can elicit an emotional response (blunting and apathy).
- Inappropriate affect

Front 24

Define ALOGIA:

Back 24

Decrease in the FLOW and SPONTANEITY of speech

Front 25

Define AVOLITION:

Back 25

Decrease in the ability to MOTIVATE onself or get things started

Front 26

Define ANHEDONIA:

Back 26

Inability to feel pleasure in any activity

Front 27

Define ATTENTION DEFICIT:

Back 27

Inability to ATTEND and TRACK mental operations

Front 28

Schneider's first rank symptoms:
-T
-D
-E
-R
-P

Back 28

-Thought insertion, withdrawal or broadcasting
-Delusional perception
-Echo de la oensee
-Running commentary
-Passivity experiences

Front 29

What neurotransmitter is largely targeted in Schizophrenia treatement?

Back 29

DOPAMINE!

Front 30

List the 4 Dopamine pathways of the brain.

Back 30

1. Nigrostriatal
2. Mesolimbic
3. Mesocortical
4. Tuberohypophyseal

Front 31

The Dopamine hypothesis states that schizophrenia is due to __________ in one of the ___________ neurotransmitter systems in the brain, and anti-psychotics work by ______________ Dopamine transmission

Back 31

Overactivity
dopamine
Inhibiting

Front 32

Recent modifications of the Dopamine Hypothesis state that POSITIVE symptoms are due to ___________ activity in the _____________ Dopamine Pathway, and NEGATIVE symptoms are due to _________ activity in the ____________ pathway

Back 32

Increased, Mesolimbic
Decreased, Mesocortical

Front 33

Patients with Schizophrenia show impairments consistent with defecits in _______ ________ function, for example:
Anhedonia
Decreased motivation
Failure to use feedback to enhance goal-directed behaviour

Back 33

Reward System

Front 34

________ may also be involved in both negative and positive symptoms, and cognitive impairments

Back 34

Glutamate

Front 35

_____________ and ______________ changes are considered important in the cognitive changes

Back 35

Cholinergic
GABAergic

Front 36

Match the hypothetical malfunctioning brain circuits to the following symptoms: (Choose from: Mesolimbic, Orbitofrontal cortex, Nucleus Acumbens [reward circuits], Amygdala, Mesocortical [prefrontal cortex], Ventromedial prefrontal cortex)
-Positive
-Negative (2)
-Cognitive
-Affective
- Aggressive (2)

Back 36

-Positive: Mesolimbic

-Negative: - Mesocortical[prefrontal cortex]
- Nucleus Accumbens [reward circuits]

-Cognitive

-Affective: -Ventromedial prefrontal cortex

- Aggressive:- Orbitofrontal cortex
- Amygdala

Front 37

The INTEGRATED DOPAMINE HYPOTHESIS:
High Dopamine in the Mesolimbic pathway causes:

Low Dopamine in the mesocortical pathway to Dorsolateral PFC causes:

Back 37

Positive Symptoms

Negative symptoms & Cognitive Symptoms

Front 38

The INTEGRATED DOPAMINE HYPOTHESIS:
Low Dopamine in the mesocortical pathway to Ventro-medial PFC causes:

Back 38

Negative Symtoms & Affective Symptoms

Front 39

The INTEGRATED DOPAMINE HYPOTHESIS: The Nigrostriatal and tuberoinfundibular pathways are ______ in schizophrenia

Back 39

Normal

Front 40

After administering a Pure D2 antagonist, Dopamine in lowered in the Mesolimbic, and mesocortical pathways.
What happens when Dopamine is LOW in the Mesolimbic Pathway?

What happens when Dopamine is LOW in the Mesocortical Pathways to DL and VM PFC?

Back 40

Positive symptoms are cured, but lack of pleasure or reward is induced.

Negative, Cognitive(DL) and Affective (VM) symptoms- Note these are lowered in schizophrenia to begin with.

Front 41

Main arguments FOR the Dopamine Hypothesis are:
1. Amphetamine-induced psychosis produces a _______________ _________ __________
2. Amphetamine ___________ schizophrenia
3. Drugs that block Dopamine receptore are ________ in relationship to their blocking potential
4. ____________ and _________ studies
5. Animal models of Dopamine Agonism resemble __________ and are _________ by Dopamine blocking agents

Back 41

1. Schizophrenia-Like Illness
2. Exacerbates
3. Antipsychotic
4. Post-mortem, Endocrine
5. Psychosis, Reversed

Front 42

Main arguments AGAINST the Dopamine Hypothesis are:
1. _____ ______ between administration of a dopamine blocker and clinical response
2. Dopamine agonists have an ________ effect on psychosis
3. Direct evidence of increased dopamine activity is _____

Back 42

1. Time course ( it takes 2-3 weeks, suggesting its not a direct effect)
2. inconsistent
3. Poor

Front 43

LIDDLE'S THREE SYNDROMES:
What are they?
-
-
-

Back 43

-Psychomotor Poverty /Negative Symptoms
-Disorganisation/ Behavioural Diaorganisation
-Reality Distortion/ Hallucinations and Delusions

Front 44

LIDDLE'S THREE SYNDROMES: What symptom pattern is seen in the Negative Symptoms/Psychomotor Poverty Syndrome? (4)

Back 44

-alogia
-anhedonia
-avollition
-affective flattening

Front 45

LIDDLE'S THREE SYNDROMES: What symptom pattern is seen in the disorganisation Syndrome? (3)

Back 45

- Formal thought disorder
-Inappropriate Affect
-Bizarre Behaviour

Front 46

LIDDLE'S THREE SYNDROMES: What symptom pattern is seen in the reality distortion Syndrome? (2)

Back 46

- Hallucinations
- Delusions

Front 47

Brain imaging of MZ twins discordant for schizophrenia have shown that Schizophrenia twins have __________ _________ and loss of ______ ______. This loss is fastest in the __________ and _________-_________ fields

Back 47

Ventricular dilatation, Grey Matter.
Temporal, parieto-frontal

Front 48

Clinical features that have been associated with ventricular enlargement include:
-Early _______ damage or _________ complications
-____________ premorbid adjustment
-_______ negative symptoms
-_______ positive symptoms
-__________ Decline
-_________ response to treatment
-More _______ neurological signs
-___________ CSF-HVA
-DOES/DOESN'T seem to be just institutionalisation, because it occurs in the ______, and in ______.

Back 48

-Early BRAIN damage or BIRTH complications
- POORER premorbid adjustment
- MORE negative symptoms
- LESS positive symptoms
-COGNITIVE Decline
- POORER response to treatment
-More MINOR neurological signs
- DECREASED CSF-HVA
- DOESN'T seem to be just institutionalisation, because it occurs in the YOUNG, and in TWINS.

Front 49

Schizophrenia involves structural changes in:
-
-
-

Back 49

- Prefrontal Cortex
- Corpus Callosum
- Ventricles

Front 50

________ may self-perceive subtle cognitive & perceptual aberrations predictive of later psychosis in schizophrenia.

These people are also characterised by objectively different measures of :
-
-
-

Although, theyre significantly less impaired than...?

Back 50

Prodromes

- Attention
- Verbal/Visual Memory
- Verbal Fluency

Patients who had already developed schizophrenia

Front 51

At BASELINE, the following areas have grey matter reduction in psychosis:
-
-
-

Back 51

- Right Temporal
- Inferior Frontal Cortex
- Cingulate

Front 52

At FOLLOWUP, the following areas have grey matter reduction in psychosis:
-
-
-
-

Back 52

- Left Medial Temporal
- Left Orbitofrontal
- Cingulate
- Cerebellum

Front 53

The 2 main pathological processes implicated in schizophrenia include the __________ and __________ lobe

Back 53

Temporal, Frontal

Front 54

There is also ________ atrophy in schizophrenia

Back 54

Hippocampal

Front 55

Evidence for Schizophrenia being a Temporal Lobe disease include:
-
-

Back 55

- TLE causes a higher tendency towards positive symptoms
- Observations of disorientated pyramidal cells in the temporal lobe (but not well replicated)

Front 56

Evidence for Schizophrenia being a Frontal Lobe Disease were shown by monozygotic twins discordant for schizophrenia. In this study, cerebral _______ flow and ___ indicated _________________ in ________ during the Wisconsin Card Sort

Back 56

Blood, PET, Hypometabolism, DLPFC

(in other words, there was less activation in the DLPFC during Wisconsin Card Sort)

Front 57

Attention deficits are consistent with the notion that there is _______ system involvement.

Non-paranoid and Negative state patients demonstrate deficits consistent with reduced ________ and ____________

Paranoid and Positive state patients may demonstrate performances _______ than normals

Back 57

Frontal

Arousal, Distractability

Better

Front 58

There is evidence of ____________ deficits in the disengagement and redirection of ________ ________ in schizophrenia.

Back 58

lateralised
visual attention

Front 59

Models of normal cognitive functioning have led to the interpretation of the attentional deficits in schizophrenia in terms of _________ distribution of _______ with limited _________ capacity.

Back 59

flexible
attention
processing

Front 60

Schizophrenics are inaccurate at recognising and labelling ______ __________.

Negative state patients with schizophrenia are also significantly impaired in conveying _______ _________. This deficit involves both _________ and __________ skills and does not appear to be related to ___________ alone, to ____________ deficit, or to an inability to ______________ the emotion.

Back 60

Facial emotion

Vocal Affect

Encoding, Decoding
Psychosis. Generalised, Experience

Front 61

Impairments in semantic content, discourse & complex language may be secondary to the cognitive deficits, particuarly __________ and ____________ functions.

Is there much evidence for BASIC language deficits in schizophrenia?

Back 61

Attention, Executive

No

Front 62

Name some types of deviant language oberved in patients with Schizophrenia:
-L
-I
-I
-P
-S

Back 62

- Loss of goal
- Illogicality
- Incoherence
- Perseveration
- Self-reference

Front 63

Schizophrenics consistently have deficits in basic _______ and _______ memory recall. Severely disturbed patients have deficits similar to _________ __________ suggesting _______ hippocampal involvement

Back 63

Verbal, Visual
Retrograde Amnesia
Bilateral

Front 64

In mildly disturbed patients and bipolar affective disorders, the deficits in memory are associated with _____________ skills that affect _________. This is probably secondary to ________ and _____________ functions

Back 64

Organisational, Encoding

Attentional, Organisational

Front 65

Visuospatial impairment is a(n) CONSISTENT/INCONSISTENT finding in schizophrenia. Tasks which load on _______ functions are more likely to be observed.

Back 65

INCONSISTENT

Frontal

Front 66

Patients with schizophrenia have CONSISTENTLY/INCONSISTENTLY impaired executive functions. This is consistent with a dysfunction of a large network mediating ______ and ___________.

Back 66

Consistently, Arousal, Attention

Front 67

The Core cognitive deficits associated with Schizophrenia include:
-A
-P
-R
-V
-V
-W
-S

Back 67

-Attention*/ info processing
-Processing speed*
-Reasoning & Problem solving
-Visual memory & Learning
-Verbal memory & Learning*
-Working Memory
-Social Cognition

*=deficits associated with the first episode of schizophrenia

Front 68

List the Neurocognitive Deficits associated with the 1st episode of schizophrenia:
-A
-P
-E
-S
-F
-V

Back 68

-Attention/ Vigilance
-Processing speed
- Executive Function
- Spatial Working Memory
- Fine motor function
- Verbal Learning and Memory

Front 69

Decreased activity in the Left dorsolateral PFC and Inferior parietal cortex are associated with which schizophrenic symptoms?

Back 69

- Negative symptoms/ Psychomotor poverty

Front 70

Increased activity in Broca's area and a Failure to decrease activity in the Superior Temporal Gyrus (Left) is associated with which symptom?

Back 70

Auditory hallucinations

Front 71

Increased activity in the hippocampal region are associated with which symptoms?

Back 71

Positive symptoms

Front 72

Increased activity in anterior cingulate cortex and decreased activity in superior temporal gyrus (left) are associated with which symptom?

Back 72

Thought disorder

Front 73

Increased activity in Amygdala is associated with what symptom?

Back 73

Persecutory delusions

Front 74

Increased activity in Cingulate Gyrus and Right parietal Lobule are associated with which symptom?

Back 74

Passivity Experiences

Front 75

Failure of normal activation in Left Inferior Prefrontal Cortex and Medial Temporal Cortex may explain the cognitive deficit in ________ _________.

Failure to normally activate Left Dorsolateral Prefrontal cortex and failure to deactivate superior temporal cortex may explain issues in _______ ________

Back 75

Working Memory

Verbal Fluency (semantic and phonemic)

Front 76

Failure of normal activation in Anterior Cingulate gyrus may explain _______ _________ issues.

And failure to normally activate Amygdala may explain __________ ________ ________

Back 76

Error Monitoring

Facial Emotional Recognition

Front 77

Failure to activate insula and parahippocampal gyrus may explain ___________ problems.

And failure to normally activate Striatum may explain difficulties with the _______ of ______ _______ saccades

Back 77

Olfactory

Inhibition, Reflex Eye