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64 Cards in this Set

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What are some neuropathological findings in schizophrenia?

1. Reduced gray matter volumes and white matter integrity leading to OVERALL SMALLER BRAIN VOLUMES.

2. Reduced mesial temporal lobe volumes, including hippocampus.

3. Reduced dendritic and synaptic complexity.

4. Lower synaptic density on pyramidal neurons.

5. Increased ventricular volumes

What is the diathesis-stress model in schizophrenia?

It suggests that an interaction between genetics, affecting later stages of neurodevelopment, and environment to trigger schizophrenia symptoms.

What is the heritability rate in schizophrenia?

80-85%

What are risk factors for schizophrenia?

1. First degree relative with schizophrenia


2. Obstetric complications (poor maternal nutrition, low birth weight, prematurity, delivery complications)


3. Intellectual disability and Autism Specturm


4. Frequent pot use in adolesence


5. Young adult age


6. Low SES


7. Unmarried or divorced parents (vs. married or widowed).

What are sex differences in Schizophrenia?

Females tend to have later illness onsent, lower negative symptom severity, greater affective symptoms, BUT better social and premorbid functioning.

What leads to worse prognosis in schizophrenia, early or late onset?

Early onset.

What are common medical comorbidities in schizophrenia?

Everything every VA patient seems to have:




1. Smoking


2. hyperlipidemia and hypertension


3. Diabetes


4. Obesity




Results in a 20% reduction in life span.

What are some common side-effects of long term antipsychotic use?

Increased cardiovascular disease because metabolic system gets jacked up and leads to obesity.

Which of the following are predictive of better functional outcome in schizophrenia?

Reduction in positive symptoms

Reduction in negative symptoms

Reduction in cognitive impairments

Reduction in cognitive impairment and negative symptoms are associated with better functional outcomes.

Reduction in positive symptoms does not affect occupational, social, or independent functioning.

What early childhood behavioral signs are observed in schizophrenia?

1. Shyness or withdrawal

2. Learning problems

3. Clumsiness

4. Depressed mood

What are common prodromal (usually in adolescence) neuropsychological changes are seen in schizophrenia?

1. Verbal memory


2. Attention


3. Emotion recognition


4. Olfactory processing

What are the most impaired neuropsychological domains at first episode psychosis?

Memory, attention, and executive dysfunction, which tend to persist despite resolution of psychosis

What is the degree of overall cognitive impairment in schizophrenia in memory, executive functioning, and attention when compared to demographically matched controls?

1 to 1.5 Standard Deviations Below Controls

Do intelligence problems continue to decline in schizophrenia?

No. Following the first psychotic episode intelligence tends to remain stable.

What type of intelligence is most negatively affected in schizophrenia?

Fluid (i.e., working memory, novel problem solving, abstraction, processing speed)

What aspects of attention are impaired in schizophrenia?

1. Slowed reaction time (orienting)


2. Poor vigilance


3. Poor selective attention.

What cognitive ability produces the largest effect sizes on testing in schizophrenia?

Processing speed.

Describe language functioning in schizophrenia.

Highly variable.

Basic vocabulary, reading, and spelling tend to be ok

Higher level skills of comprehending complex syntax or semantics are impaired.

How are visuospatial abilities affected in schizophrenia?

They are not. Visuospatial abilities are relatively preserved.

What aspects of memory are impaired in schizophrenia?

All aspects of Declarative memory: Encoding, storage, organization, and retrieval




Prodromal memory impairments are very predictive of a RAPID conversion to psychosis.

What is the relationship between olfaction and negative symptoms of schizophrenia?

Olfactory problems are predictive of later negative symptoms (as well as onset of psychosis).

Are patient's with schizophrenia safe to drive?

Yep...for the most part. Cognitive deficits and medication effects should always be considered, though.

What tends to be most highly correlated to decision-making capacity in schizophrenia?

Cognitive deficits.

Most patients retain decision making capacity.

Do anti-psychotics produce cognitive benefits?

Nope. Just reduction of positive symptoms of schizophrenia.

What are side effects of traditional antipsychotics?

1. Extrapyramidal movement problems


2. Tardive dyskinesia/dystonia


3. Iatrogenic problems from meds to treat the above problems, which have a large anticholinergic burden.

When cognitive decline does occur later in life for patients with schizophrenia, what dementia(s) does it tend to look like?

Frontotemporal dementia

What is the liklihood that a monozygotic twin with schizophrenia will have a sibling that has schizophrenia?

30%




10% for sibilings/parents




2% for second degree relatives

What test is one of the strongest predictors of future schizophrenia in at-risk adolescents?

Odor identification

What is a major benefit of second generation antipsychotics?

Amelioration of positive symptoms

What pharmacological mechanism do first and second generation antipsychotics work through?

D2 dopamine receptor antagonism

Is cognitive remediation effective in schizophrenia?


Yes.

What is more effective for improving occupational functioning in schizophrenia, Individual placement with Support or Voc Rehab?

Individual placement with support

What age is the cut off for early onset schizophrenia?

Onset before age 13

What is schizoaffective disorder?

Schizoaffective disorder is a condition in which a person experiences a combination of schizophrenia symptoms — such as hallucinations or delusions — and significant separate mood disorder symptoms, such as mania or depression.

What neurological system is most affected in mood disorders?

Limbic System

What are the central functions of the limbic system and their corresponding key structures?

HOME!!!


1. Homeostasis, autonomic and neuroendocrine control (Hypothalamus)


2. Olfaction (Olfactory bulbs and cortex)


3. Memory (Hippocampus)


4. Emotions and drives (Amygdala)

What are all the structures of the limbic system?

1. Cingulate gyrus


2. Parahippocampal gyrus


3. Collateral sulcus that continues into rhinal sulcus


4. Uncus (bump located on anterior parahippocampal gyrus)


5. Medial orbitofrontal cortex


6. Temporal poles


7. Insular cortex


8. Hippocampus


9. Amygdala


10. Hypothalamus


11. Anterior and drosomedial Thalamic nuclei


12. Nucleus accumbens


13. Basal forebrain/Olfactory cortex


14. Nucleus Basalis of Meynert


15. Septal region





What is the piriform nucleus for?

Primary olfactory cortex, near the amygdala.

Where does fMRI show increased activation in depression?

Ventral limbic system (i.e., genu of the cingulate gyrus, amygdala, ventral striatum)

Note amygdala has the least established link to depression when compared to the cingulate, hippocampus, and prefrontal cortex.

What structural differences have been found between bipolar disorder/mania and unipolar depression?

Depression has reduced volume in the striatum

Mania/Bipolar patients have reduced overall brain volume and reduced blood flow in the dorsomedial and drosolateral prefrontal cortecies.

What neurotransmitters tend to have their balance upset in depression?

Monoamines, which include:



Serotonin


Norepinephrine


Dopamine




(and probably also glutamate)

What role does serotonin play in the brain?

Modulates:




1. Sleep


2. Aggression


3. Eating


4. Sex


5. Impulse control


6. Mood

What role does norepinephrine play in the brain?

Manages reactions to stress




Depressed people have been found have less norepinephrinergic neurons.

What is the relationship between serotonin and norepinephrine levels in the brain?

Lower serotonin leads to a drop in norepinephrine.

What role does dopamine play in the brain?

Regulating drives to seek out rewards and pleasure.

Not for certain, but DA binding problems in the striatum is thought to play a role in andedonia.

What cognitive domain is affected in bipolar disorder and mania, but not other affective disorders?

Visuospatial functioning

What is the average gender and age of a depressed person?

A 32 year old woman

What is the average gender and age of someone with bipolar disorder?

A 25 year old woman

Does bipolar tend to develop earlier in men or women?

Men

What are the criteria for rapid cycling biploar disorder?

4 or more episodes of depression and mania within a one year period.




Associated with younger onset and severe bipolar disorder

What limbic structures are implicated in Anxiety Disorder?

Amygdala which triggers the HPA axis.




The cingulate gyrus and orbitofrontal cortex

What structures are implicated in OCD?

Head of the caudate, anterior cingulate, and orbitofrontal cortex.

What areas are implicated in PTSD?

Amygdala, hippocamppus, prefrontal cortex.

What neurotrasnmitters are involved in anxiety?

Reduced GABA

Decreased serotonin (secondary cause)

Increased norepinephrine

Corticotropin Releasing Hormone (increased, triggering fight or flight)

What cognitive abilities are affected/not affected most in depression and anxiety?

1. Attention and Concentration (mild when no mood symptoms present, but correlated with severity of mood problem).




2. Slowed processing speed due to lack of motivation, not primary slowed cognitive performance.




3. Memory acquisition impairments with little improvement on repetition. Better recognition than recall, and not as severe as neurological illness.




4. Language and Visuospatial functioning are spared.





Deficits in which cognitive domain differentiate OCD and Bipolar disorder from depression and other anxiety disorder?

Visuospatial problems and visual memory problems due to right hemisphere involvement.

What is the rate of true dementia conversion in pseudodementia patients?

20%

Which neurotransmitter is excitatory and helps produce a heightened "fight or flight" response?

Norepinephrine

Which neurotransmitter implicated in mood disorders is responsible for changes in sleep, eating, sexual behavior, aggression, and impulse control?

Serotonin (think of it as being related to the behavioral aspects of depression)

Which of the following is not associated with depression?




Amygdala


Hippocampus


Prefrontal cortex


Anterior cingulate

Amygdala. This is associated with stress.

What is the pattern of memory performance for depressed patients?

Worse memory for unrelated information (i.e., lists) than contextualized information (i.e., stories).

Poor acquisition, with worse free recall, but normal recognition.

Which neurotransmitter is least connected with depression?

GABA

What structure is damaged in Kluver-Bucy syndrome?

Bilateral damage of the amygdala

What are the symptoms of Kluver-Bucy syndrome?

1. Visual agnosia


2. Hypersexuality


3. Hyperorality


4. Docility


5. Amnesia


6. Hyperphagia (pica)