schizophrenia

psychosis

mental state characterized by impaired reality and is manifested by a constellation of symptoms that have been described since BC

psychotic disorders

disturb particularly human aspects of perception and cognition

schizophrenia

split mind, recent term for a very old phenomenon

dissociative thinking, delusions, hallucinations, affective disturbance, inability to integrate feelings, thoughts, memories, and perceptions into a coherent whole

dementia praecox

paranoia, persecutions/grandiose delusions, auditory/tactile hallucination, emotional blunting, bizarre thoughts, stereotype behavior

leads to early cognitive decline, early deterioration of the brain

seen a lot in the elderly

estrogen

regulate dopamine activity, mitochondrial function, and HPA axis activity, important pathophysiological pathways in schizophrenia

may play a protective role, raise availability and efficacy of antipsychotics

delusions

false beliefs, not amenable to change by reason or experience

thought disorder

loosening of associations among thoughts, word salad

hallucinations

a perception that occurs in the absence of a stimulus (usually auditory)

catatonic

common schizophrenia subtype that involves altering periods of immobility and excited agitation

paranoid

common schizophrenia subtype that includes delusions of grandeur or persecution, auditory hallucinations, but normal intellectual functioning and expression of affect

positive

schizophrenia symptoms often associated with older individuals who respond well to conventional antipsychotic medications that block D2

excess and distortions of normal function (such as hallucinations, delusions, and bizarre behaviors)

negative

schizophrenia symptoms usually associated with younger individuals that are resistant to classical but reduced by “atypical” antipsychotics

diminution or loss of normal function (such as social withdrawal, flat affect, anhedonia, etc.)

DISC1

most studied gene, disrupted in Schizophrenia 1 (neurodevelopment, neuronal migration, synaptic plasticity)

enlarged ventricles

indicate degeneration but is not unique to schizophrenia

more common in chronic types with negative symptoms (started early in life)

hypofrontality hypothesis

discordant twins: low frontal blood flow only in affected twin

deficits in Wisconsin Card Sorting Task (WCST)

deficits in Stroop test

wisconsin card sorting test (WCST)

schizophrenics cannot shift attention to other criterion

frontal lobe activity lower at rest, especially in right hemisphere, does not increase during task

drug treatment increased activation of frontal lobes

D2

the better the drug binds to this receptor, the better it will be as an antipsychotic

better at treating positive symptoms

5HT2

atypical antipsychotics have a higher affinity for this receptor than D2, but work just as well

lower risk of motor side effects

rule of thirds

commonly held by American psychiatrists and found to hold true in Europe

categorizes individuals with schizophrenia based on how well they respond to treatment

typical antipsychotics

phenothiazine (chlorpromazine)

butyrophenones (haloperidol)

block D2 receptors and alleviate + symptom

atypical antipsychotics

clozapine, risperidone, olanzapine

dystonia

abrupt spasms of tongue / face

frightening and requires immediate attention

tardive dyskinesia

late (tardy) neurological symptom, stereotyped involuntary movements, particularly of face and jaw

most feared because it could be irreversible

norepinephrine

receptor blockade can cause postural hypotension

histamine

receptor blockade can cause sedation / drowsiness, weight gain

muscarinic acetylcholine

receptor blockade can cause memory deficits, constipation / urinary retention, tachycardia, blurred vision, dry mouth

parkinsonism

risk with schizophrenia treatment

tremors, muscle rigidity, loss of facial expression

akinesia and akathisia

neuroleptic malignant syndrome (NMS)

risk with schizophrenia treatment

can be dangerous and life threatening, fever, rigidity, altered consciousness

autonomic nervous system instability (rapid heart rate and fluctuations in blood pressure

hebephrenic

schizophrenia subtype that includes silly immature emotionally with disorganized behavior, mood incongruence, senseless laughter, delusions, and regressive behavior

disorganized

schizophrenia subtype with disorganized speech and thoughts

residual

schizophrenia subtype with no longer any delusions, hallucinations, disorganized speech, or behavior

negative symptoms (flat affect) or attenuated positive symptoms (odd beliefs)

NRG 1

expression and activation of glutamate (NMDA) and other neurotransmitter receptors (GABA, Ach)

role in neurodevelopment, affecting cellular differentiation and neuronal migration

DTNBP 1

synaptic plasticity

COMT

DA metabolism

high levels of DA or low levels in PFC

RGS4

regulates G-protein activity, neurotransmitter release, cognitive deficits