BMS 200: Schizophrenia and Migraines Quiz

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Questions and Answers

Which symptom is classified as a negative symptom of schizophrenia?

Blunted emotional expressions (correct)

Hallucinations

Increased social interaction

Delusions of grandeur

What is a common cognitive symptom associated with schizophrenia?

Difficulty with working memory (correct)

Intense vocalization

Rapid speech

Increased physical activity

What is the role of dopamine in the pathogenesis of schizophrenia?

Dopamine levels are decreased throughout the brain.

Dopamine has no known association with schizophrenia.

Dopamine exclusively causes negative symptoms.

Dopaminergic system dysregulation is linked to psychosis. (correct)

At what age range does schizophrenia typically onset?

Puberty to early 30s Signup and view all the answers

Which of the following is NOT a characteristic of negative symptoms in schizophrenia?

Extensive verbal communication Signup and view all the answers

What effect do drugs that increase dopamine have on schizophrenia?

They can induce or exacerbate psychosis. Signup and view all the answers

What is a notable vulnerability of GABA interneurons in individuals with schizophrenia?

They are highly susceptible to developmental damage. Signup and view all the answers

Which of the following describes a psychomotor symptom of schizophrenia?

Slowed movements and effortful actions Signup and view all the answers

What is the minimum duration for continuous signs of schizophrenia to be considered valid for diagnosis?

6 months Signup and view all the answers

Which of the following describes the phenomenon of 'derailment' in schizophrenia?

Thoughts shifting abruptly from one topic to another Signup and view all the answers

What is 'poverty of speech' primarily characterized by?

Limited verbal output or brief responses Signup and view all the answers

Which of the following is a key feature of a delusion?

It is held firmly despite contradictory evidence. Signup and view all the answers

Which symptom involves branching off into unrelated topics during conversation?

Tangentiality Signup and view all the answers

What best describes 'neologism' within the context of schizophrenia?

Creation of new, often nonsensical words Signup and view all the answers

What differentiates a hallucination from a delusion?

Hallucinations involve a sensory perception in the absence of an external stimulus. Signup and view all the answers

Which statement best describes the DSM V criteria for schizophrenia?

Two or more specific signs or symptoms must be present, with one being either delusions, hallucinations, or disorganized speech. Signup and view all the answers

What does thought blocking refer to in schizophrenia?

Abrupt interruption of thoughts during speaking Signup and view all the answers

What is the common characteristic of negative symptoms in schizophrenia?

They represent a decrease in normal emotional and behavioral function. Signup and view all the answers

Which behavior is associated with catatonia in schizophrenia?

Motor immobility and stupor Signup and view all the answers

Which characteristic is NOT associated with disorganized speech in schizophrenia?

Social withdrawal Signup and view all the answers

Which of the following best describes an example of a hallucination?

A patient hears voices commanding them to act without any external stimulus. Signup and view all the answers

What is a central part of the dopaminergic hypothesis of schizophrenia?

An overactivity of dopamine pathways is linked to the symptoms. Signup and view all the answers

In the context of inflammation and migraines, which factor is most likely to be linked to their pathophysiology?

Decreased levels of gut microbiota diversity. Signup and view all the answers

Which of the following conditions can indicate the presence of hallucinations?

Neurological disorders, substance withdrawal, or intoxication. Signup and view all the answers

What is the estimated increased risk of migraines in individuals with IBS?

40-80% Signup and view all the answers

Which of the following statements about serotonin and its relationship to IBS and migraines is accurate?

Pharmaceuticals targeting serotonin receptors are effective for both IBS and migraines. Signup and view all the answers

Which pro-inflammatory cytokines are known to be elevated in migraine sufferers?

IL-1Beta, IL-6, IL-8, and TNF-alpha Signup and view all the answers

What role does dysbiosis play in the pathophysiology of IBS and migraines?

It promotes an increase in pro-inflammatory cytokine release due to LPS leakage. Signup and view all the answers

How do certain bacterial strains affect serotonin metabolism in the gut?

They metabolize tryptophan, potentially influencing local gut serotonin levels. Signup and view all the answers

What role does calcitonin-gene-related peptide (CGRP) play in migraine pathophysiology?

It mediates neurotransmission and acts as a pain modulator. Signup and view all the answers

Which phenomenon is most closely associated with the neurovascular theory of migraine?

Spreading depression of neural excitability. Signup and view all the answers

How does nerve growth factor (NGF) influence pain transmission in migraines?

It enhances the release of brain-derived neurotrophic factor (BDNF) from C fibres. Signup and view all the answers

What is the significance of antidromic action potentials in pain fibers during a migraine?

They can lead to the release of substances like substance P and CGRP into peripheral tissues. Signup and view all the answers

What condition has been associated with the improvement of migraine symptoms upon eradication?

H.pylori infection Signup and view all the answers

Which of the following is NOT a characteristic of neurogenic inflammation in the context of migraines?

Decreased excitability of spinal networks. Signup and view all the answers

What is a potential effect of substance P in migraine pathophysiology?

It promotes mast cell degranulation and vasodilation. Signup and view all the answers

Which network is likely influenced by the locus ceruleus during a migraine episode?

The nociceptive afferent modulatory network. Signup and view all the answers

What effect does chronic stress have on phasic firing in the amygdala?

Weaker phasic firing Signup and view all the answers

Which factors seem to contribute to the development of schizophrenia?

Childhood and adolescent stress Signup and view all the answers

What is the primary function of antipsychotic medications in schizophrenia treatment?

Block D2 receptors Signup and view all the answers

Which of the following neurotransmitter activities is characterized by hyperfunctioning in schizophrenia?

Dopaminergic activity Signup and view all the answers

How do pro-inflammatory cytokines relate to schizophrenia symptoms during psychosis?

They normalize upon antipsychotic treatment Signup and view all the answers

What role does kynurenic acid play in the context of schizophrenia?

Inhibits NMDA receptor function Signup and view all the answers

What is a notable effect of increased stress on GABA-ergic neurons in schizophrenia?

Loss of inhibitory GABA-ergic neurons Signup and view all the answers

Which areas are involved in the projection of the dopaminergic system relevant to cognitive symptoms in schizophrenia?

A wide variety of brain areas Signup and view all the answers

Study Notes

BMS 200: Schizophrenia, Migraines & Microbiome

Course focuses on schizophrenia, migraines, and the microbiome.

Outcomes

Students will describe the epidemiology and clinical features of schizophrenia.
The dopaminergic hypothesis of schizophrenia and the role of inflammation in its pathophysiology will be discussed.
The evidence linking inflammation and the gut microbiome to migraine pathophysiology will be detailed.

Common Psychiatric Presentations: Delusion

A delusion is a clearly false belief indicative of an abnormality in thought content.
Cultural or religious background, and intelligence level cannot explain the belief.
The belief persists despite evidence to the contrary.
Delusions can be caused by various factors, including mental, neurological, or medical disorders.
Examples include schizophrenia, substance use, bipolar disorder, major depressive disorder, delirium, and dementia.

Definition for Hallucination

A hallucination is a sensory perception in the absence of a corresponding external stimulus.
Hallucinations occur in the sensory domain (e.g., visual, auditory, tactile).
Vivid and clear without voluntary control.
Hallucinations can occur with or without insight, and are not always related to mental illness—they can occur as part of grief or adjustment disorders.

Schizophrenia – DSM V Criteria (Simplified)

Two (or more) of the following symptoms are present. At least one must be delusions, hallucinations or disorganized speech.
Delusions
Hallucinations
Disorganized speech (e.g., frequent derailment or incoherence).
Grossly disorganized or catatonic behavior
Negative symptoms (e.g., diminished emotional expression or avolition).
Continuous symptoms for at least 6 months, and one month active symptoms.
Level of functioning in work, school, relationships, or self-care is markedly decreased.
Cannot be attributed to another condition.

Schizophrenia - Definitions: Disorganized Speech and Thoughts

Disorganized Speech/Thought: characterized by derailment, poverty of speech, tangentiality, lack of logical connection, perseveration, neologisms, thought blocking, clanging, and echolalia, these are part of a phenomenon known as "thought disorders".
Catatonia: Disorganized behavior can be related to schizophrenia. It involves psychomotor disturbances such as stupor, rigidity, strange postures ("waxy flexibility"), excessive activity, echolalia, and echopraxia.
Derailment (Loose Associations): Shifting abruptly between unrelated topics in speech, making it difficult to follow. Lack of connection or logic.
Poverty of Speech: Reduced quantity or content of speech. Brief, monosyllabic responses, and lack of detail.
Tangentiality: Responding to a question with a totally or partially irrelevant answer or completely unrelated ideas.
Lack of Logic/Illogical Thinking: Conclusions or statements that don't logically follow.

Schizophrenia - Definitions: Neologism, Thought Blocking, Clanging, Echolalia

Neologism: Creation of new, nonsensical words.
Thought Blocking: Sudden interruptions of thought.
Clanging: Focusing on the phonetic aspects of words (rhyming, alliteration).
Echolalia: Repetition of words or phrases from another speaker without understanding.

Schizophrenia - Disorganized Behavior

Involves a significant disruption in the ability to perform daily activities.
Incoherent Behavior: Bizarre, nonsensical actions, such as inappropriately dressing (e.g., heavy coats in hot weather), aimless wandering, difficulty initiating tasks, or completing tasks.
Inappropriate Emotional Responses: Laughing or crying at inappropriate times, unpredictable behavior, or sudden shifts in mood.
Difficulty in Planning or Sequencing: Difficulty in tasks like meal preparation or personal hygiene due to cognitive impairment.

Schizophrenia - Catatonia

A complex psychomotor syndrome characterized by abnormal movements, behaviors, and reactions.
Motor Immobility: Reduced or complete lack of voluntary movement.
Stupor: Profound unresponsiveness to stimuli.
Rigidity: Muscular stiffness that prevents movement.
Strange Postures (Catalepsy): Unusual, often uncomfortable or bizarre postures that are maintained.
Excessive Motor Activity: Excessive, purposeless activity not influenced by external stimuli, impulsivity

Schizophrenia – Negative Symptoms

Communication: Limited speech, minimal responses, pauses.
Emotion/Affect: Reduced range of emotional experiences, blunted expressions, monotonous speech.
Social Activity: Few friends, minimal desire for social interactions.
Motivation: Little motivation to engage in daily activities. Decreased interest in hobbies, grooming, and self-care.
Psychomotor Activity: Slowed movements, fewer expressive gestures.

Schizophrenia: Onset, Pathogenesis, and Cognitive Symptoms

Onset typically occurs between puberty and the third decade.
Pathogenesis is not fully understood, but dysregulation in dopaminergic systems is implicated in positive symptoms such as psychosis.
Neurological basis for cognitive symptoms is poorly understood.
Cognitive symptoms include problems with working memory, attention, executive functions (organization), social cognition (understanding cues).

Dopamine and Schizophrenia

There is hyper-responsiveness of the dopaminergic system in schizophrenia.
Antipsychotic drugs block dopamine receptors (D2).
Dopamine-increasing drugs (e.g., L-dopa, amphetamines) worsen psychosis.
GABA interneurons are last to develop, vulnerable to developmental insults, highly susceptible to damage from oxidative stress and glutamatergic drive particularly early postnatal.

Dopaminergic System

A complex network of neurons in the brain that use dopamine as a neurotransmitter.
The main dopaminergic areas include the ventral tegmental area (VTA), and substantia nigra.
These areas project to various brain regions, influencing different functions like motivation, motor control, and executive functions.
Dopamine is released in a tonic (steady) and phasic (transient) fashion. Tonic firing is decreased in stress responses, while phasic firing is stronger with interesting/acute stressors.

Inflammation and Schizophrenia

General inflammation may be linked to schizophrenia.
Elevations in pro-inflammatory cytokines (e.g., TNF-alpha, IL-6, IL-1beta) during psychosis often normalize with antipsychotic treatment.
Pro-inflammatory cytokines can lead to kynurenic acid production, which blocks NMDA receptors.
Activation of microglia and cognitive dysfunction and grey matter volume loss.

Migraine – Pathophysiology

The key pathway for migraine pain involves the trigeminal nerve's connection to the meninges.
Important modulation of neurotransmitters plays a role, including those from the brainstem nuclei.
Problems with modulation of pain sensation are implicated as a cause.
Vascular dilation and constriction (vasomotion) may play a role.

Migraine – Pathophysiology (Medications)

Medications acting on the central pathway include 5-HT1 receptors important in the trigeminal nucleus and thalamus and serotonin (using "-triptans" and/or CGRP).

Migraine, Pathophysiology – (Theories)

The best-accepted theory for Migraines is a neurovascular one, involving primary neural dysfunction leading to "spreading depression," a wave of neural excitability that spreads through the cortex and activates the trigeminal complex, leading to vascular pain.

Central Sensitization

Pro-inflammatory cytokines release nerve growth factor (NGF).
NGF increases brain-derived neurotrophic factor (BDNF) from C fibers.
This increases the excitability of "pro-pain" dorsal horn networks and C fibre transmission.

Neurogenic Inflammation

Action potentials can move in both directions along pain fibres.
Substances released from C fibers, like substance P and CGRP, can cause neurogenic inflammation by causing mast cell degranulation, vasodilation, and edema.

Migraines & Gut Microbiome

Eradication of H. pylori may improve migraine symptoms.
H. pylori triggers the release of CGRP, possibly increasing nerve sensitization.
Irritable bowel syndrome (IBS) is more common in migraine sufferers (increased risk 40-80%).
Food intolerances can trigger both IBS and migraine episodes.
Pharmaceuticals that modulate serotonin receptors are effective in both IBS and migraines.

Possible Mechanisms (Gut Microbiome & Migraines)

Pro-inflammatory cytokines (IL-1beta, IL-6, IL-8, TNF-alpha, IFN) are increased in migraine sufferers, and likely involved.
Dysbiosis (imbalance in gut microbiome) may lead to increased gut permeability and subsequent LPS leakage.

References

Specific references provided, encompassing articles, research papers, and relevant studies.

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Description

This quiz covers key concepts in BMS 200, focusing on schizophrenia, migraines, and the microbiome. Students will explore the epidemiology, clinical features of schizophrenia, and the link between inflammation and the gut microbiome in relation to migraines. Test your understanding of delusions, hallucinations, and psychiatric presentations.