Schizophrenia

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Questions and Answers

What is a potential effect of L-DOPA in susceptible individuals?

  • Decreased dopamine receptor sensitivity
  • Increased dopamine production without side effects
  • Enhanced mood stabilization
  • Triggered psychotic episodes (correct)

What is the primary action of chlorpromazine?

  • It decreases dopamine turnover
  • It acts as a dopamine receptor antagonist (correct)
  • It increases dopamine release in the brain
  • It enhances dopamine transporter activity

What evidence contradicts the dopamine hypothesis in schizophrenia?

  • Corroborated findings from consistent PET scans
  • No consistent evidence for increased dopaminergic transmission (correct)
  • Elevated levels of D1 receptors in the mesolimbic region
  • Increased levels of dopamine release observed in drug-naive patients

What is a noted discrepancy with the dopamine hypothesis related to treatment effects?

<p>Delayed onset of treatment benefits (A)</p> Signup and view all the answers

Which conclusion can be drawn regarding dopamine receptors in schizophrenia?

<p>Drug treatment effects may influence receptor measurements post-mortem (D)</p> Signup and view all the answers

What role does the DISC 1 gene play in the context of schizophrenia?

<p>Regulates dopamine homeostasis (B)</p> Signup and view all the answers

Which psychosocial factor can precipitate the onset of schizophrenia?

<p>Stress (B)</p> Signup and view all the answers

What brain structural abnormality has been associated with schizophrenia?

<p>Ventricular enlargement (D)</p> Signup and view all the answers

What is a significant structural finding in the brains of individuals with schizophrenia?

<p>Decreased numbers of small neurons in superficial layers (B)</p> Signup and view all the answers

Which environmental factor is associated with a higher incidence of schizophrenia in offspring?

<p>Viral infection during pregnancy (D)</p> Signup and view all the answers

What hormonal response is noted in schizophrenia patients within an emotionally charged home environment?

<p>Blunted cortisol response (C)</p> Signup and view all the answers

How does the COMT gene relate to schizophrenia?

<p>It breaks down dopamine (B)</p> Signup and view all the answers

What are cytoarchitectural abnormalities associated with in the context of schizophrenia?

<p>Differences in neuronal size distribution (B)</p> Signup and view all the answers

What role does DISC1 play in relation to neuronal migration?

<p>It interacts with proteins mutated in lissencephaly. (C)</p> Signup and view all the answers

What is a primary function of antipsychotics in the treatment of schizophrenia?

<p>They block dopamine receptors. (B)</p> Signup and view all the answers

Which of the following is a goal for improving therapy for schizophrenia?

<p>To aim for early and accurate diagnosis. (A)</p> Signup and view all the answers

What is the significance of Clozapine as an antipsychotic?

<p>It is an atypical antipsychotic with a unique action. (B)</p> Signup and view all the answers

Which factor complicates the expression of schizophrenia?

<p>An interaction between genetic and environmental factors. (A)</p> Signup and view all the answers

What is the primary cause of premature death in people with schizophrenia?

<p>Suicide (C)</p> Signup and view all the answers

Which of the following best describes the symptoms associated with schizophrenia?

<p>A mix of positive and negative symptoms including hallucinations and cognitive impairment (B)</p> Signup and view all the answers

Which statement is true regarding the genetic basis of schizophrenia?

<p>Monozygotic twins show a concordance rate of approximately 48%. (B)</p> Signup and view all the answers

What is a critical difficulty in treating schizophrenia?

<p>The episodic nature of the disorder complicates consistent treatment. (A)</p> Signup and view all the answers

Which of the following is highlighted as a limitation of current schizophrenia treatments?

<p>They may not address the full spectrum of symptoms. (D)</p> Signup and view all the answers

What role does stress play in the context of schizophrenia?

<p>It is a major precipitating factor for the illness. (C)</p> Signup and view all the answers

How might the prospects for understanding and treating schizophrenia improve in the future?

<p>Through advancements in neurobiological research and targeted therapies. (C)</p> Signup and view all the answers

Which type of hallucination is most commonly experienced by individuals with schizophrenia?

<p>Auditory hallucinations (B)</p> Signup and view all the answers

Which brain structure is associated with positive symptoms of schizophrenia?

<p>Temporal lobe (D)</p> Signup and view all the answers

What is indicated about the left hemisphere in individuals with schizophrenia during verbal tasks?

<p>Lateralization appears disrupted in schizophrenia. (A)</p> Signup and view all the answers

Which of the following best describes the relationship between genetics and environment in schizophrenia?

<p>Genetics and environment synergistically affect the condition. (B)</p> Signup and view all the answers

What is hypofunctionality of the dorsal-lateral prefrontal cortex cited as in schizophrenia?

<p>The orchestra without a conductor metaphor. (D)</p> Signup and view all the answers

What neurochemical changes are generally observed in the frontal cortex of individuals with schizophrenia?

<p>Lower levels of dopamine, glutamate, and GABA. (A)</p> Signup and view all the answers

Which brain dysfunction is primarily involved in negative symptoms of schizophrenia?

<p>Prefrontal cortex dysfunction. (D)</p> Signup and view all the answers

Which of the following statements about dopamine in schizophrenia is accurate?

<p>Dopamine is implicated due to indirect evidence. (D)</p> Signup and view all the answers

What is a notable structural change found in the brains of individuals with schizophrenia?

<p>Enlarged ventricles and decreased size of the temporal lobe. (A)</p> Signup and view all the answers

Which COMT allele is associated with a linkage to schizophrenia?

<p>Valine 108 (D)</p> Signup and view all the answers

What role does Neuregulin play in relation to schizophrenia?

<p>It regulates neuronal differentiation and migration. (D)</p> Signup and view all the answers

What is the effect of increased neuregulin signaling on the NMDA receptor according to current hypotheses?

<p>Reduces its function (D)</p> Signup and view all the answers

Which protein does the DISC1 interact with in the context of schizophrenia?

<p>LIS1 (A)</p> Signup and view all the answers

What is the observed condition regarding the prefrontal cortex (PFC) in brain imaging related to schizophrenia?

<p>Hypofunctionality (C)</p> Signup and view all the answers

In the context of schizophrenia, what is responsible for chromosomal translocation linked to the DISC1 gene?

<p>Familial inheritance (B)</p> Signup and view all the answers

What is primarily noted about the expression of DISC1 during neuronal development?

<p>It is increased. (D)</p> Signup and view all the answers

Which of the following best summarizes the proposed symptoms related to PFC and subcortical systems in schizophrenia?

<p>PFC shows hypofunctionality while subcortical systems exhibit excessive activity. (C)</p> Signup and view all the answers

Flashcards

Schizophrenia

A mental disorder characterized by a fragmentation of cognitive processes and personality, leading to a complex array of symptoms. It often manifests in adolescence and can be triggered by stress, with symptoms appearing and disappearing in episodes.

Auditory Hallucinations in Schizophrenia

Auditory hallucinations, which are often perceived as internal voices or ‘inner speech’, are one of the hallmark positive symptoms of schizophrenia.

Positive Symptoms of Schizophrenia

These are symptoms that are present in individuals with schizophrenia, but are absent in healthy individuals. They include thought disorders, stereotyped behaviours, poverty of affect, cognitive impairment and temporal disorientation.

Negative Symptoms of Schizophrenia

These symptoms are characterized by reductions in normal behaviour. They include poverty of affect (decreased emotional expression), cognitive impairment and temporal disorientation.

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Genetic Basis of Schizophrenia

The concordance rate for monozygotic (identical) twins in schizophrenia around 48% is significantly higher than for dizygotic twins. This suggests that genetic factors play a significant role in the development of schizophrenia.

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Environmental and Genetic Influences on Schizophrenia

Tienari's study showed that children adopted away from 'schizophrenic' mothers had an 8% chance of developing schizophrenia, compared to 1% for children adopted from 'normal' mothers. This suggests that both genetic predisposition and environmental factors contribute to the development of schizophrenia.

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Complexity of Schizophrenia Genetics

The genetic basis of schizophrenia is complex, involving thousands of risk loci. This indicates that multiple genes contribute to the development of schizophrenia, making it challenging to understand the exact mechanisms.

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Schizophrenia as a Pathway Disease

The "pathway disease" concept proposes that schizophrenia is not caused by a single gene, but rather by a combination of genes, environmental factors, and developmental processes that interact in complex ways to create the disorder.

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Schizophrenia as a Synergy

Schizophrenia is not a single condition but arises from a complex interaction between genetic predispositions and environmental triggers.

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What is Schizophrenia?

Schizophrenia is a complex mental disorder where the brain's normal functioning is disrupted, leading to a range of symptoms that affect thinking, behavior, and emotions. People with schizophrenia often have difficulty distinguishing between reality and fantasy.

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Positive Symptoms

Positive symptoms are the additional behaviors or experiences that occur in individuals with schizophrenia, which are not present in healthy individuals.

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Negative Symptoms

Negative symptoms are the absence or reduction of normal behaviors in individuals with schizophrenia. This can include experiencing a flat affect, reduced motivation, and difficulty speaking or initiating social interactions.

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Temporal Lobe and Schizophrenia

The temporal lobe in the brain plays a crucial role in aspects of memory, language processing, and auditory perception. In individuals with schizophrenia, abnormalities in this area are strongly associated with positive symptoms, particularly auditory hallucinations.

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Prefrontal Cortex and Schizophrenia

The prefrontal cortex is a brain region involved in higher-level cognitive functions like executive control, planning, and decision-making. In individuals with schizophrenia, dysfunction in this area is associated with negative symptoms.

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Basal Ganglia and Schizophrenia

The basal ganglia are brain structures involved in motor control and reward processing. Antipsychotic medications, which are used to treat schizophrenia, primarily target this area of the brain.

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Neurochemical Imbalances in Schizophrenia

Dopamine and glutamate are neurotransmitters that play vital roles in various brain functions. In schizophrenia, there are imbalances in these neurotransmitters. Dopamine tends to be increased in the basal ganglia, while glutamate and GABA are diminished in the prefrontal cortex.

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DISC 1 Gene

A protein involved in regulating dopamine levels in the brain. It's implicated in schizophrenia due to disrupted dopamine homeostasis.

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COMT Gene

An enzyme responsible for breaking down dopamine in the brain.

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Neuregulin

A family of proteins that are involved in cell communication, growth, and differentiation. It's implicated in schizophrenia, possibly due to disrupted development and connectivity in the brain.

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Stress-Schizophrenia Relationship

The hypothesis that stress can trigger or contribute to the onset of schizophrenia, especially in individuals with a genetic predisposition.

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Blunted Cortisol Response in Schizophrenia

A phenomenon observed in individuals with schizophrenia, where their cortisol levels, stress hormones, do not respond to stressors as expected.

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Ventricular Enlargement in Schizophrenia

A structural abnormality found in the brains of some individuals with schizophrenia, where the fluid-filled spaces called ventricles are larger than normal. This is thought to reflect a decrease in brain tissue volume.

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Hippocampus in Schizophrenia

A specific area of the brain that is often affected in schizophrenia, showing a reduction in volume. The hippocampus is crucial for memory, learning, and emotional regulation.

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Early Brain Injury Hypothesis in Schizophrenia

The hypothesis that schizophrenia is caused by an early, possibly prenatal, developmental abnormality that affects the brain. This abnormality is not due to degeneration of existing brain tissue, but rather a disruption of normal brain development.

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Dopamine Hypothesis

A theory suggesting that schizophrenia is caused by excessive dopamine activity in specific brain regions like the mesolimbic and mesocortical pathways.

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Dopamine Receptor Antagonist

A class of drugs used to treat psychosis, particularly schizophrenia, by blocking dopamine receptors in the brain.

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Increased DA Turnover with Chlorpromazine

The phenomenon where individuals with schizophrenia show an increase in dopamine metabolites in their cerebrospinal fluid (CSF) after taking antipsychotic medications.

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Discrepancies with the DA Hypothesis

A controversial aspect of the dopamine hypothesis where there is inconsistent evidence supporting higher levels of dopamine or dopamine receptor numbers in individuals with schizophrenia.

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Long Term Changes in Dopaminergic Pathways

The delay observed between when antipsychotic medication is started and when its full therapeutic effect is seen, potentially due to changes in dopaminergic pathways over time.

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DISC1

A genetic factor linked to neuronal migration, its malfunction is associated with lissencephaly, a disorder characterized by smooth brain surface, suggesting a role in brain development and organization.

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Antipsychotics and Dopamine Receptors

Antipsychotic medications, particularly typical ones, work by blocking dopamine receptors, thus reducing dopamine activity in the brain. This is thought to be beneficial in treating schizophrenia symptoms, especially positive ones, as dopamine hyperactivity in certain brain regions is associated with these symptoms.

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Clozapine: An Atypical Antipsychotic

Clozapine, an atypical antipsychotic, has shown promising results in treating schizophrenia, particularly in patients who have failed to respond to traditional antipsychotics. It's valuable in managing a wide range of symptoms and improving patient outcomes.

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Environmental & Genetic Factors in Schizophrenia

Schizophrenia, a complex condition, arises from a combination of environmental and genetic factors. This intricate interplay between nature and nurture shapes an individual's susceptibility to the disorder.

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Catechol-O-methyltransferase (COMT)

An enzyme involved in dopamine metabolism. Its less stable form, methionine 108, is linked to higher synaptic dopamine levels, while the more stable form, valine 108, is associated with schizophrenia and cognitive deficits.

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Disrupted in Schizophrenia 1 (DISC1)

A gene involved in neuronal development and migration. Its disruption is linked to schizophrenia and other psychiatric disorders.

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Hypofunctional Prefrontal Cortex (PFC) Hypothesis

A hypothesis suggesting that schizophrenia arises from a functional imbalance between the prefrontal cortex (PFC) and subcortical dopamine systems. The PFC may be hypoactive, leading to less inhibition of hyperactive subcortical systems.

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Chromosomal Translocation

A chromosomal alteration that can result in DNA breaks and rearrangements. It can lead to gene disruptions, such as the disruption of DISC1.

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DISC1 Interactome

The network of proteins that interact with DISC1 and may be involved in the pathogenesis of schizophrenia.

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Study Notes

Schizophrenia Overview

  • Suicide is the leading cause of premature death in people with schizophrenia.
  • An estimated 10% to 13% of deaths among individuals with schizophrenia are due to suicide.

Topics of Study

  • Symptoms and Causes
  • Antipsychotics and the Dopamine Hypothesis
  • Genetics and Beyond the Dopamine Hypothesis
  • Workshop on an exam question

Learning Outcomes

  • Critically assess neurobiological hypotheses for schizophrenia.
  • Discuss the difficulties in treating schizophrenia.
  • Describe the main drugs used to treat schizophrenia, and their mechanisms of action.
  • Discuss limitations of the drugs used to treat schizophrenia.
  • Outline experimental approaches used to study the neurobiological basis of schizophrenia.
  • Comment on how prospects for understanding and treating schizophrenia could improve in the future.

Schizophrenia Part 1: Symptoms and Causes

  • Swiss psychiatrist Eugen Bleuler (1908) coined the term "fragmentation of cognitive processes and personality" to describe schizophrenia.
  • Schizophrenia often begins in adolescence.
  • Symptoms are complex and varied.
  • Stress can trigger episodes of illness.
  • Episodes of illness frequently occur.

Symptoms of Schizophrenia

  • Positive symptoms: Hallucinations (mainly auditory, "inner speech"), thought disorders, and stereotypical behaviors.
  • Negative symptoms: Poverty of affect, cognitive impairment, and temporal disorientation.

Time Course of Schizophrenia

  • Symptoms of schizophrenia often vary in their onset.
  • Mood symptoms, anxiety, and substance use can be present preceding the onset of the illness.
  • Positive symptoms increase in severity during the progressive phase.
  • Negative symptoms are also apparent and may persist.
  • Cognitive deficits are often evident, remaining stable over the course of the illness.
  • Residual symptoms can include prolonged cognitive issues, and mood disturbances.

Causes of Schizophrenia

  • 1. Genetic: Supported by high concordance rates in monozygotic twins (48%). The genetic basis of schizophrenia is complex, involving thousands of risk loci and their interactions.
    • DISC1 (Disrupted in Schizophrenia 1 gene)
    • COMT (catechol-O-methyl transferase gene)
    • Neuregulin
  • 2. Psychosocial: Adolescent onset, stress can precipitate illness, higher relapse rate in emotionally charged home environments, and blunted cortisol response.
  • 3. Structural Brain Damage: Some studies show ventricular enlargement and decreased volume in the temporal lobe, especially the hippocampus. However, no gliosis, meaning no neurodegenerative changes. (Questions remain about early brain injury, obstetric complications, and developmental abnormalities.)
  • 4. Viral Infection: Higher incidence in patients born in late winter or spring. Hypothesis proposes that exposure to a virus during the second trimester of pregnancy may increase the risk of schizophrenia in the child. This remains a hypothesis and possible mechanisms for this link need further investigation.

Current Understanding

  • Genetic susceptibility plays a role, but the environment can influence the expression of genes.
  • Positive symptoms are linked to the temporal lobe.
  • Negative symptoms are linked to the prefrontal cortex.

Schizophrenia Part II: Neurochemical Imbalances

  • Regional changes: Dopamine and glutamate may be higher in the basal ganglia and dopamine, glutamate, and GABA lower in the frontal cortex.

Schizophrenia Part II: Antipsychotics and the Dopamine Hypothesis

  • Indirect evidence links dopamine to schizophrenia: Reserpine (an antipsychotic) and amphetamines (induce toxic psychosis in susceptible individuals), and L-DOPA (can trigger psychotic episodes).
  • Chlorpromazine, acts as a dopamine receptor antagonist.
    • Chlorpromazine increases dopamine turnover.
  • The dopamine hypothesis proposes that excess dopamine neurotransmission in the mesolimbic and mesocortical regions of the brain contributes to schizophrenia symptoms.

Atypical Antipsychotics

  • More effective against negative symptoms, less sedation.
  • Reduced adverse effects on movement disorders. Atypical antipsychotics include clozapine, quetiapine, olanzapine, risperidone, aripiprazole, asenapine, and paliperidone.

Site of Brain Dysfunction

  • 1. Limbic Structures: (e.g. temporal lobe) decreased in size & increased activity in some parts.
  • 2. Dominant Cerebral Hemisphere: Dysfunction in the left hemisphere(e.g. Broca's area), influencing verbal function.
  • 3. Prefrontal Cortex: Underfunction, "Orchestra without a conductor" impairment.
  • 4. Basal Ganglia: Site of action for antipsychotics.

Summary of Recent Advances

  • Evidence for involvement of the prefrontal cortex and subcortical dopamine function in positive and negative symptoms of schizophrenia.

Conclusions on Schizophrenia Research

  • Increase understanding of the genetic basis of the disorder and mechanisms for the illness.
  • Inform development of new models and improved treatments for schizophrenia.
  • Understanding the complex interaction between environmental and genetic factors that may exacerbate the disorder.
  • Aim for early, accurate diagnosis.
  • Develop treatments that mitigate the disorder's impact on patients.

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