Schizophrenia Overview and Symptoms
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Questions and Answers

What is a characteristic feature of delusions in schizophrenia?

  • Sensory experiences without real external stimuli
  • Lack of response to external stimuli
  • False, irrational beliefs inconsistent with cultural reality (correct)
  • Confused and incoherent speech

    • Which neurotransmitter dysregulation is primarily associated with positive symptoms of schizophrenia?

  • Dopamine hyperactivity (correct)
  • Glutamate deficiency
  • Serotonin imbalance
  • Norepinephrine excess

    • Which of the following best describes negative symptoms of schizophrenia?

  • Vivid hallucinations and disorganized thoughts
  • Increased motivation and goal-directed behavior
  • Decreased emotional expression and social engagement (correct)
  • Enhanced sensory perception and euphoria

    • Which factor is NOT considered part of the multifactorial etiology of schizophrenia?

    <p>Prolonged exposure to sunlight</p> Signup and view all the answers

    What type of behavior might someone with disorganized or catatonic behavior exhibit?

    <p>Repetitive and bizarre actions, or lack of movement</p> Signup and view all the answers

    What is a common self-management challenge reported by individuals with schizophrenia?

    <p>Apathy and lack of motivation</p> Signup and view all the answers

    Which of the following neurotransmitter imbalances is least associated with the pathophysiology of schizophrenia?

    <p>Adrenaline excess</p> Signup and view all the answers

    Which statement accurately reflects the incidence of schizophrenia in the general population?

    <p>Affects 1% of the population</p> Signup and view all the answers

    What is primarily associated with dopaminergic hyperactivity in the mesolimbic pathway?

    <p>Positive symptoms</p> Signup and view all the answers

    Which antipsychotic drug class primarily targets D2 receptors?

    <p>Typical antipsychotics</p> Signup and view all the answers

    Which effects are associated with the mesocortical dopaminergic pathway?

    <p>Negative symptoms and cognitive deficits</p> Signup and view all the answers

    What is a common side effect of typical antipsychotics related to the nigrostriatal pathway?

    <p>Extrapyramidal symptoms</p> Signup and view all the answers

    Which of the following drugs exemplifies a typical antipsychotic?

    <p>Haloperidol</p> Signup and view all the answers

    What impact do atypical antipsychotics have on the treatment of schizophrenia symptoms?

    <p>Address both positive and negative symptoms with less motor side effects</p> Signup and view all the answers

    What condition is commonly linked to the blockade of D2 receptors in the tuberoinfundibular pathway?

    <p>Hyperprolactinemia</p> Signup and view all the answers

    Which of the following best describes NMDA receptor hypofunction in schizophrenia?

    <p>Contributes to both positive and negative symptoms as well as cognitive dysfunction</p> Signup and view all the answers

    What is one of the significant drawbacks of antipsychotic treatment related to patient response?

    <p>30% of patients do not respond to treatment</p> Signup and view all the answers

    Which side effect is specifically associated with typical antipsychotics due to D2 receptor blockage in the nigrostriatal pathway?

    <p>Extrapyramidal symptoms</p> Signup and view all the answers

    What is a common endocrine side effect of blocking D2 receptors in the tuberoinfundibular pathway?

    <p>Galactorrhea</p> Signup and view all the answers

    How do atypical antipsychotics differ from typical antipsychotics in terms of receptor action?

    <p>They act on both D2 and serotonin 5-HT2A receptors</p> Signup and view all the answers

    Which of the following is NOT a side effect commonly associated with typical antipsychotics?

    <p>Apathy</p> Signup and view all the answers

    What mechanism allows atypical antipsychotics to mitigate the risk of extrapyramidal side effects?

    <p>Partial blockade of D2 receptors</p> Signup and view all the answers

    What potential effect can abrupt cessation of antipsychotic medication cause?

    <p>Psychotic episode</p> Signup and view all the answers

    Which potential outcome is associated with typical antipsychotic drugs due to their cardiac effects?

    <p>Pro-arrhythmic effects</p> Signup and view all the answers

    What is a significant advantage of second-generation antipsychotic drugs compared to first-generation antipsychotic drugs?

    <p>They are more effective in treating negative symptoms.</p> Signup and view all the answers

    Which of the following is NOT a common side effect associated with second-generation antipsychotic drugs?

    <p>Extrapyramidal symptoms</p> Signup and view all the answers

    What is the primary reason for combining antipsychotic drugs with antimuscarinic agents?

    <p>To improve the side effect profile.</p> Signup and view all the answers

    What is a serious potential outcome of antipsychotic malignant syndrome?

    <p>Death from renal or cardiovascular failure</p> Signup and view all the answers

    Which of the following pharmacokinetic aspects is associated with antipsychotic drugs?

    <p>Depot preparations lasting 2–4 weeks after IM injection.</p> Signup and view all the answers

    Which drug is effective against the negative symptoms of schizophrenia but can lead to agranulocytosis?

    <p>Clozapine</p> Signup and view all the answers

    In the management of violent patients with hyperactive psychotic states, which option is frequently administered intramuscularly at a lower dose compared to oral administration?

    <p>Chlorpromazine</p> Signup and view all the answers

    Which of the following describes a common anticholinergic side effect of antipsychotic drugs?

    <p>Blurred vision</p> Signup and view all the answers

    Study Notes

    Schizophrenia

    • Chronic and complex psychiatric disorder that affects how a person thinks, perceives reality, manages emotions, and interacts with others.
    • Affects young people and is often chronic and disabling
    • Affects 1% of the population

    Symptoms of Schizophrenia

    • Delusions: False, irrational beliefs not shared by cultural reality (e.g., persecution, special powers)
    • Hallucinations: Sensory experiences without external stimulus, typically auditory (hearing voices)
    • Disorganized thinking: Confused, incoherent speech or difficulty organizing thoughts logically
    • Disorganized or catatonic behavior: Unpredictable, bizarre, or repetitive behaviors (lack of response to stimuli to hyperactivity)
    • Negative symptoms: Diminished emotional and social capabilities (apathy, flat affect, social withdrawal, lack of motivation)
    • Other symptoms: Anxiety, guilt, depression, self-punishment, suicide attempts (50% of cases), difficulty with "selective attention".

    Etiology of Schizophrenia

    • Multifactorial disorder
    • Genetics: Strong familial predisposition
    • Environmental factors: Perinatal complications, viral infections during pregnancy, early psychological trauma
    • Neurobiology: Dysregulation in the dopaminergic system and neurotransmitter imbalances

    Dopaminergic Dysregulation in Schizophrenia

    • Hyperactivity of dopamine transmission in the mesolimbic pathway causes positive symptoms (hallucinations, delusions).
    • Dopaminergic hypoactivity in the mesocortical pathway is linked to negative symptoms (flat affect, anhedonia) and cognitive deficits.

    Glutamate Dysregulation in Schizophrenia

    • Hypofunction of NMDA (N-methyl-D-aspartate) receptors, particularly in the prefrontal cortex and hippocampus.
    • Reduced NMDA receptor activity contributes to positive and negative symptoms, as well as cognitive dysfunction.

    Dopaminergic Pathways Relevant to Antipsychotics

    • Mesolimbic pathway: Involved in emotional regulation and motivation. Hyperactivity in this pathway is linked to positive symptoms. Antipsychotics reduce hyperactivity, alleviating hallucinations and delusions.
    • Mesocortical pathway: Associated with cognitive and affective functions. Dopamine hypoactivity is linked to negative symptoms and cognitive deficits. Atypical antipsychotics may improve symptoms through serotonergic modulation.
    • Nigrostriatal pathway: Controls motor function. D2 receptor blockade in this pathway leads to extrapyramidal side effects (EPS).
    • Tuberoinfundibular pathway: Regulates prolactin secretion. D2 receptor blockade here increases prolactin levels, causing hyperprolactinemia (menstrual disturbances, galactorrhea, sexual dysfunction).

    Antipsychotic Drugs

    • Two groups:
      • First generation (typical or conventional): Primarily block D2 receptors, reducing positive symptoms but often causing significant motor side effects. (Chlorpromazine, Haloperidol, Fluphenazine, Flupentixol, Clopentixol)
      • Second generation (atypical): Block both D2 and 5-HT2A receptors, offering a more balanced treatment of positive and negative symptoms with a lower risk of EPS, but carry a risk of metabolic issues. (Clozapine, Risperidone, Sertindole, Quetiapine, Amisulpride, Aripiprazole, Zotepine, Ziprasidone)

    Current Treatment for Schizophrenia: Drawbacks

    • Not all patients respond (30% do not).
    • Most are ineffective in relieving negative and cognitive impairments.
    • Wide variety of side effects: Extrapyramidal motor, endocrine, and sedative effects.
    • May shorten survival due to cardiac (pro-arrhythmic) effects.
    • Abrupt cessation can lead to psychotic episode.

    Mechanism of Action of Typical Antipsychotics

    • Block D2 receptors in the dopaminergic system, reducing positive symptoms of schizophrenia (hallucinations, delusions)
    • Blocking D2 receptors in other pathways, such as the nigrostriatal pathway, can lead to EPS (rigidity, bradykinesia, tremors)
    • Blocking D2 receptors in the tuberoinfundibular pathway can cause hyperprolactinemia (increased prolactin levels, leading to galactorrhea and sexual dysfunction)

    Adverse Drug Reactions (ADRs) of Typical Antipsychotics

    • Severe EPS: Acute dystonia, akathisia, tardive dyskinesia, and parkinsonism
    • Sedation
    • Weight gain
    • Galactorrhea and sexual dysfunction
    • Hypotension, due to blocking other receptors (e.g., H1, α1, M1)

    Mechanism of Action of Atypical Antipsychotics

    • Act on a wider range of receptors, less likely to cause EPS
    • Block both D2 and 5-HT2A receptors
    • Blockade of 5-HT2A receptors in the prefrontal cortex helps reduce negative symptoms and cognitive deficits.
    • Modulates dopamine activity in other pathways, minimizing the risk of EPS
    • Partial D2 receptor blockade reduces positive symptoms while minimizing dopamine blockade in other pathways.

    Advantages of Atypical Antipsychotics

    • Cause fewer EPS and have a lower risk of tardive dyskinesia
    • More effective in treating negative symptoms and cognitive impairments than first-generation drugs

    ADRs of Atypical Antipsychotics

    • Metabolic syndrome (weight gain, hyperglycemia, dyslipidemia)
    • Anticholinergic effects (dry mouth, constipation, blurred vision)
    • Risk of QT prolongation (alteration in cardiac electrical activity)

    Effect of Antipsychotics on Muscarinic Receptors

    • Some antipsychotics are also muscarinic antagonists.
    • Blocking D2 receptors enhances overproduction of acetylcholine and muscarinic activation.
    • Combining antipsychotics with antimuscarinic drugs may improve the side effect profile.
    • Side effects: Constipation, dry mouth, blurred vision

    Other Side Effects of Antipsychotics

    • Jaundice
    • Antipsychotic malignant syndrome: Muscle rigidity, rapid increase in body temperature and mental confusion, usually reversible, but death from renal or cardiovascular failure occurs in 10-20% of cases

    Pharmacokinetics of Antipsychotics

    • At least 40% of schizophrenic patients fail to take drugs as prescribed.
    • Acute toxicity of antipsychotic drugs is slight.
    • Plasma half-life: 15-30h, can be given orally or by intramuscular (IM) injection in urgent situations.
    • Slow-release (depot) preparations are available. IM injection provides 2-4 weeks of action.

    Clinical Uses of Antipsychotics

    • Behavioural emergencies: Control hyperactive psychotic states (Chlorpromazine, Haloperidol, Olanzapine, Risperidone). IM dose is lower than oral dose.
    • Schizophrenia: First-generation antipsychotic drugs, depot injections (e.g., Flupentixol decanoate) for better compliance, newer antipsychotic drugs, Clozapine (can cause agranulocytosis, effective against negative features of schizophrenia).

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    Description

    Explore the chronic psychiatric disorder known as schizophrenia, which significantly influences how individuals think and perceive reality. This quiz covers the common symptoms, including delusions, hallucinations, and disorganized behavior, providing insight into its complex nature and impact on young people.

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