Exam 19: Schizophrenia: Antipsychotic Drugs
Which findings in rat experiments support glutamate signaling involvement in the positive symptoms of schizophrenia?
D
The genetic basis of schizophrenia has been explored by family studies, twin studies, linkage studies, searching for candidate genes, and using the microarray technique. Describe evidence from three of these research areas.
In the general population, the incidence of schizophrenia is approximately 1%. Both family studies and twin studies show that there is a significant genetic component for inheriting schizophrenia. First-degree relatives have an average lifetime risk 12 times higher (6-17%) than the general population. More distant (second-degree) relatives risk is still higher than the general population (average incidence of approximately 4% higher than the general population). Comparisons of monozygotic twins to dizygotic twins provide further confirmation of the role of genetics. Dizygotic twins (that share the same proportion of genes as siblings but also share the same prenatal and usually postnatal environment) have a concordance rate of 17%. Identical twins (or monozygotic) who share virtually all of their genes have a 48% concordance rate. These studies provide a compelling argument for the role of genes, although there is also a role for environment, otherwise the concordance rate would be markedly higher. Linkage studies look for similarities in the loci in families with affected members and some of these have been identified as possible sites that increase the risk for developing schizophrenia.
How has schizophrenia been treated in the past? What happened in the 1950s to change this situation? Describe the typical course of schizophrenia, and indicate how patients are treated today.
Prior to the introduction of antipsychotics in the 1950s, patients with schizophrenia were typically hospitalized. With the introduction of the first antipsychotics, hyperactivity, manic symptoms, and positive symptoms disappeared for many people who were then released from the hospital. Possible outcome is often discussed in terms of the "law of thirds": one-third of patients treated with antipsychotics show excellent response to the drug and may not ever need hospitalization even if they discontinue their medicine; one-third show improvement in symptoms but may experience relapse that requires hospitalization again from time to time; and one-third shows reduced recovery and may spend a considerable amount of time hospitalized.
Cite evidence that shows that the traditional neuroleptics exert their clinical effects on the dopamine system, specifically dopamine receptors. Describe the homeostatic changes at the synapse that most likely account for the therapeutic effectiveness.
Abilify (aripiprazole) can simultaneously decrease DA receptor activation in some brain regions and increase it in others, and this drug is classified as a(n)
Which of the following does not support the dopamine hypothesis of schizophrenia?
The most consistent functional abnormality in the brains of individuals with schizophrenia is
Which of the following was an important finding of CATIE, a blinded controlled study comparing multiple antipsychotics to replicate "real-world" prescriptions to a representative patient population?
One way that parkinsonian side effects from antipsychotic medications can be treated is
According to the positive/negative symptom classification scheme for schizophrenia,
List the four major dopamine pathways in the brain and identify the antipsychotic drug side effects associated with each. In general, how do doctors manage side effects when prescribing drugs for patients with schizophrenia?
Polymorphisms in the _______ gene, which codes for proteins _______, are associated with a higher probability of schizophrenia.
Prenatal inflammation models such as maternal exposure to polyI:C during pregnancy results in _______ in hippocampal neurogenesis.
Describe two structural and two functional abnormalities that have been reported in schizophrenia.
Which of the following is evidence for a possible role for glutamate in symptoms of schizophrenia?
Why are selective D2 receptor antagonists like sulpiride not usually a first choice as antipsychotic agents?
Which statement regarding broad-spectrum antipsychotics is false?
Which of the following is an advantage of clozapine in the treatment of schizophrenia?
Which of the following is a neuroendocrine side effect of the traditional antipsychotic medications?
Which statement regarding the diagnosis of schizophrenia is false?
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