Schizophrenia

• Positive symptoms
• Negative symptoms

• Thought disorder
• Hallucinations
• Delusions

• Social withdrawal
• Lack of affect
• Reduced motivation

• Is it genetic?
• What do twin studies tell us?

• Is schizophrenia a recessive gene?

• Too much or too little dopamine?
• Parkinson's patients
• Amphetamine psychosis

• Projects from ventral tegmentum area
• to nucleus accumbens
• to amygdala

• first antipsychotic
• dopamine receptor blocker
• does it work on both positive and negative symptoms?

• Blocks D4 receptors in the nucleus accumbens
• Very expensive
• But very effective for treatment-resistant patients
• Must have regular blood work to monitor for fatal blood disease

• Involuntary movements of face, neck, hands, or trunk
• Caused by supersensitivity of neurons in neostriatum (D2 receptors)
• Clozapine doesn't cause tardive dyskinesia - Why?

• Which months?
• Why?
• Is it more likely in urban or rural populations?
• Why?

• Farther from the equator, more or less schizophrenia?
• Why?

• Refeeding after a thiamine deficiency,
• Particularly during the 2nd trimester

• Direct effect?
• Or suppression of immune system?
• What was the study?

• Home movies
• Schizophrenics as children showed more negative affect and abnormal movements

• Larger ventricles in twin with schizophrenia
• Mono- vs. Dichorionic
• Fingerprints and palm lines

• Associated with positive or negative symptoms?
• Wisconsin Card Sorting Test
• Hypofrontality

• MZ twins 40%
• DZ twins 11% concordance rate

• monoamine oxidase inhibitors
• problem?

• tricyclic antidepressants
• selective serotonin reuptake inhibitors

• Reserpine, a monoamine antagonist, works how?
• Reserpine causes depression
• it also makes noradrenergic beta receptors supersensitive

• low levels of metabolite of serotonin found in CSF of suicide attempters, particularly those who made violent attempts
• activity of serotoninergic systems appears to inhibit aggression

• restricting tryptophan in the diet for 24 hours in depressed patients, then giving amino acid cocktail, resulted in increased depressive symptomatology
• Why?

• They appear to result in subsensitivity
• caused by decrease in number of postsynaptic noradrenergic beta receptors
• So, decreased amounts of a neurotransmitter may result in supersensitivity (more receptors)
• and increased amounts of the neurotransmitter may result in subsensitivity (fewer receptors)

• effective
• for treatment-resistant patients
• unilateral electrode placement results in less amnesia
• also results in subsensitivity at a faster rate than medications

• depressed people have more shallow sleep-stage 1
• less slow wave (stages 3 & 4)
• wake up more
• less REM latency
• more rapid eye movements during REM

• REM sleep deprivation or total sleep deprivation
• antidepressants suppress REM sleep

• most often in winter, but can occur in summer
• role of zeitgebers
• phototherapy

• MZ twins 72%
• DZ twins 14% concordance rate
• Treatment: lithium