1) What are the hallmark symptoms of schizophrenia?
Its hallmark symptoms are psychotic symptoms such as auditory hallucination (hear voices) and delusion.
2) What are the positive symptoms and negative symptoms of schizophrenia?
- Thought disorder (disorganized thinking)
- Movement disorder (agitated body movement & repeated movement)
- Disruption of normal emotion and behaviour (can be mistaken for depression)
- “Flat affect” (a person’s face does not move or talks in a dull/monotonous voice)
- Lack of pleasure in everyday life
- Neglect basic personal hygiene (may seem lazy or unwilling to help themselves)
3) What is the incidence of schizophrenia?
- 1% worldwide
4) What is the evidence that there’s a genetic component to vulnerability for schizophrenia?
- Have genetic component (if one twin have it, the other twin have 60% of getting it)
- Immediate biological relatives have 10 times greater risk than the general population
5) What is the evidence that there may be a prenatal influence?
- Delivery complications
- Born during winter months
- Epidemic (mothers who have flu during the second trimester / influenza virus)
- Malnourished mothers / Mothers in a famine state
6) There’s no sex difference in the overall incidence of schizophrenia. There are important sex
difference in timing, prognosis, and symptoms. What are these sex differences?
- Men: 18 – 25 / Women: 25 – 35 or over 40
- Men are said to have a higher chance of getting it
- Men: Higher presence of negative & disorganised symptoms
- Women: Higher prevalence of affective symptoms (lack or decline in emotional response)
7) What is the neurodevelopment hypothesis for schizophrenia? Evidence?
- Schizophrenia is caused by developmental abnormalities in the nervous system during the prenatal or
- Rh-negative mother with Rh-positive baby has twice the rate of schizophrenia for second and later
o E.g. blood type o+ positive = Rh = Tell us the type of protein in the red blood cells o APositive = “A” protein & Rh factor /ANegative = “A” protein only
o If mum isA+ and baby is A-, the body immune system would learnt to attack the Rh-factor of
the second baby with the Rh-factor which increase the chance of getting this disorder
8) What is the dopamine hypothesis for schizophrenia?
a. What is the evidence for it?
- It predict that schizophrenia is caused by too much dopamine
o Help with schizophrenia positive symptom
o Kill the dopamine in the subtantia nigra
o Dopamine receptor antagonist
9) What is the glutamate hypothesis?
a. What’s the evidence for it?
- Hypofunction of glutamatergic signaling via NMDAreceptors.
(Too little or too much glutamate in the prefrontal cortex lead to schizophrenia)
- Produce positive and negative symptoms of schizophrenia
o Hypotheses: since it cause both positive and negative effect, it could be the fundamental
cause of this disorder which pass to the dopamine
o E.g. PCP (angel dust) = Users behave similar to schizophrenia but it is drug induced
10)Are these three hypotheses mutually exclusive? Explain.
11)How is schizophrenia treated?
- Antipsychotic medication
o Chlorpromazine (Thorazine)
Kill the dopamine in the subtantia nigra
Dopamine receptor antagonist
Have some sort of brain damage related to thorazine
Have motor issue when used in long term
o Ritalin (methylphenidate)
Block dopamine transporter
- Therapy can help to cope with illness
12)Which drugs mimic the symptoms of schizophrenia? How?
Phencyclidine (PCP), also known as angel dust.
- Exhibit hallucination and neurotoxic effects - It is an NMDAantagonist as it binds to the D1 receptor (a sub-unit of DAT – dopamine transporter)
13) Know and understand Figures 15.9 and 15.11.
14) What are the symptoms of major affective disorder?
Major Depressive Disorder
- Sadness and helplessness for a long period of time
- Low energy, feel worthless, little pleasure from sex or food (anhedonia)
- Contemplate suicide
- Sleep disorder, inability to concentrate
- Usually is episodic
15) What are the symptoms of bipolar disorder?
- Behaviour alternates between depression and mania
o Restless activity, excitement, laughter, self-confidence, rambling speech and loss of inhibition
- 2 types:
o Bipolar l – Full blown episodes of mania
o Bipolar II – Milder agitation and anxiety
Hard to differentiate with depression
16) How is unipolar depression treated?
- Unipolar depression only have symptoms at one end of the spectrum
o ECT (electroconvulsive therapy)
a. MAOIs, ECT, Tricyclic, SSRIs, SNRIs
i. How do each of these affect the synapse?
MAO inhibitors (MAOIs)
- Block breakdown of serotonin and catecholamines
- Used as last resort:
o For people who do not respond to tricyclics
- Must avoid tyramine (amino acid) – works with MAOIs to increase blood pressure which could be
- Block the reuptake of serotonin (5-HTT – serotonin transporter) o More serotonin in the synapse for a longer period
o Serotonin are released but unable to be reuptake Gets diffused away Decrease in the
serotonin “storage pool”
- Mild side effects – sexual side effect
o Does not matter at the beginning of the treatment as patients have no interest in sex but it will
matter as mood starts to return
- Increase nervousness, contraindicated for patients suffering from both depression and anxiety
SNRI (Serotonin and norepinephrine reuptake inhibitors)
- An antidepressant drug that specifically inhibits the reuptake of norepinephrine and serotonin
without affecting the reuptake of other neurotransmitters
- Starting to be more commonly used in clinic
- It is stable in adults but less unstable in children and adolescent
ECT – electroconvulsive therapy
- However, it works for depression and is used again:
o Uses less intense shock as too much ECT can cause brain damage
o Used for those who do not response to drugs
o Have short term effect and must be followed with drugs or ongoing ECT to prevent relapse