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Summary Nursing 660 Exam 1 Study Guide Notes Review
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Nursing 660 Exam 1 Study Guide Notes Review
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Nursing 660 Exam 1 Study Guide Notes Review●Identify the different brain regions that are affected in schizophrenia
and psychosis and how these effects translate into signs and symptoms of schizophrenia/psychosis.
○Mesolimbic - positive symptoms - malfunctioning mesolimbic
○Mesocortical/prefrontal (also nucleus accumbens ‘reward circuits’) - negative symptoms - malfunctioning mesocortical/prefrontal, nucleus accumbens (nucleus accumbens may also be involved in increased rate of substance abuse and abuse seen in patients with schizophrenia
○Ventromedial prefrontal cortex - affective symptoms
○Orbitofrontal cortex (also amygdala) - aggressive symptoms - d/t abnormal information processing in orbitofrontal cortex and amygdala; aggressive symptoms are hypothetically associated with impairment in impulse control
○Dorsolateral prefrontal cortex - cognitive symptoms - d/t abnormal information processing in dorsolateral prefrontal cortex
●Know the positive and negative symptoms of schizophrenia, where they
originate from, and what medications treat these symptoms.
○Positive symptoms : these are psychotic behaviors that are not generally seen in healthy individuals. Those with positive symptoms may lose touch with some aspects of reality. Symptoms: delusions, hallucinations, thought disorders (unusual or dysfunctional ways of thinking), movement disorder (agitated body movements)
i.Origin : Arising from the mesolimbic dopamine pathway (Positive symptoms of schizophrenia are hypothetically modulated by malfunctioning mesolimbic circuits)
ii.Delusions, Hallucinations, Distortions or exaggerations in
language and communication, Disorganized speech,
Disorganized behavior, Catatonic behavior, and Agitation
iii.Medications that treat positive symptoms: antipsychotics (i.e. Risperidone; Quetiapine;
Ziprasidone, etc.)
○Negative symptoms : disruptions to normal emotions and behaviors.
Characterized by: flat affect, reduced feelings of pleasure in
everyday life, difficulty beginning and sustaining activities,
decreased communication.
i.Origin : Arising from the mesocortical dopamine pathway (Negative
symptoms are hypothetically linked to malfunctioning mesocortical circuits and may also involve mesolimbic regions such as the nucleus accumbens).
ii.Medications that treat negative symptoms: Vraylar, Amisulpride iii.Types :
1.Alogia – Poverty of speech; e.g., talks little, uses few words 2.Affective blunting – Reduced range of emotions
(perception, experience and expression); e.g., feels
numb or empty inside, recalls few emotional
experiences, good or bad
3.Asociality – Reduced social drive and interaction; e.g., little sexual interest, few friends, little interest in spending time with (or little time spent with) friends
4.Anhedonia – Reduced ability to experience pleasure; e.g., finds previous hobbies or interests unpleasurable
5.Avolition – Reduced desire, motivation, persistence; e.g., reduced ability to undertake and complete everyday tasks; may have poor personal hygiene
●Identify the emerging neurobiological hypothesis of schizophrenia.
-In untreated schizophrenia, the mesolimbic pathway is hypothesized to be hyperactive, resulting in excess dopamine at the synapse, which leads to positive symptoms such as delusions and hallucinations. All known antipsychotic drugs capable of treating positive psychotic symptoms are blockers of the D2 receptor. These observations have been formulated into a theory of psychosis sometimes referred to as the “dopamine hypothesis of schizophrenia.” A more precise modern designation is the “mesolimbic dopamine hypothesis of positive symptoms of schizophrenia,” since it is believed that it is hyperactivity
specifically in this particular dopamine pathway that mediates the positive symptoms of psychosis. Hyperactivity of the mesolimbic dopamine pathway hypothetically accounts for positive psychotic symptoms whether those symptoms are part of the illness of schizophrenia or of drug-induced psychosis, or whether they are positive psychotic symptoms accompanying mania, depression, or dementia.
Hyperactivity of mesolimbic dopamine neurons may also play a role in
aggression and hostile symptoms in schizophrenia and related illnesses. It is not known what causes this mesolimbic dopamine hyperactivity, but current theories state that it is the downstream consequence of dysfunction in the prefrontal cortex and hippocampal glutamate activity.
-A major current hypothesis for the cause of schizophrenia proposes
that glutamate activity at N-methyl-d-aspartate (NMDA) receptors is hypofunctional due to abnormalities in the formation of glutamatergic NMDA synapses during neurodevelopment.
●Identify the different dopamine pathways and what role each pathway
plays in relation to schizophrenia/psychosis and treatment.
○Brain imaging shows cerebral atrophy and enlarged fluid filled
ventricles, as well as shrinkage in prefrontal cortex, temporal, basal
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