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\author{Shelbi (kfisher17)}
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  /Title (pathophysiology-of-schizophrenia.pdf)
  /Creator (Cheatography)
  /Author (Shelbi (kfisher17))
  /Subject (Pathophysiology of Schizophrenia Cheat Sheet)
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Pathophysiology of Schizophrenia Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Shelbi (kfisher17)} via \textcolor{DarkBackground}{\uline{cheatography.com/79317/cs/21868/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Shelbi (kfisher17) \\
  \uline{cheatography.com/kfisher17} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 24th February, 2020.\\
   Updated 24th February, 2020.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\begin{tabularx}{8.4cm}{X}
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Psychosis}}  \tn
% Row 0
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\mymulticolumn{1}{x{8.4cm}}{A symptom of mental illness characterized by the loss of contact with reality} \tn 
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\mymulticolumn{1}{x{8.4cm}}{Manifestations: hallucinations, disorganized thoughts and speech, emotions exhibited in an abnormal manner} \tn 
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\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Causes of psychosis \newline • Functional: schizophrenia, manic phase of bipolar disorder, psychotic depression \newline • Organic: Alzheimer's disease and other causes of dementia, brain tumors \newline • Drug abuse: cocaine, amphetamine, PCP ("angel dust")}  \tn 
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\begin{tabularx}{8.4cm}{x{2.56 cm} x{5.44 cm} }
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Epidemiology}}  \tn
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Lifetime prevalence & 1\% in US and worldwide \tn 
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Onset & Most commonly in young adults \tn 
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Sex & Equally prevalent in men and women \tn 
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Frequency & More frequent in people born in cities and born between January and April and in the northern hemisphere \tn 
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Suicide & \textasciitilde{} 15\% \tn 
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\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Structural Abnormalities}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Decreased cortical thickness in the absence of gliosis}} & ⇨ Gliosis (proliferation of the glial cells) occurs as a compensatory change in the degenerative disease in the brain (typically happens later in life) \tn 
% Row Count 8 (+ 8)
% Row 1
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{\bf{Reduction in volume of the frontal lobe, medial temporal lobe, thalamic and hippocampus}} & ⇨ increased ventricular size \tn 
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\mymulticolumn{2}{x{8.4cm}}{{\bf{Decreased blood flow and glucose metabolism in the frontal lobe and left temporal lobe}}} \tn 
% Row Count 15 (+ 2)
% Row 3
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{\bf{Abnormal (excessive) synaptic pruning}} & ⇨ decreased number of glutamanergic dendritic spines in PFC in individuals with schizophrenia \tn 
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 & ⇨ Synaptic Pruning: the process of synapse elimination that occurs between age 2 and onset of puberty \tn 
% Row Count 26 (+ 6)
% Row 5
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\mymulticolumn{2}{x{8.4cm}}{{\bf{Multiple NT systems interact in a particular way to cause the signs and Sx of SZ}}} \tn 
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% Row 6
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{\bf{Functional abnormalities are related to alterations in:}} & Dopamine, Glutamate, Serotonin \tn 
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\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{New Research: a person's risk of schizophrenia is increased if they inherit specific variants in a gene related to synaptic pruning}} \newline {\emph{⇨ {\bf{Complement Component 4 (C4)}}: plays a role in the immune system, as well as brain development}}}  \tn 
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Pathogenesis of SZ | {\bf{DOPAMINE}}}}  \tn
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\seqsplit{Hypothesis} & SZ results from dysregulation of the mesolimbic and mesocortical pathways \tn 
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Reasons & Drugs that block dopamine receptors are used in the Tx of SZ \tn 
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 & Drugs that increase dopaminergic activity (ie. amphetamines) can cause psychosis \tn 
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Pathogenesis of SZ | {\bf{SEROTONIN}}}}  \tn
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\mymulticolumn{1}{x{8.4cm}}{▶ Serotonergic neurons originate in the raphe nuclei and project extensively to all regions of the cortex, basal ganglia, limbic system, hypothalamus, cerebellum and brain stem} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{▶ {\bf{High density of 5-HT-2A receptors in the cerebral cortex}} ⇨ {\bf{5-HT-2A Receptors modulate the release of DA, glutamate, NE, GABA, and ACh}} ⇨ regulation of cognitive processes, working memory, and attention} \tn 
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% Row 2
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\mymulticolumn{1}{x{8.4cm}}{Serotonin 5-HT-2A receptor blockers ({\emph{2nd generation antipsychotic agents}}) are used in the Tx of SZ} \tn 
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\mymulticolumn{1}{x{8.4cm}}{▶ = NORMAL}  \tn 
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Clinical Manifestations}}  \tn
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\seqsplit{Definition} & a chronic disorder of thought and affect with the individual having a {\emph{significant disturbance}} in interpersonal relationships and {\emph{ability to function}} in society on a daily basis \tn 
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% Row 1
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\seqsplit{Symptomology} & Often occur in {\bf{cycles}}, alternating periods of improvement ({\bf{remissions}}) with periods of psychosis ({\bf{relapses}}) \tn 
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 & During acute psychotic episodes, the pt loses touch with reality \tn 
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 & Impaired psychosocial functioning during remissions \tn 
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\mymulticolumn{2}{x{8.4cm}}{Although the course of illness is variable, the long-term prognosis is poor} \tn 
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% Row 5
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\mymulticolumn{2}{x{8.4cm}}{{\emph{Grouped into positive, negative, and cognitive symptoms}}} \tn 
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Positive & Delusions (often paranoid) \tn 
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 & Hallucinations (most often auditory) \tn 
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 & Thought Disorder (disorganized speech, loose associations) \tn 
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Negative & Poverty of speech and speech content \tn 
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 & Flattening of emotional responsed \tn 
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% Row 11
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 & Withdrawal from social contacts \tn 
% Row Count 30 (+ 2)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Clinical Manifestations (cont)}}  \tn
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\seqsplit{Cognitive} & Impaired attention, working memory, and executive function \tn 
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\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Positive sx correlate with abnormalities in limbic pathways in the brain \newline ⇨ Hyperactivity of Mesolimbic DA pathways ⇨ positive sx \newline  \newline Negative and cognitive sx can be associated with prefrontal lobe dysfunction \newline ⇨ hypoactivity of mesocortical DA pathway ⇨ negative and cognitive sx \newline  \newline Positive sx typically respond to tx, while negative and cognitive sx often persist and contribute to chronic disability}  \tn 
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\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{{\bf{Negative Symptoms}}}}  \tn
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{\bf{Alogia \& Poverty of Speech}} & May speak very little or speech may have little meaningful content \tn 
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% Row 1
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 & May have long delays between words and sentences, as if the connections between thoughts and speech were interrupted or blocked \tn 
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{\bf{Flattening or blunting of affect}} & May have reduced emotional expression \tn 
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 & May not smile or frown in response to happy or sad events \tn 
% Row Count 16 (+ 3)
% Row 4
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 & Their voices may not change tone or pitch \tn 
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% Row 5
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 & May not maintain eye contact or other kinds of emotional links with other people \tn 
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% Row 6
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{\bf{Anhedonia and Avolition}} & May seem to lose interest in and energy for pleasurable activities and achievements \tn 
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% Row 7
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 & Avolition = lack of desire, drive, or motivation to pursue meaningful goals \tn 
% Row Count 32 (+ 4)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{{\bf{Negative Symptoms}} (cont)}}  \tn
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{\bf{Catatonia and Posturing}} & May seem to freeze into unusual body positions or stop moving entirely \tn 
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 & Catatonic pt's will sometimes hold rigid poses for hours and will ignore any external stimuli \tn 
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 & May also show stereotyped, repetitive movements \tn 
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\mymulticolumn{2}{x{8.4cm}}{{\bf{COGNITIVE SYMPTOMS}}} \tn 
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{\bf{Lack of Motivation and Social Withdrawal}} & Contribute to poor-self care skills, difficulties maintaining employment, and living independently \tn 
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{\bf{Impaired Attention}} & Trouble focusing or paying attention \tn 
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{\bf{Impaired Working Memory}} & Ability to use information immediately after learning it \tn 
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% Row 15
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{\bf{Poor executive function}} & Ability to understand information and use it to make decisions \tn 
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\mymulticolumn{2}{x{8.4cm}}{{\emph{➩ Patients often have difficulty learning from their experiences and they can repeatedly make the same mistakes in situations requiring judgment}} \newline  \newline {\emph{➩ Poor insight into the severity of their disorder ➩ they tend to stop therapy}}}  \tn 
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\begin{tabularx}{8.4cm}{X}
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Schizophrenia}}  \tn
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\mymulticolumn{1}{x{8.4cm}}{A chronic psychiatric disorder characterized by impairments in the perception of realist, most commonly manifesting as disorganized and bizarre thoughts, delusions, hallucinations, inappropriate affact, in the context of {\bf{significant social or occupational dysfunction}}} \tn 
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% Row 1
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\mymulticolumn{1}{x{8.4cm}}{Multiple emotional and cognitive functions are affects -{}-\textgreater{} results in disability for a large proportion of SZ patients} \tn 
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\mymulticolumn{1}{x{8.4cm}}{Only partially effective, {\emph{symptomatic}} treatment are available} \tn 
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\mymulticolumn{1}{x{8.4cm}}{• {\emph{Nothing {\bf{CURES/FIXES}} the problem}}}  \tn 
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\begin{tabularx}{8.4cm}{x{2.16 cm} x{5.84 cm} }
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Etiology and Causes}}  \tn
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{\bf{Etiology}} & Unknown; cause is multifactorial \tn 
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{\bf{Genetics}} & Significant genetic component, with a complex, non-Mendelian inheritance \tn 
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 & The greatest risk factor is a {\bf{positive}} family history \tn 
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Genetic Studies & Many different genes are involved; patients inherit several risk genes \tn 
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 & SNPs and CNVs \tn 
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\seqsplit{Environment} & Pt's more likely to experience premature birth, low birth weight, and perinatal hypoxia \tn 
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 & Maternal viral infection during pregnancy (especially during the 2nd trimester) \tn 
% Row Count 17 (+ 3)
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 & {\bf{Early neurodevelopmental defect (brain vulnerability determines by genetic predisposition) combined with environmental factors/stressors}} ⇨ abnormal migration of neurons during CNS development ⇨ results in abnormal neuronal connectivity and abnormal brain circuits -{}-\textgreater{} SZ \tn 
% Row Count 27 (+ 10)
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\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Dopaminergic Pathways in the Brain}}  \tn
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\mymulticolumn{2}{x{8.4cm}}{{\bf{Nigrostriatal}}} \tn 
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 & Originates in the substantia nigra ⇨ projects to the striatum \tn 
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 & Originates in the hypothalamus ⇨ projects to the anterior pituitary \tn 
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\mymulticolumn{2}{x{8.4cm}}{{\bf{Tuberoinfundibular}}} \tn 
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 & Part of basal ganglia ⇨ involved in the movement and pathogenesis of Parkinson's disease \tn 
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 & Endocrine function (dopamine inhibits prolactin secretion) \tn 
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{\bf{Mesolimbic and Mesocoritcal Pathways}} & Involved in the pathogenesis of SZ \tn 
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 & Both pathways originate in the ventral tegmental area ⇨ project to parts of the limbic system and the cortex \tn 
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 & Mesolimbic: VTA ⇨ Nucleus accumbens \tn 
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 & Mesocortical: VTA ⇨ Prefrontal Cortex (PFC) \tn 
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\begin{tabularx}{8.4cm}{X}
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Pathogenesis of SZ | GLUTAMATE}}  \tn
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\mymulticolumn{1}{x{8.4cm}}{The glutamatergic system is most widespread excitatory NT system in the brain} \tn 
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\mymulticolumn{1}{x{8.4cm}}{Unlike dopaminergic neurons, glutamatergic neurons are distributed throughout the brain and play a role in sensory processing, memory, and other higher-level functions} \tn 
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% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Abnormal synaptic pruning of glutaminergic neurons ⇨ Decreased number of glutametergic dendritic spines in individuals with SZ ⇨ abnormal (decreased) neuronal connectivity} \tn 
% Row Count 10 (+ 4)
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\mymulticolumn{1}{x{8.4cm}}{Glutamate Receptors: ionotropic (NMDA, AMPA, KA) and metabotropic glutamate receptors} \tn 
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\mymulticolumn{1}{x{8.4cm}}{▶ Normally, glutamatergic neurons inhibit dopaminergic neuronal activity in the VTA} \tn 
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\mymulticolumn{1}{x{8.4cm}}{▶ Glutamatergic neurons do NOT interact with dopaminergic neurons directly, but indirectly through GABA ({\emph{inhibitory}}) interneurons} \tn 
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\mymulticolumn{1}{x{8.4cm}}{▶ When glutamatergic neuron is activated in the PFC ⇨ GABA neuron activation in the VTA ⇨ inhibition of dopamine neuron activity in the VTA} \tn 
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\mymulticolumn{1}{x{8.4cm}}{In SZ: NMDA receptor hypofunction hypothesis ⇨ glutamatergic neuronal or NMDA receptor deficiency results in dopaminergic hyperactivity ⇨ hallucinations and delusions ⇨ {\bf{hyperactivity of mesolimbic pathway}}} \tn 
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\mymulticolumn{1}{x{8.4cm}}{{\emph{The most important glutamate receptor is NMDA ⇨ it carries the MOST excitatory neurotransmission in the brain}}   \newline  \newline {\bf{ ▶ = NORMAL FUNCTIONS }}}  \tn 
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\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{**POSITIVE SYMPTOMS}}  \tn
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{\bf{Delusions}} & False beliefs that a person holds onto even when they are bizarre or could not possibly be true \tn 
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 & May involve fears ({\emph{paranoid delusions}}), guilt, jealousy, religion, spirits, one's body and mind control \tn 
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{\bf{Hallucinations}} & A perception in the absence of external stimulus (seeing, hearing, or sensing things that are not real) \tn 
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 & Most common are auditory hallucinations ({\emph{hearing voices}}); voices may keep a running commentary on the person's behaviors, tell them what to do, carry on conversations about them, accuse them, or may have arguments with each other \tn 
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{\bf{Other Hallucinations}} & Visual, tactile, olfactory, gustatory \tn 
% Row Count 31 (+ 2)
\end{tabularx}
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\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{**POSITIVE SYMPTOMS (cont)}}  \tn
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{\bf{Disorganized speech, thoughts, and beliefs}} & May lose track of their ideas, meanings, and words ({\emph{Word Salad}}) \tn 
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 & Thought processes are disconnected ({\emph{a sentence or phrase is not logically connected to those that occur before or after; loose associations}}) \tn 
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 & Ideas and images may become jumbled or linked together illogically or words and meaning that should be linked instead may become disconnected \tn 
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{\bf{Disorganized Movement and Behaviors}} & May use exaggerated or repeated gestures, or may seem to be fidgeting, hyperactive, or preoccupied with meaningless physical movements \tn 
% Row Count 27 (+ 7)
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\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{3.84 cm} x{4.16 cm} }
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Hypothesis of SZ (Together)}}  \tn
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Dopamine & SZ comes from dysregulation of mesolimbic and mesocortical pathways \tn 
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NMDA Receptor Hypofunction Hypothesis & Glutamatergic neuronal or NMDA receptor deficiency results in dopaminergic hyperactivity, which leads to hallucinations and delusions \tn 
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 & Hyperactivity of mesolimbic pathway \tn 
% Row Count 13 (+ 2)
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\end{tabularx}
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% That's all folks
\end{multicols*}

\end{document}