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Schizophrenia - Coggle Diagram

- - - - Preoccupation with one or more delusions or frequent auditory hallucinations
      - None of the following is prominent: disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect
  - - - Purposeless excessive motor activity
      - Echolalia or echopraxia
      - Motoric immobility as evidenced by catalepsy
      - extreme negativism
      - peculiarities of voluntary movements as evidenced by posturing
  - - - The criteria are not met for catatonic type
      - All of the following are prominent
        
        Disorganized speech
        
        Disorganized behavior
        
        Flat or inappropriate affect
  - - - Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior
      - There is continuing evidence of the disturbance, as indicated by the presence of negative symptoms or two or more symptoms listed in criterion A for Schizophrenia, present in attenuated form
- - - - lack of motivation
    - - difficulty in expressing their emotions
    - - inability to feel pleasure
- - - - Glutamate activity at NMDA receptors are hypofunctional due to abnormalities in the formation of glutamatergic NMDA synapses during neurodevelopment
    - - main dopamine pathways
        
        Mesocortical pathway
        
        Ventral tegmental area (VTA)
        
        prefrontal cortex
        
        cognition, executive functions
        
        Hypoactivity of Dopamine lead to negative psychotic symptoms of Schizophrenia
        
        3 more items...
        
        Nigrostriatal pathway
        
        substantia nigra
        
        striatum (caudate and putamen)
        
        coordination of body movements
        
        inhibition by antipsychotics lead to extrapyramidal side effects
        
        Mesolimbic pathway
        
        Ventral tegmental area (VTA)
        
        nucleus accumbens.
        
        pleasure and reward
        
        hyperactivity of dopamine lead to positive psychotic symptoms of Schizophrenia
        
        2 more items...
        
        Tuberoinfundibular pathway
        
        arcuate and periventricular nuclei of the hypothalamus
        
        infundibular region (median eminence)
        
        inhibit prolactin release
        
        inhibition by antipsychotics lead to elevated serum prolactin
    - - Hypofunction of NMDA receptors, located on GABAergic interneurons resulting in hyperstimulation of cortical neurons.
    - - Norepinephrine is an important player in the regulation of dopamine and serotonin and so in the pathophysiology of schizophrenia.
    - - Irregularities in acetylcholine levels in the cortex resulted in cognitive symptoms of schizophrenia.
    - - 5-HT2A receptor activity increased and 5-HT1A receptor stimulation decreased
        
        5-HT2A receptor overstimulation causes downregulation and results in low density of 5-HT2A receptors in addition to upregulation and high density of 5-HT1A receptors
        
        Increased stimulation of the presynaptic 5-HT1A autoreceptors shuts down serotonin release
        
        Decreased 5-HT activity increase dopaminergic transmittion
        
        Exacerbation of positive and negative symptoms associated with schizophrenia
- - - - D2 receptor antagonism + effect on other receptors e.g. 5-HT2A
      - Risperidone
      - Aripiprazole
      - Quetiapine
      - Amisulpride
      - Clozapine
    - - D2 receptor antagonism
      - Chlorpromazine
      - Flupentixol
      - Haloperidol
- - - - e.g. frequent derailment or incoherence
    - - i.e. diminished emotional expression or avolition