神经病理学医学知识培训.ppt

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神经病理学医学知识培训.ppt

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神经病理学医学知识培训

SchizophreniaEmilKraepelin“DementiaPraecox’(1896)Blueler“Schizophrenia”Onset:adolescenceoryoungadulthoodDSM-IVreview:Positivesymptoms(delusions,hallucinations,disorganizedspeechorbehavior)Negativesymptoms(catatonia,affectiveflattening,withdrawal,oravolition)Social-occupationaldisturbance6+months

AssociatedFeaturesCognitiveDisturbancesMemorySensoryfilteringAttentionEmotionrecognitionEye-trackingInterpersonalDysfunction

SubtypesCatatonicParanoidDisorganizedUnlikelytobearelatedtoasinglephysiopathology

NeuropathologyNeurodevelopmentalhypothesisNeurodegenerativehypothesisDopaminehypothessisGlutamatergichypothesis**Thesearenotexclusive

Whatcausesschizophrenia?Heritable(Shastry,2023)EnvironmentalfactorsEpidemiologicalstudiesBirthcomplicationsMaternalstressSeasonalityeffectViralepidemicsLatitudeeffectRhincompatibility

Neuropathology

StructuralalterationsBehavioralsymptomsindicativeofbraindamage(unusualratesofblinking,poorcontrolofeyemovements,unusualfacialexpressions)Enlargedventricles(WeinbergerWyatt,1982;Andreason)

VentricularenlargementinmonozygotictwinwithschizophreniaBarondes,1993

HippocampalvolumelossandenlargedventriclesVanHeronetal.,2023

Neuropathology

Structuralalterations(cont)Alterationsinnumerousareas,includingfrontallobes,medialtemporallobes,lateraltemporallobes,parietallobe,basalganglia,corpuscallosum,thalamusandeventhecerebellumWhitematterdeficitsEvidenceofdisorganizedneuronsandfailuresofmigrationAltereddensityanddisorganizationofneuronsfoundinthewhitematterbelowlayerVIinthecortexDisorganizedpyramidalcellsinthehippocampus

Altereddevelopmentofhippocampalpyramidalneurons

NeurodevelopmentalHypothesisHomemoviesfromfamilieswithschizophrenicchilddisplayedabnormalbehavior(Walkeretal,1994;1996)Childrenwholaterbecomeschizophrenicexhibitpoorsocialadjustmentandschoolperforman