Biochemical basis

of psychosis
PBL21
Under supervision of Dr. Sally Safwat
 Table of contents
01 Introduction 04 Brain changes 07 Questions

02 Risk factors 05 Treatment 08 References

03 Clinical picture 06 Home message

 01

Introduction
Psychosis refers to a collection of symptoms
that affect the mind, where there has been
some loss of contact with reality, these
symptoms include dilutions (false fixed
believe) together with hallucinations
( mental impression of sensory vividness in
absence of a stimulus).
 02
Risk factors
 Genetics Gender Brain changes Living environment
Family history of More in females urban city
psychotic disorders
Like schizophrenia
thyroid or adrenal disease Brain injury including stroke Brain tumor or cyst

HIV and other infections Dementia such as Alzheimer's Childhood brain trauma
disease
Alcohol misuse
Abnormal fetal development
Due to maternal malnutrition
Medicine
In rare situations,
psychosis can also occur
as a side effect of some
types of medicine or
Drug misuse because of an overdose
Like cocaine, LSD of that medicine. Not getting
and cannabis enough sleep
03
Symptoms of psychosis
 Those that add to the person’s normal functioning

Delusions

disorganized
speech,
thoughts or
Hallucinations behaviour
 Normal functioning becoming lost or reduced

Restricted emotional Difficulty with Reduced socialization

and facial expression generating ideas and motivation
 Difficulties with
difficulties with attention Difficulties with memory
concentration
 04
Brain changes
There are some interesting
changes that occur in the
brain during psychosis due
to changes to How normally
the neurotransmitters work,
especially dopamine.
Dopamine plays a significant role in
psychosis ; it has 4 pathways:

1. Nigrostriatal
2. Mesocortical
3. Mesolimbic
4. Tuberoinfundibular
Mesolimbic pathway
It is a Pathway between the dopaminergic neurons of the ventral
trigeminal area (VTA) which is controlled by GABA-nergic neurons
and D2 receptors in nucleus accumbens (NAC). Activation of these
receptors primarily mediates feelings of pleasure and reward.
o In psychosis there is excess release of
dopamine from VTA neurons so a lot VTA
of dopamine will bind to D2 receptors
in the NAC leading to excess
activation of D2 receptors.
o This will lead to appearance of the
positive symptoms like hallucinations
and delusions. D2

NA
C
o The nucleus accumbens has connections to the amygdala, associated
with emotions, this attributes feelings towards the experienced
reward.
o Connections to the hippocampus, can attribute memories of pleasure
to the experience to reinforce this sensation to happen again.
o Stimulating the nucleus accumbens is important for daily activities,
but over-stimulation can affect our memory and emotions leading to
cognitive symptoms .
Mesocortical pathway
It is a Pathway between the dopaminergic neurons of the ventral
trigeminal area (VTA) and the D1 receptors in the prefrontal cortex
(PFC). Activation of these receptors brings about the conscious
experience of the pleasure and reward being experienced.
Attention, concentration, and decisions can be made as a result of
pleasure and reward.
o In psychosis there is low release of
VTA
dopamine from VTA neurons so less
dopamine will bind to D1 receptors in
the PFC leading to less activation of
D1 receptors.
o This will lead to appearance of the
negative symptoms like Avolition.
D1

PFC
Dysfunction in this pathway can therefore result in poor
concentration and an inability to make decisions (cognitive
symptoms).
 05

Treatment
Psychosis can be treated, and many people make a good recovery,
especially if they get help early. It usually consists of:
o Antipsychotic drugs (D2 antagonist) like risperidone and
clozapine.
o Psychosocial interventions.
o Drugs that regulate dopamine Don't work for everyone.
o Clozapine is one of the most effective antipsychotics on the market, it is
reserved for people who are resistant to all other treatments.
o This drug has minimal effects on dopamine, yet it is very effective.
o That is why studies suggest that dopamine is not the only
neurotransmitter involved in psychosis, but norepinephrine, serotonin
and GABA are undoubtedly involved.
 06
Home message
 Some tips for people at high risk of getting psychosis

Avoid the misuse of drugs

especially the ones that
Do some physical and trigger psychiatric episodes
relaxation activity

Never stop taking or take

overdose of a prescribed
medicine unless advised to
do so by a GP or another
qualified healthcare
professional responsible for Avoid using
Get enough sleep your care. alcohol
07
Ahmed is 18 years old was caught by the police,
stripped to the waist in the middle of winter, he was
taken to the hospital, when asked he kept saying that
he gets his energy through light like the tree, the GP
treating Ahmed noticed that he is talking with himself
when the GP asked him who are you talking to, he said
cannot you see him it is Andro. Immediately the GP
did his investigations by asking some questions and
doing some tests, he found out Ahmed is in no
medications, admits smoking cannabis, drinks very
little alcohol, his blood tests (liver, thyroid,…) and MRI
are normal, and his Mom's brother has
schizophrenia, when asked about daily activities, he
said that he has lost the motivation to do anything.
The GP in the end diagnosed him with psychosis.
Which dopamine pathway is affected causing
Ahmed to have psychosis?

1. Nigrostriatal
2. Mesocortical
3. Mesolimbic
4. Tuberoinfundibular
5. Both 2 &3
According to Ahmed’s case which one of these
factors increased his risk of having psychosis ?

1. Drinking a lot of alcohol with having a

family history of psychotic disorders
2. smoking cannabis with having a family
history of psychotic disorders
3. Taking medications that trigger
psychosis
4. Having hyperthyroidism
Which one of these choices is a positive
symptom of psychosis that Ahmed had?

1. Alogia
2. Thoughts blocking
3. Hallucinations
4. Depression
What is the cause for the positive symptoms
in psychosis that Ahmed had?
1. Excess activation of D1 receptors in
mesocortical pathway
2. Excess activation of D2 receptors in
mesolimbic pathway
3. Low levels of dopamine that bind to D1
in the mesocortical pathway
4. Low levels of dopamine that bind to D2
in the mesolimbic pathway
What is the cause for the negative symptoms
in psychosis that Ahmed had ?
1. Low dopamine levels that bind to D1
receptors in the mesocortical pathway
2. High dopamine levels that bind to D1
receptors in the mesocortical pathway
3. High dopamine levels that bind to D2
receptors in the mesolimbic pathway
4. Low dopamine levels that bind to D2
receptors in the mesolimbic pathway
 08

References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2632542
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9080788/
https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/psychosis
https://www.nhs.uk/mental-health/conditions/psychosis/causes/
https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/psychosis
https://www.simplypsychology.org/the-role-of-dopamine-as-a-neurotransmitter-in-th
e-human-brain.html

https://www.nimh.nih.gov/health/publications/understanding-psychosis
 Our team
Data collectors:
Aseel Hassan Alwabari, Zahraa Baqer Alaali, Ahmed Fahd, Mohamed
Khaled, Amr Abu Samra,
Ahrar Alnasser, Seif Mohamed,Nada Abdalgalile, Sayed Mahmood
Almosawi
PPT:
Nada Abdalgalile
Presenters:
Magda Hatem, Malek Eid, Sayed Mahmood Almosawi, omar Alsarawi
Under supervision of Dr.Sally Safwat
Thanks!