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Mesocortical dopamine pathway — MRCPsych Paper A MCQ

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HardNeuroanatomyMesocortical dopamine pathwayMRCPsych Paper A

A 29-year-old man with schizophrenia has persistent avolition, alogia and asociality despite remission of hallucinations and delusions. Clinically significant depression, sedation, substance misuse and extrapyramidal adverse effects have been excluded. According to the classical dopamine-pathway model of schizophrenia, relative hypofunction of which projection is most closely associated with this presentation?

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Correct answer: C — Ventral tegmental area to prefrontal cortex

A is the mesocortical dopamine projection, arising predominantly in the ventral tegmental area and projecting to the prefrontal cortex. Within the classical dopamine model, reduced signalling in this pathway is associated with negative and cognitive symptoms. The stem supports primary negative symptoms by excluding depression, sedation, substance misuse and extrapyramidal effects. The ventral tegmental area–nucleus accumbens projection is mesolimbic and is classically linked to positive symptoms. The nigrostriatal projection mediates motor function and is implicated in extrapyramidal adverse effects. The arcuate nucleus–median eminence projection is tuberoinfundibular and regulates prolactin. The retinohypothalamic tract conveys light information for circadian entrainment. Mesocortical hypofunction remains a useful examination model rather than a complete or conclusively established explanation of negative symptoms.

Reference: Collo G, Mucci A, Giordano GM, et al. Negative Symptoms of Schizophrenia and Dopaminergic Transmission: Translational Models and Perspectives Opened by iPSC Techniques. Frontiers in Neuroscience. 2020. https://pubmed.ncbi.nlm.nih.gov/32625059/