21 Psychosis Flashcards
Define psychosis.
Presence of hallucinations or delusions but patientd have lack of insight
(describes symptoms- not diagnosis in itself)
What are hallucinations?
Hallucination= perception without stimulus
Can be any sensory modality
(Visual hallucinations= usually organic - caused by problem with brain or eyes)
What are hypnogogic and hypnopompic hallucinations?
Hallucinations going to sleep/waking up
= Normal in population
What is a delusion?
Delusion= fixed, false belief which is unshakeable. Outside of cultural norms.
What are the first rank symptoms for schizophrenia? (7)
- Auditory hallucinations (thought echo, runnig commentary)
- Passivity experiences (believing external force causing feeling or action)
- Thought withdrawal (thoughts taken out of patients mind by someone else)
- Thought broadcast (belief others can hear their thoughts)
- Thought insertion (ones thoughts are someone elses inserted into their mind)
- Delusional perceptions
- Somatic hallucinations (eg feeling organs moving)
What is meant by positive and negative of schizophrenia? (give examples of each)
Positive= gained symptoms
Negative= eg self neglect
It is thought that dopamine pathways are involved in the pathophysiology of schizophrenia. What is the evidence to support this?
- Drugs eg amphetamines- cause release of dopamine- induces psychotic symptoms
- Medications that antagonise dopamine receptors help treat psychosis
There are thought to be 4 dopamine pathways in the brain. What are they?
Where does the dopaminergic mesolimbic pathway in the brain go from and to?
Is it thought to be underactive or overactive in schizophrenia?
Where does the dopaminergic mesocortical pathway in the brain go from and to?
Is it thought to be underactive or overactive in schizophrenia?
What brain changes can we see in schizophrenia compared to a normal brain? (5)
- Enlarged ventricles
- Reduced grey matter (reduced brain weight)
- Decreased temporal volume (auditory hallucinations)
- Reduced hippocampal formation, amygdala, parahippocampal gyrus, prefrontal cortex
- Decrease pre-synaptic markers, oligodendroglia and thalamic neurons
–> Aberrant connectivity
Give some of the causes of schizophrenia. (organic)
- Delirium due to infection
- Alcohol withdrawal (delirium tremens)
- Drugs
- Seizure
- Hyperthyroidism
- Lupus
- Parkinson’s treatment (L-DOPA)
State 5 different types of schizophrenia:
- Paranoid
- delusions/hallucinations= prominent
- Hebephrenic
- patient acts inappropriately/in childish manner
- delusions/hallucinations= not as prominent
- Simple
- loss of drive, social withdrawal
- (Different to depression- social withdrawal rather than low mood)
- Catatonic
- Patient= mute, posturing (stuck in position), negativism (won’t do as told), rigidity, waxy flexibility (moved and stay in position) , command automatism (told to do something then keep doing it)
- Undifferentiated
- Can’t put into subtype–> too many/insufficient symptoms
Schizophrenia is a type of psychosis. Give 3 other types:
- Drug induced: symptom develop within 2 weeks of substance, last >48hrs but don’t exceed 6 months
- Affective: psychotic experiences come with mood- eg depressed patients have delusions of guilt
- Post partem: within days of delivery- can develop very quickly
What drugs can we use to treat schizophrenia? (2 types)
- Typical antipsychotics (First generation)
- Block all D2 receptors in CNS dopaminergic pathways
- Atypical antipsychotics (Second generation)
- Lower affinity for D2 receptors, milder side effects as dissociate rapidly from D2 receptor
- Also block serotonin receptors
Both affect mesolimbic and mesocortical pathways
Why were second generation antipsychotics developed?
Typical antipsychotics (block all D2 receptors) - cause symptoms of Parkinson’s and acute dystonia (can’t talk/swallow/move)
(cause low dopamine- basal ganglia stimulates cortex less)
How is acute induced (by anti-psychotics) dystonia treated?
Anti-cholinergic drugs
What are some of the side effects of Atypical antipsychotics?
- Impaired glucose tolerance
- Weight gain
- Hypercholesterolaemia
State an autoimmune cause of schizophrenia:
anti-NMDA encephalitis
Why is it thought that untreated schizophrenic patients develop catatonia?
Explain why taking antipsychotics (dopamine receptor blockers) can cause side effects such as:
Amennorhoea, galactorrhea, decreased fertility, reduced libido, long term osteopenia/osteoporosis
- Dopamine normally inhibits prolactin release from pituitary
- Lower dopamine- increased prolactin levels
–> Amennorhoea, galactorrhea, decreased fertility, reduced libido, long term osteopenia/osteoporosis
Anti-psychotics can be hard to administer due to patients lacking insight and therefore a lack of adherence. What are the different ways hat anti-psychotic medication can be administered?
Orally
Short acting intramuscular injection
Depot injection
What is the prognosis like for schizophrenia?
Earlier treated= better prognosis
Moderately good global outcome in 50%
