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
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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
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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?
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Where does the dopaminergic mesolimbic pathway in the brain go from and to?
Is it thought to be underactive or overactive in schizophrenia?
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Where does the dopaminergic mesocortical pathway in the brain go from and to?
Is it thought to be underactive or overactive in schizophrenia?
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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
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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
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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
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Why is it thought that untreated schizophrenic patients develop catatonia?
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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%
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