Class 1 Flashcards
Symptoms of Psychosis
- Positive symptoms: delusions, hallucinations,
thought disorganization, hostility - Negative symptoms: affective blunting, thought
impoverishment, aboulia (diminished motivation),
anhedonia (?) - Cognitive symptoms: attention/concentration,
executive planning, memory - Impulsive symptoms: aggressiveness, suicidality,
substance abuse
Symptoms of Psychosis that can be “Pseudopsychotic”
• Delusions: a fixed belief or a “fluid” belief or an overvalued idea or an obsessional idea with a “psychotic” flavor (personality/cultural issues; obsessive-compulsive disorder)
• Persecutory, referential, grandiose, somatic, guilt
• Hallucinations: perceptual disturbances unrelated to the external environment – auditory, visual, olfactory, gustatory, somatic, synaesthetic
• Many non-psychotic people can hear at one or more times in their life simple “voices” (periodic paralysis, mourning); childhood sexual abuse with dissociations (including but not usually associated with borderline
personality disorder); associated with substance abuse (auditory may predominate, but visual, olfactory, gustatory are more pronounced);
associated with various neurological diseases (visual olfactory, gustatory, somatic more pronounced)
• Negative symptoms: neuroleptic effect of medication
(too much dopamine blockade); over sedation;
comorbid major depression (30% of patients with
schizophrenia); comorbid anxiety (generalised
anxiety, panic/agoraphobia); hoarding/OCD; social
phobia)
• Hypothyroidism, anaemia, psychodynamic/social
difficulties
• Thought disorganization: difficulty to follow the train of thought of the patient; thought blocking is rare but delay of response is common (negative symptom) – poor sleep, substance abuse, but not affective disorders, rarely aphasia
• Cognitive symptoms: acute intoxication, acute neurologic event, dissociative episode (no memory for different alter), comorbid attention deficit disorder, comorbid anxiety disorder
• Impulsive symptoms: substance abuse (e.g. ups and downs of stimulant abuse, alcohol intoxication and suicidality); personality factors/intermittent explosive disorder; family history of substance abuse
synasthetic: more
more psychedelic drug experience, feel sounds, taste things that you see
borderline and voices
don’t have a delusional explanation for the voices, voices don’t respond to antipsychotic rx, never have negative symptoms of schizophrenia
schizotypal vs psychosis
schizotypal don’t necessarily share same ethipathological than psychosis. Seems like they’re on the autistic spectrum in their interpersonal relationships, overvalued ideas
Etiopathology of Psychotic Disorders
- DSM-IV/DSM-5 categories of no predictive therapeutic value
- RDoCs (Research Domain Criterias) supposedly more “scientific” in finding biological correlates that would lead to more homogeneous groups in order to study treatment has been unhelpfully unpredictive
- No specific biological workers
- Specific genes for medication responsiveness or symptoms prediction have been disappointing
- European consortium : 108 genes identified for schizophrenia and many overlapped with bipolar disorder
A new Paradigm for Schizophrenia Therapeutic Markers
• Hyperdopaminergia: 70-80% of all patients who respond to dopamine blocking antipsychotics
• Normodopaminergia: 20-30% of all patients “treatment
resistant schizophrenia” or clozapine-responsive
schizophrenia
• Normodopaminergia: 5-10% first episode psychosis – partial response to clozapine/ECT7
• But resistance to clozapine increases over time to 40-70%
Etiopathology of Schizoaffective Disorders and Delusional Disorders
• Schizoaffective disorder : the psychotic part is likely reflected in the etiopathology of schizophrenia, including pharmacoresistance
• Mania is essentially also a hyperdopaminergic problem
• Genetics of bipolar/schizoaffective disorder are quite variable and share many areas with schizophrenia
• Delusional Disorder – no evidence for a clear
biological/genetic etiopathology
Psychosocial Aspects of Etiology of Psychotic Disorders
• In more well-defined and common psychotic disorders (schizophrenias, schizoaffective disorders), there are clear familial risks, even if the exact genes are not known in a given case
• For example, the well-known Danish Adoption Study suggested that the heritability of schizophrenia if one parent were affected would be 10-15%, and > 40% if two parents were affected
• In terms of more clear cut psychosocial aspects of etiology of psychoses, the following factors have some (unquantifiable) influence:
o Immigration
o Deafness, blindness
• On the other hand, childhood sexual and psychological abuse has an unclear association
Name the Psychotic Disorders
• Schizophrenia o Schizophreniform disorder o Schizophrenia multi-episodes • Schizoaffective Disorder • Brief Psychotic Disorder • Substance-induced Psychotic Disorder • Catatonia • Delusional Disorder • Schizotypal Personality Disorder
Schizophreniform Disorder criteria
• Two or more of the following for at least one month but less than six months
1) Delusions
2) Hallucinations
3) Disorganized speech
4) Grossly disorganized or catatonic behaviour
5) Negative symptoms
• Not attributable to substance abuse or medical conditions
• Absence of blunted affect and good premorbid functioning are good prognostic features
Schizophreniform Disorder epidemiology
• About a third of individuals will recover within the six
months period
• Two thirds will eventually receive a diagnosis of schizophrenia
• Epidemiology and genetic risk is same as
schizophrenia
• Functional consequences are similar for
schizophrenia
Schizophrenia epidemiology
• Prevalence : 0.3-0.7% • Sex ratio differs across samples • Poor prognosis factors – males • Late onset cases (over 40 years old) over represented by females
Schizophrenia Development and course:
o Psychotic features in late teens up to mid-thirties, males earlier than females
o Slow gradual onset in most; 15-20% have favourable outcome
o Psychotic symptoms tend to decline in late middle and old age due to normal age-related declines in dopamine activity
Risk factors schizophrenia
late winter / early spring birth (?),
urban environment, pregnancy and birth
complications with hypoxia, greater paternal age
Cultural/linguistic factors in misidentifying symptoms
Suicide risk schizophrenia
5-6% die by suicide; 20% attempts; highest risk in comorbid substance abuse
Differential Diagnosis schizophrenia
• Major affective disorder with psychosis or catatonic features • Delusional disorder • Schizotypal personality disorder • Obsessive compulsive disorder and body dysmorphic disorder • Post traumatic stress disorder • Autism Spectrum disorder
