Kirkpatrick > Psychotic Disorders Flashcards
What is the definition of psychosis?
defective/lost contact w/ reality esp as evidenced by delusions, hallucinations, & disorganized speech & behavior
what is a hallucination?
a perception of something (visual/audio) w/ no external cause
what is a delusion?
fixed false belief that is NOT shared by other member’s of a person’s subculture
what is disorganized speech?
irrelevance & incoherence of verbal productions ranging from simple blocking & mild circumstantiality to total loosening of associations
T/F: disorganized speech & behavior can mimic fluent aphasia
true (“in some instances”)
what are the 3 iterations of catatonia you need to know?
catatonia
catatonic excitement
malignant catatonia
what is catatonic excitement?
aimless overactivity
what is catatonia?
physical immobility (increased muscle tone) w/ little-no speech & autonomic OVERactivity (fever, tachycardia)
Catatonia might be more common in what disorder?
affective disorder
what are the 3 treatments for catatonia?
lorazepam
antipsychotics
electroconvulsive therapy
what is malignant catatonia?
catatonia that may include delirium & can be fatal
what are the 6 negative symptoms possibly found in schizophrenia (not in all pts)?
blunted affect poverty of speech anhedonia asocial amotivation lack of normal distress
Define “negative symptoms”
decrease or absence of a normal behavior or experience
What disorders can have psychosis?
dementia
serious depression
mania
delirium
what is unique about schizophrenia & psychosis?
it is NOT an affective disorder w/ psychosis
but it can manifest as schizophrenia AND idiopathic psychosis (not d/t another disorder)
Schizophrenia must have 2+ sx for 1 month. what are the 3 sx that the pt MUST show ONE of?
delusions
hallucinations
disorganized speech
what are the 5 sx a pt may show for a dx of schizophrenia?
delusions hallucinations disorganized speech grossly disorganized or catatonic behavior negative sx
Schizophrenia must have ____ sx for ___ month(s)
2 or more sx
1 month
What are the 2 exclusions for schizophrenia dx?
Affective disorder
Autism spectrum
T/F: for a dx of schizophrenia, a pt must show a decline in his/her level of function
TRUE
for how long must a pt show continuous signs for a schizophrenia dx?
6 months (prodromal, criterion A, or residual)
T/F: Schizophrenia has a spectrum
true
it includes 8 disorders
People conceived during an African famine had increased risk for what diseases?
schizophrenia depression atherogenic plasma lipids coronary heart disease type 2 diabetes
what are 10 risk factors for schizophrenia?
low birth weight obstetrical complications winter birth (summer birth for a subgroup) gestational diabetes prenatal famine prenatal stress (incl infection) advanced paternal age cannabis physical/sexual abuse in childhood/early adolescence immigration
what are the known genes implicated in schizophrenia?
DISC1
neuregulin 1
T/F: schizophrenia is never caused by copy number variants of genes
false
several of the genetic risk factors for schizophrenia are also risk factors for what?
autism
mental retardation
T/F: for many pts, schizophrenia starts at age 10
FALSE
starts IN UTERO which is terrifying
what suggests that schizophrenia might start in utero?
that high-risk toddlers of moms w/ schizophrenia have abn motor & cognitive development
AND
that adults w/ schizophrenia had abn motor & social fxn as children
VERY GENERALLY speaking, what can prenatal & perinatal events increase the risk of?
several diseases that are only apparent in ADULT life
what does “sufficient cause” mean?
causal pathway
when you do that thing, you contract disease
when does psychosis usually present?
late adolescence/early adulthood
when are negative sx assoc w/ psychotic disorders usually detectable?
childhood
when is cognitive impairment assoc w/ psychotic disorders usu detectable?
preschool children at high risk of psychosis
T/F: psychosis usu brings ppl to their first clinical contact
TRUE
it’s the usual cutoff point for the “premorbid” period
what is the peak age of first-admission for schizophrenia (in England)?
20-24 yo
what gives you the highest risk of relapse after the first psychotic episode?
medication non-adherence (4x risk)
what 4 things increase your risk of relapse after the first psychotic episode?
medication non-adherence (4x)
persistent substance use (3x)
carers’ critical comments (2.3x)
poorer premorbid adjustment (2.2x)
what 4 things does the conceptual model of a disorder dictate?
assessment
treatment options offered
treatment development
research
what is the pathophysiology of schizophrenia according to the USUAL model?
abnormal dopamine regulation
what are the 2 big problems with the USUAL model of schizophrenia?
other NTs are involved w/ psychosis
AND
other disorders have psychotic sx
T/F: people w/ schizophrenia have no other neuropsych probs besides psychosis
FALSE
they have neuropsych probs other than psychosis
T/F: schizophrenic pts have significant problems OUTSIDE the brain
TRUE
what is the strongest predictor of level of fxn in outpts?
cognitive impairment
people with schizophrenia die how many years earlier than the general population?
20-25 years
in another place he has 15-20 so go with 20
why is there a focus on psychosis in schizophrenic pts if they have other probs?
psychosis is a treatable aspect
it’s a big predictor of fxn
historical accident that distorted our conceptualization of the illness
when does cognitive impairment present?
prior to psychosis onset
T/F: all schizophrenia pts might have some degree of cognitive impairment
true
what is the best predictor of a pt’s level of function?
cognitive function (NOT severity of psychotic sx!)
what are the rates (%) of major depression in schizophrenia?
30-35%
2-3x gen pop
what risk factors do schizophrenia & depression share?
low birth weight
prenatal famine
winter birth
do depression & schizophrenia share aspects of pathophys?
yes
hella
what % of schizophrenics have a lifetime dx of alcohol abuse/dependence?
34% ++
what % of schizophrenics have a lifetime dx of substance abuse/dependence?
47% ++
what drug may increase the risk of schizophrenia?
mary jane
when does substance abuse increase in schizophrenics?
prior to onset of psychosis
what 4 anxiety disorders have increased prevalence in schizophrenia?
obsessive compulsive syndrome
panic attacks
PTSD
GAD
what are other neuropsych sx assoc w/ psychosis?
neurological signs
dyskinetic movements
oculomotor dysfxn
polydipsia
Are comorbid syndromes common w/ schizophrenia?
YES
they’re practically the “rule”
what is one possible explanation for why psychosis has so many comorbid conditions?
they probably share some common biology/pathophys
what are 2 explanations for mechanisms of comorbid conditions w/ schizophrenia?
some might be part of the inherited schizo spectrum
some might share env risk factors w/ schizophrenia
what causes the greatest number of deaths in schizophrenic pts?
cardiovascular disease (weirdly)
what contributes to early death in schizophrenics?
antipsychotic meds > diabetes, weight gain
high prevalence of sedentary lifetsyle & smoking
Psychotic pts have higher or lower pulse pressure than controls?
HIGHER
Psychotic pts have more or less free androgens than controls?
LESS
psychotic pts have higher or lower telomere content than controls?
LOWER
i.e. their telomeres are shorter
what are “state markers”?
cytokines that change during exacerbations
which cytokines are the “state markers”?
IL-1 beta
IL-6
TGF-beta
what are “trait markers of illness”?
cytokines that are elevated at first clinical contact AND remain elevated
which cytokines are the “trait markers of illness”?
IL-12
IFN-gamma
TNF-alpha
sIL-2R
what things suggest accelerated aging in psychotic pts?
increased mortality pattern cognitive dysfxn abn glucose tolerance inc inflammation inc pulse pressure shortened telomeres abn signaling for adult stem cells decreased free testosterone in males
what are adult circulating stem cells?
multipotent (NOT pluripotent) stem cells that have a broad differentiation potential
what are adult circulating stem cells involved in?
normal repair processes
where do adult circulating stem cells reside?
bone marrow mostly
can be mobilized & localized to other organs
what is the main chemokine that controls adult circulating stem cell movement?
SDF1alpha
stromal-derived factor 1 alpha
What medical problem is assoc w/ abn SDF1alpha pathology?
diabetes
do pts w/ psychosis have high or low SDF1alpha?
LOW
do psychotic patients have normal brain volume?
no
decreased volume in many areas
what are the neurons like in pts w/ psychosis?
decreased neuropil
increased neuron density
decreased # of neurons in some places
in pts w/ psychosis, how is dopamine affected?
increased release in some regions
what is NMDA receptor expression like in psychotic pts?
abnormal
what is the white matter like in pts w/ psychosis?
decreased volume
abnormal fiber orientation
what 3 things can cause transient mild increases in psychotic sx in schizophrenic pts?
cannabis
serotonin agonists
NMDA antagonists
what are the 3 current treatments for psychosis?
antipsychotic meds
treating other neuropsych syndromes
psychosocial TX
in terms of family interventions, what can increase risk of relapse?
“expressed emotion” > critical & intrusive comments
what 5 good things can family interventions do for pts w/ psychosis?
decrease relapse freq reduce hospital admission increase med adherence general social fxn decrease expressed emotion
what does cognitive remediation help with the MOST?
social cognition (medium effect)
is schizophrenia a psychotic disorder?
NO
which is weird because this lecture is about psychotic disorders & schizophrenia
T/F: schizophrenia is restricted to the brain
false
T/F: psychosis always has the greatest impact on schizophrenic pts fxn
FALSE
in some phases, other neuropsych things have the greatest impact
are neuropsych syndromes like abn movements comorbid w/ schizophrenia or are they part of the disease?
part of the disease
does schizophrenia respond to dopamine antagonists?
yes
variably
what is the purpose of medical care for schizophrenic pts?
improve & maintain QOL
extend life
deal w/ disability, discomfort, or death
