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Block 8 Week 6 Rhonda > Kirkpatrick > Psychotic Disorders > Flashcards

Kirkpatrick > Psychotic Disorders Flashcards

1
Q

What is the definition of psychosis?

A

defective/lost contact w/ reality esp as evidenced by delusions, hallucinations, & disorganized speech & behavior

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2
Q

what is a hallucination?

A

a perception of something (visual/audio) w/ no external cause

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3
Q

what is a delusion?

A

fixed false belief that is NOT shared by other member’s of a person’s subculture

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4
Q

what is disorganized speech?

A

irrelevance & incoherence of verbal productions ranging from simple blocking & mild circumstantiality to total loosening of associations

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5
Q

T/F: disorganized speech & behavior can mimic fluent aphasia

A

true (“in some instances”)

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6
Q

what are the 3 iterations of catatonia you need to know?

A

catatonia
catatonic excitement
malignant catatonia

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7
Q

what is catatonic excitement?

A

aimless overactivity

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8
Q

what is catatonia?

A

physical immobility (increased muscle tone) w/ little-no speech & autonomic OVERactivity (fever, tachycardia)

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9
Q

Catatonia might be more common in what disorder?

A

affective disorder

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10
Q

what are the 3 treatments for catatonia?

A

lorazepam
antipsychotics
electroconvulsive therapy

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11
Q

what is malignant catatonia?

A

catatonia that may include delirium & can be fatal

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12
Q

what are the 6 negative symptoms possibly found in schizophrenia (not in all pts)?

A 
blunted affect
poverty of speech
anhedonia
asocial
amotivation
lack of normal distress
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13
Q

Define “negative symptoms”

A

decrease or absence of a normal behavior or experience

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14
Q

What disorders can have psychosis?

A

dementia
serious depression
mania
delirium

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15
Q

what is unique about schizophrenia & psychosis?

A

it is NOT an affective disorder w/ psychosis

but it can manifest as schizophrenia AND idiopathic psychosis (not d/t another disorder)

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16
Q

Schizophrenia must have 2+ sx for 1 month. what are the 3 sx that the pt MUST show ONE of?

A

delusions
hallucinations
disorganized speech

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17
Q

what are the 5 sx a pt may show for a dx of schizophrenia?

A 
delusions
hallucinations
disorganized speech
grossly disorganized or catatonic behavior
negative sx
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18
Q

Schizophrenia must have ____ sx for ___ month(s)

A

2 or more sx

1 month

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19
Q

What are the 2 exclusions for schizophrenia dx?

A

Affective disorder

Autism spectrum

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20
Q

T/F: for a dx of schizophrenia, a pt must show a decline in his/her level of function

A

TRUE

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21
Q

for how long must a pt show continuous signs for a schizophrenia dx?

A

6 months (prodromal, criterion A, or residual)

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22
Q

T/F: Schizophrenia has a spectrum

A

true

it includes 8 disorders

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23
Q

People conceived during an African famine had increased risk for what diseases?

A 
schizophrenia
depression
atherogenic plasma lipids
coronary heart disease
type 2 diabetes
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24
Q

what are 10 risk factors for schizophrenia?

A 
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
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25
Q

what are the known genes implicated in schizophrenia?

A

DISC1

neuregulin 1

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26
Q

T/F: schizophrenia is never caused by copy number variants of genes

A

false

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27
Q

several of the genetic risk factors for schizophrenia are also risk factors for what?

A

autism

mental retardation

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28
Q

T/F: for many pts, schizophrenia starts at age 10

A

FALSE

starts IN UTERO which is terrifying

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29
Q

what suggests that schizophrenia might start in utero?

A

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

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30
Q

VERY GENERALLY speaking, what can prenatal & perinatal events increase the risk of?

A

several diseases that are only apparent in ADULT life

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31
Q

what does “sufficient cause” mean?

A

causal pathway

when you do that thing, you contract disease

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32
Q

when does psychosis usually present?

A

late adolescence/early adulthood

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33
Q

when are negative sx assoc w/ psychotic disorders usually detectable?

A

childhood

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34
Q

when is cognitive impairment assoc w/ psychotic disorders usu detectable?

A

preschool children at high risk of psychosis

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35
Q

T/F: psychosis usu brings ppl to their first clinical contact

A

TRUE

it’s the usual cutoff point for the “premorbid” period

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36
Q

what is the peak age of first-admission for schizophrenia (in England)?

A

20-24 yo

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37
Q

what gives you the highest risk of relapse after the first psychotic episode?

A

medication non-adherence (4x risk)

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38
Q

what 4 things increase your risk of relapse after the first psychotic episode?

A

medication non-adherence (4x)
persistent substance use (3x)
carers’ critical comments (2.3x)
poorer premorbid adjustment (2.2x)

39
Q

what 4 things does the conceptual model of a disorder dictate?

A

assessment
treatment options offered
treatment development
research

40
Q

what is the pathophysiology of schizophrenia according to the USUAL model?

A

abnormal dopamine regulation

41
Q

what are the 2 big problems with the USUAL model of schizophrenia?

A

other NTs are involved w/ psychosis
AND
other disorders have psychotic sx

42
Q

T/F: people w/ schizophrenia have no other neuropsych probs besides psychosis

A

FALSE

they have neuropsych probs other than psychosis

43
Q

T/F: schizophrenic pts have significant problems OUTSIDE the brain

A

TRUE

44
Q

what is the strongest predictor of level of fxn in outpts?

A

cognitive impairment

45
Q

people with schizophrenia die how many years earlier than the general population?

A

20-25 years

in another place he has 15-20 so go with 20

46
Q

why is there a focus on psychosis in schizophrenic pts if they have other probs?

A

psychosis is a treatable aspect
it’s a big predictor of fxn
historical accident that distorted our conceptualization of the illness

47
Q

when does cognitive impairment present?

A

prior to psychosis onset

48
Q

T/F: all schizophrenia pts might have some degree of cognitive impairment

A

true

49
Q

what is the best predictor of a pt’s level of function?

A 
cognitive function
(NOT severity of psychotic sx!)
50
Q

what are the rates (%) of major depression in schizophrenia?

A

30-35%

2-3x gen pop

51
Q

what risk factors do schizophrenia & depression share?

A

low birth weight
prenatal famine
winter birth

52
Q

do depression & schizophrenia share aspects of pathophys?

A

yes

hella

53
Q

what % of schizophrenics have a lifetime dx of alcohol abuse/dependence?

A

34% ++

54
Q

what % of schizophrenics have a lifetime dx of substance abuse/dependence?

A

47% ++

55
Q

what drug may increase the risk of schizophrenia?

A

mary jane

56
Q

when does substance abuse increase in schizophrenics?

A

prior to onset of psychosis

57
Q

what 4 anxiety disorders have increased prevalence in schizophrenia?

A

obsessive compulsive syndrome
panic attacks
PTSD
GAD

58
Q

what are other neuropsych sx assoc w/ psychosis?

A

neurological signs
dyskinetic movements
oculomotor dysfxn
polydipsia

59
Q

Are comorbid syndromes common w/ schizophrenia?

A

YES

they’re practically the “rule”

60
Q

what is one possible explanation for why psychosis has so many comorbid conditions?

A

they probably share some common biology/pathophys

61
Q

what are 2 explanations for mechanisms of comorbid conditions w/ schizophrenia?

A

some might be part of the inherited schizo spectrum

some might share env risk factors w/ schizophrenia

62
Q

what causes the greatest number of deaths in schizophrenic pts?

A

cardiovascular disease (weirdly)

63
Q

what contributes to early death in schizophrenics?

A

antipsychotic meds > diabetes, weight gain

high prevalence of sedentary lifetsyle & smoking

64
Q

Psychotic pts have higher or lower pulse pressure than controls?

A

HIGHER

65
Q

Psychotic pts have more or less free androgens than controls?

A

LESS

66
Q

psychotic pts have higher or lower telomere content than controls?

A

LOWER

i.e. their telomeres are shorter

67
Q

what are “state markers”?

A

cytokines that change during exacerbations

68
Q

which cytokines are the “state markers”?

A

IL-1 beta
IL-6
TGF-beta

69
Q

what are “trait markers of illness”?

A

cytokines that are elevated at first clinical contact AND remain elevated

70
Q

which cytokines are the “trait markers of illness”?

A

IL-12
IFN-gamma
TNF-alpha
sIL-2R

71
Q

what things suggest accelerated aging in psychotic pts?

A 
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
72
Q

what are adult circulating stem cells?

A

multipotent (NOT pluripotent) stem cells that have a broad differentiation potential

73
Q

what are adult circulating stem cells involved in?

A

normal repair processes

74
Q

where do adult circulating stem cells reside?

A

bone marrow mostly

can be mobilized & localized to other organs

75
Q

what is the main chemokine that controls adult circulating stem cell movement?

A

SDF1alpha

stromal-derived factor 1 alpha

76
Q

What medical problem is assoc w/ abn SDF1alpha pathology?

A

diabetes

77
Q

do pts w/ psychosis have high or low SDF1alpha?

A

LOW

78
Q

do psychotic patients have normal brain volume?

A

no

decreased volume in many areas

79
Q

what are the neurons like in pts w/ psychosis?

A

decreased neuropil
increased neuron density
decreased # of neurons in some places

80
Q

in pts w/ psychosis, how is dopamine affected?

A

increased release in some regions

81
Q

what is NMDA receptor expression like in psychotic pts?

A

abnormal

82
Q

what is the white matter like in pts w/ psychosis?

A

decreased volume

abnormal fiber orientation

83
Q

what 3 things can cause transient mild increases in psychotic sx in schizophrenic pts?

A

cannabis
serotonin agonists
NMDA antagonists

84
Q

what are the 3 current treatments for psychosis?

A

antipsychotic meds
treating other neuropsych syndromes
psychosocial TX

85
Q

in terms of family interventions, what can increase risk of relapse?

A

“expressed emotion” > critical & intrusive comments

86
Q

what 5 good things can family interventions do for pts w/ psychosis?

A 
decrease relapse freq
reduce hospital admission
increase med adherence
general social fxn
decrease expressed emotion
87
Q

what does cognitive remediation help with the MOST?

A

social cognition (medium effect)

88
Q

is schizophrenia a psychotic disorder?

A

NO

which is weird because this lecture is about psychotic disorders & schizophrenia

89
Q

T/F: schizophrenia is restricted to the brain

A

false

90
Q

T/F: psychosis always has the greatest impact on schizophrenic pts fxn

A

FALSE

in some phases, other neuropsych things have the greatest impact

91
Q

are neuropsych syndromes like abn movements comorbid w/ schizophrenia or are they part of the disease?

A

part of the disease

92
Q

does schizophrenia respond to dopamine antagonists?

A

yes

variably

93
Q

what is the purpose of medical care for schizophrenic pts?

A

improve & maintain QOL
extend life
deal w/ disability, discomfort, or death

Block 8 Week 6 Rhonda (12 decks)

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