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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
what are the known genes implicated in schizophrenia?
DISC1 | neuregulin 1
26
T/F: schizophrenia is never caused by copy number variants of genes
false
27
several of the genetic risk factors for schizophrenia are also risk factors for what?
autism | mental retardation
28
T/F: for many pts, schizophrenia starts at age 10
FALSE | starts IN UTERO which is terrifying
29
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
30
VERY GENERALLY speaking, what can prenatal & perinatal events increase the risk of?
several diseases that are only apparent in ADULT life
31
what does "sufficient cause" mean?
causal pathway | when you do that thing, you contract disease
32
when does psychosis usually present?
late adolescence/early adulthood
33
when are negative sx assoc w/ psychotic disorders usually detectable?
childhood
34
when is cognitive impairment assoc w/ psychotic disorders usu detectable?
preschool children at high risk of psychosis
35
T/F: psychosis usu brings ppl to their first clinical contact
TRUE | it's the usual cutoff point for the "premorbid" period
36
what is the peak age of first-admission for schizophrenia (in England)?
20-24 yo
37
what gives you the highest risk of relapse after the first psychotic episode?
medication non-adherence (4x risk)
38
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)
39
what 4 things does the conceptual model of a disorder dictate?
assessment treatment options offered treatment development research
40
what is the pathophysiology of schizophrenia according to the USUAL model?
abnormal dopamine regulation
41
what are the 2 big problems with the USUAL model of schizophrenia?
other NTs are involved w/ psychosis AND other disorders have psychotic sx
42
T/F: people w/ schizophrenia have no other neuropsych probs besides psychosis
FALSE | they have neuropsych probs other than psychosis
43
T/F: schizophrenic pts have significant problems OUTSIDE the brain
TRUE
44
what is the strongest predictor of level of fxn in outpts?
cognitive impairment
45
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
46
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
47
when does cognitive impairment present?
prior to psychosis onset
48
T/F: all schizophrenia pts might have some degree of cognitive impairment
true
49
what is the best predictor of a pt's level of function?
``` cognitive function (NOT severity of psychotic sx!) ```
50
what are the rates (%) of major depression in schizophrenia?
30-35% | 2-3x gen pop
51
what risk factors do schizophrenia & depression share?
low birth weight prenatal famine winter birth
52
do depression & schizophrenia share aspects of pathophys?
yes | hella
53
what % of schizophrenics have a lifetime dx of alcohol abuse/dependence?
34% ++
54
what % of schizophrenics have a lifetime dx of substance abuse/dependence?
47% ++
55
what drug may increase the risk of schizophrenia?
mary jane
56
when does substance abuse increase in schizophrenics?
prior to onset of psychosis
57
what 4 anxiety disorders have increased prevalence in schizophrenia?
obsessive compulsive syndrome panic attacks PTSD GAD
58
what are other neuropsych sx assoc w/ psychosis?
neurological signs dyskinetic movements oculomotor dysfxn polydipsia
59
Are comorbid syndromes common w/ schizophrenia?
YES | they're practically the "rule"
60
what is one possible explanation for why psychosis has so many comorbid conditions?
they probably share some common biology/pathophys
61
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
62
what causes the greatest number of deaths in schizophrenic pts?
cardiovascular disease (weirdly)
63
what contributes to early death in schizophrenics?
antipsychotic meds > diabetes, weight gain | high prevalence of sedentary lifetsyle & smoking
64
Psychotic pts have higher or lower pulse pressure than controls?
HIGHER
65
Psychotic pts have more or less free androgens than controls?
LESS
66
psychotic pts have higher or lower telomere content than controls?
LOWER | i.e. their telomeres are shorter
67
what are "state markers"?
cytokines that change during exacerbations
68
which cytokines are the "state markers"?
IL-1 beta IL-6 TGF-beta
69
what are "trait markers of illness"?
cytokines that are elevated at first clinical contact AND remain elevated
70
which cytokines are the "trait markers of illness"?
IL-12 IFN-gamma TNF-alpha sIL-2R
71
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 ```
72
what are adult circulating stem cells?
multipotent (NOT pluripotent) stem cells that have a broad differentiation potential
73
what are adult circulating stem cells involved in?
normal repair processes
74
where do adult circulating stem cells reside?
bone marrow mostly | can be mobilized & localized to other organs
75
what is the main chemokine that controls adult circulating stem cell movement?
SDF1alpha | stromal-derived factor 1 alpha
76
What medical problem is assoc w/ abn SDF1alpha pathology?
diabetes
77
do pts w/ psychosis have high or low SDF1alpha?
LOW
78
do psychotic patients have normal brain volume?
no | decreased volume in many areas
79
what are the neurons like in pts w/ psychosis?
decreased neuropil increased neuron density decreased # of neurons in some places
80
in pts w/ psychosis, how is dopamine affected?
increased release in some regions
81
what is NMDA receptor expression like in psychotic pts?
abnormal
82
what is the white matter like in pts w/ psychosis?
decreased volume | abnormal fiber orientation
83
what 3 things can cause transient mild increases in psychotic sx in schizophrenic pts?
cannabis serotonin agonists NMDA antagonists
84
what are the 3 current treatments for psychosis?
antipsychotic meds treating other neuropsych syndromes psychosocial TX
85
in terms of family interventions, what can increase risk of relapse?
"expressed emotion" > critical & intrusive comments
86
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 ```
87
what does cognitive remediation help with the MOST?
social cognition (medium effect)
88
is schizophrenia a psychotic disorder?
NO | which is weird because this lecture is about psychotic disorders & schizophrenia
89
T/F: schizophrenia is restricted to the brain
false
90
T/F: psychosis always has the greatest impact on schizophrenic pts fxn
FALSE | in some phases, other neuropsych things have the greatest impact
91
are neuropsych syndromes like abn movements comorbid w/ schizophrenia or are they part of the disease?
part of the disease
92
does schizophrenia respond to dopamine antagonists?
yes | variably
93
what is the purpose of medical care for schizophrenic pts?
improve & maintain QOL extend life deal w/ disability, discomfort, or death

Block 8 Week 6 Rhonda (12 decks)

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