L20 - Psychosis

Question 1

Psychosis

Answer 1

Presence of hallucinations or delusions

Question 2

Hallucinations

Answer 2

Perception without a stimulus

• auditory
• visual
• touch
• taste
• smell

Question 3

Visual hallucinations

Answer 3

Normally has an organic cause like space occupying lesion

Question 4

Hypnogogic

Answer 4

• hallucination when going to sleep

Question 5

Hypnopompic

Answer 5

Hallucinations when waking up

Question 6

Delusions

Answer 6

Fixed false belief which is unshakeable and outside cultural norms

Question 7

First rank symptoms of schizophrenia

Answer 7

Auditory hallucinations
Passitivity experiences - not in control of your body
Thought withdrawal, broadcast or insertion
Delusional perception
Somatic hallucinations

Question 8

Auditory hallucinations

Answer 8

Thought echo - hearing thoughts aloud
Running commentary - voice commentating on one’s actions
Third person - voices conversing with each other about the patient

Question 9

Passivity experiences

Answer 9

Patient believes that their action or feelings is caused by an external force

Question 10

Thought withdrawal

Answer 10

Thoughts are being taken out of your mind

Question 11

Thought broadcast

Answer 11

Everyone knows what the person is thinking

Question 12

Thought insertion

Answer 12

Thoughts implanted by others

Question 13

Delusional perception

Answer 13

Attributing new meaning to a normally perceived object normally involving one’s self

Question 14

Somatic hallucinations

Answer 14

Mimics feelings from inside the body

Question 15

Positive symptoms

Answer 15

Delusions
Hallucinations
Thoughts disorder
Lack of insight

Question 16

Negative symptoms

Answer 16

Under activity 
Low motivation 
Social withdrawal 
Emotional flattening 
Self neglect

Question 17

Dopamine theory of schizophrenia

Answer 17

• Dopamine concentration too high therefore causes schizophrenia
• Drugs e.g. amphetamines cause the release of dopamine and induced psychotic symptoms
• dopamine antagonists on D2 successfully treat psychosis

Question 18

4 dopaminergic pathways in the brain

Answer 18

Mesolimbic
Mesocortical
Nigrostriatal
Tuberoinfundibular pathway

Question 19

Mesolimbic pathway

Answer 19

From: ventral tegmental area
To:
- limbic structures - amygdala, septal area and hippocampal formation
- nucleus accumbens

Overactive in schizophrenia - too much dopamine giving positive symptoms

Question 20

Mesocortical pathway

Answer 20

From: ventral tegmental area

To: frontal cortex and cingulate cortex

Under active in schizophrenia- negative symptoms

Question 21

Brain changes in schizophrenia

Answer 21

Enlarged ventricles 
Reduced grey matter - reduced brain weight 
Decreased temporal lobe volume 
Reduced:
- amygdala
- prefrontal cortex 
- parahippocampal gyrus
- hippocampal formation

Question 22

Neuropathology of schizophrenia

Answer 22

Decreased pre -synaptic markers
Decreased oligodendrolagia
Decreased thalamic neurones

= aberrant connectivity theory - inappropriate connectivity

Question 23

Other theories of schizophrenia

Answer 23

Limbic structures - regulating emotional behaviour

Basal ganglia - motor symptoms e.g. catatonia

Question 24

Typical antipsychotics

Answer 24

• block D2 receptors in all CNS dopaminergic pathways
• main action on mesolimbic and mesocortical pathways
• side effects as affects other pathways e.g Parkinsonism
• good for positive symptoms

Question 25

Atypical antipsychotics

Answer 25

Lower affinity for D2 receptors
Milder side effects a dissociate rapidly
Also block serotonin receptors

Question 26

Side effects of atypical antipsychotics

Answer 26

• impaired glucose tolerance - diabetes
• weight gain
• hypercholesterolnaemia - CHD
• prolonged QT - ventricular tachycardia

Question 27

Nigrostriatal pathway

Answer 27

From: substantia nigra pars compacta

To: striatum

By giving dopamine antagonists there is less dopamine so there is decreased movement

Question 28

Catatonia

Answer 28

More than 2 weeks of:

• mutism/ stupor
• excitement
• posturing
• negativism
• rigidity
• waxy flexibility
• command automatism

Question 29

Why do people get catatonia

Answer 29

Less GABA binding so loss of inhibitor effect

Question 30

Tuberoinfundibular pathway

Answer 30

From: arcuate and periventricular nuclei of the hypothalamus

To: infundibular region of the hypothalamus

Question 31

Hyperprolactinaemia

Answer 31

Dopamine normally inhibits prolactin release from the pituitary

Dopamine antagonists lower dopamine resulting in higher prolactin

Can cause:

• amenorrhoea
• galactorrhoea
• decreased fertility
• reduced limbic
• osteoporosis/ osteopenia

Question 32

Difficulties in treating schizophrenia

Answer 32

Lack of insight - don’t believe they are unwell

Medications are often not taken

Question 33

Alternative methods of medication delvelivery

Answer 33

Orodispersible - dissolve quickly
Short acting IM
Depot injections - long acting and slow

Question 34

Prognosis of schizophrenia

Answer 34

Earlier someone is treated the better the prognosis

Moderately good long term global outcome - 50%

Question 35

Good prognosis factors

Answer 35

Absence of family history 
Good premorbid function 
Acute onset 
Mood disturbances
Prompt treatment 
Maintenance of initiative and motivation

Question 36

Onset in males and females

Answer 36

Males - early 20s

Females - late 20s

Question 37

Consequences of schizophrenia

Answer 37

Higher mortality 
High incidences of CVS disease, resp disease and cancer 
Suicide risk 9x higher 
50% have substance misuse 
High rate of cigarette smoking