L20 - Psychosis Flashcards

1
Q

Psychosis

A

Presence of hallucinations or delusions

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2
Q

Hallucinations

A

Perception without a stimulus

  • auditory
  • visual
  • touch
  • taste
  • smell
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3
Q

Visual hallucinations

A

Normally has an organic cause like space occupying lesion

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4
Q

Hypnogogic

A
  • hallucination when going to sleep
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5
Q

Hypnopompic

A

Hallucinations when waking up

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6
Q

Delusions

A

Fixed false belief which is unshakeable and outside cultural norms

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7
Q

First rank symptoms of schizophrenia

A

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

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8
Q

Auditory hallucinations

A

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

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9
Q

Passivity experiences

A

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

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10
Q

Thought withdrawal

A

Thoughts are being taken out of your mind

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11
Q

Thought broadcast

A

Everyone knows what the person is thinking

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12
Q

Thought insertion

A

Thoughts implanted by others

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13
Q

Delusional perception

A

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

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14
Q

Somatic hallucinations

A

Mimics feelings from inside the body

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15
Q

Positive symptoms

A

Delusions
Hallucinations
Thoughts disorder
Lack of insight

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16
Q

Negative symptoms

A
Under activity 
Low motivation 
Social withdrawal 
Emotional flattening 
Self neglect
17
Q

Dopamine theory of schizophrenia

A
  • 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
18
Q

4 dopaminergic pathways in the brain

A

Mesolimbic
Mesocortical
Nigrostriatal
Tuberoinfundibular pathway

19
Q

Mesolimbic pathway

A

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

Overactive in schizophrenia - too much dopamine giving positive symptoms

20
Q

Mesocortical pathway

A

From: ventral tegmental area

To: frontal cortex and cingulate cortex

Under active in schizophrenia- negative symptoms

21
Q

Brain changes in schizophrenia

A
Enlarged ventricles 
Reduced grey matter - reduced brain weight 
Decreased temporal lobe volume 
Reduced:
- amygdala
- prefrontal cortex 
- parahippocampal gyrus
- hippocampal formation
22
Q

Neuropathology of schizophrenia

A

Decreased pre -synaptic markers
Decreased oligodendrolagia
Decreased thalamic neurones

= aberrant connectivity theory - inappropriate connectivity

23
Q

Other theories of schizophrenia

A

Limbic structures - regulating emotional behaviour

Basal ganglia - motor symptoms e.g. catatonia

24
Q

Typical antipsychotics

A
  • 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
25
Q

Atypical antipsychotics

A

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

26
Q

Side effects of atypical antipsychotics

A
  • impaired glucose tolerance - diabetes
  • weight gain
  • hypercholesterolnaemia - CHD
  • prolonged QT - ventricular tachycardia
27
Q

Nigrostriatal pathway

A

From: substantia nigra pars compacta

To: striatum

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

28
Q

Catatonia

A

More than 2 weeks of:

  • mutism/ stupor
  • excitement
  • posturing
  • negativism
  • rigidity
  • waxy flexibility
  • command automatism
29
Q

Why do people get catatonia

A

Less GABA binding so loss of inhibitor effect

30
Q

Tuberoinfundibular pathway

A

From: arcuate and periventricular nuclei of the hypothalamus

To: infundibular region of the hypothalamus

31
Q

Hyperprolactinaemia

A

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
32
Q

Difficulties in treating schizophrenia

A

Lack of insight - don’t believe they are unwell

Medications are often not taken

33
Q

Alternative methods of medication delvelivery

A

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

34
Q

Prognosis of schizophrenia

A

Earlier someone is treated the better the prognosis

Moderately good long term global outcome - 50%

35
Q

Good prognosis factors

A
Absence of family history 
Good premorbid function 
Acute onset 
Mood disturbances
Prompt treatment 
Maintenance of initiative and motivation
36
Q

Onset in males and females

A

Males - early 20s

Females - late 20s

37
Q

Consequences of schizophrenia

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