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Y2 - CNS > Lecture 20 - Psychosis > Flashcards

Lecture 20 - Psychosis Flashcards

1
Q

What is the definition of Psychosis?

A

The presence of hallucinations or delusions

Its not a diagnosis it describes symptoms

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2
Q

What are hallucinations?

A

Perception without stimuli

Can be in any sensory modality (visual or auditory etc..)

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3
Q

What are the 2 types of hallucinations healthy individuals can experience?

A

Hypnogogic

Hypnopompic

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4
Q

What are hypnogogic hallucinations?

A

Hallucinations where you get them while going to sleep

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5
Q

What are hypnopompic hallucinations?

A

Hallucinations when waking up

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6
Q

What are delusions?

A

A fixed false belief which is unshakeable and outside of cultural norms

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7
Q

Do patients with schizophrenia have a split mind or personality?

A

No

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8
Q

Are schizophrenic patients more dangerous than other patients?

A

No not generally

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9
Q

What are Schneiders First Rank Symptoms of Schizophrenia?
(Pathognomic of schizophrenia)

A

Auditory hallucinations
Passivity experiences
Though withdrawal, broadcast or insertion
Delusional perceptions
Somatic hallucinations

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10
Q

What are auditory hallucinations in schizophrenia?

A

Thoughts echo
Running commentaries of action
Third person voice talking about patient

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11
Q

What are passivity experiences in schizophrenia?

A

Belief that action or feelings are caused by external forces (someone else is moving their limbs)

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12
Q

What are thought withdrawals, broadcast or insertion in schizophrenia?

A

Withdrawal (something taking their thoughts away)
Broadcast (people know what patients thinking)
Insertion (thoughts being implanted)

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13
Q

What are delusional perceptions?

A

New meanings to a normally perceived object

(Red traffic light = alien invasion)

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14
Q

What are somatic hallucinations?

A

Sense of being touched when not actually being touched

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15
Q

What are positive symptoms and negative symptoms in schizophrenia?

A

Added symptoms = Positive

Symtoms that take away from patient = Negative

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16
Q

What are some positive symptoms of Schizophrenia?

A

Delusions
Hallucinations
Thought disorders (cant organise thoughts)
Lack of insight

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17
Q

What are some negative symptoms of schizophrenia?

A

Under activity
Low motivations
Social withdrawal
Emotional flattening
Self neglect

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18
Q

What is the main theory of why Schizophrenia occurs?

A

Dopamine theory

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19
Q

What is the Dopamine Theory of Schizophrenia?

A

Drugs that release dopamine (excess) causes Psychotic symptoms

Medications antagonising Dopamine receptors treat psychosis and those who have highest affinty to D2 receptors work most effectively

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20
Q

What types of drug cause the releaese of lots of dopamine leading to schizophrenia psychosis?

A

Amphetamines

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21
Q

What are the 4 Dopamine pathways in the brain?

A

Mesolimbic
Mesocortical
Nigrostriatal
Tuberoinfundibular pathway

22
Q

What 2 dopamine pathways are thought to have different activities in schizophrenia?

A

Mesolimbic pathway
Mesocortical pathway

23
Q

How is the activity of the Mesolimbic pathway affected in schizophrenia?

A

Overactive

24
Q

How is the activity of the Mesocortical pathway affected in schizophrenia?

A

Under active

25
Q

What symptoms of schizophrenia does the overactive mesolimbic pathway produce in schizophrenia?

A

Positive symptoms

26
Q

What symptoms of schizophrenia does the underactive Mesocortical pathway produce in schizophrenia?

A

Negative symptoms

27
Q

What are some structures in the mesolimbic pathway?

A

Starts from ventral tegmental area to:

-amygdala
-hippocampus
-nucleus accumbens

28
Q

What symptoms of schizophrenia does the under active mesocortical pathway produce in schizophrenia?

A

Negative symptoms

29
Q

What are some structures in the mesolimbic pathway?

A

Ventral tegmental area to:
-amygdala
-hippocampus
-nucleus accumbens

30
Q

What are some structures in the mesocortical pathway?

A

From ventral tegmental area to:
-frontal cortex
-cingulate cortex

31
Q

What are some brain changes in schizophrenia?

A

Enlarged ventricles
Reduced grey matter
Decreased temporal lobe volume
Reduced hippocampal formation, amygdala, parahippocampal gurus (all lambic structures)
Reduced prefrontal cortex formation

32
Q

What are the neuorpathological changes seen in schizophrenia?

A

Decreased synaptic markers
Decreased Oligodendrocytes
Less thalamic neurones

33
Q

Why can some patients with schizophrenia present with motor symtoms?

A

Sometimes basal ganglia can be affected

34
Q

What is the treatment for Schizophrenia?

A

Antipsychotics that block D2 receptors in dopaminergic pathways in CNS
(Typical and Atypical antipsychotics)

35
Q

Where is the main site of action of typical antipsychotics?

A

D2 receptors in all CNS dopaminergic pathways but mainly on Mesolimbic and Mesocortical pathways

36
Q

What causes the side effects of typical antipsychotics?

A

Antagonism of D2 receptors in other pathways that aren’t the mesolimbic and Mesocortical pathways in the CNS

37
Q

Why do atypical antipsychotics have milder side effects than typical antipsychotics?

A

They dissociates rapidly from D2 receptors since have lower affinty

38
Q

What other receptors except for D2 receptors to atypical antipsychotics block?

A

5HT2 so have some action on serotonin systems

39
Q

What are some side effects of atypical antipsychotics?

A

Obesity
Hyperlipidaemia
Glucose intolerance

40
Q

Why can giving antipsychotics lead to drug induced Parkinson’s?

A

Dopamine blocked in the nigrostriatal pathway

Less dopamine = less movement harder to initiate movement
So direct pathway of basal ganglia not stimulated so the thalamus doesn’t receive as much inhibition so get tremor

41
Q

What structures are part of the nigrostriatal pathway?

A

Substantial nigra pars compacta
Striatum (caudate and putamen)

42
Q

What are the 4 key signs in Parkinson’s disease?

A

Brady Kinesin
Lead pipe rigidity
Pil rolling tremor
Hypertonia

43
Q

What is Catatonia?

What causes it?

A

Excess of dopamine for some reason leads to slow movement

Seen in extreme schizophrenia

44
Q

What is thought to cause catatonia?
How’s it treated?

A

Excess dopamine in schizophrenia leads to less GABA being able to bind so lose inhibitory effects of neurones

GIVE LORAZEPAM

45
Q

What is the tuberoinfundibular pathway?

A

From arcuate and periventricular nuclei of hypothalamus

To infundibular region of hypothalamus

46
Q

Why can you get Hyperprolactinaemia when giving antipsychotics?

A

Antipsychotics antagonise dopamine
Dopamine normally inhibits prolactin
So giving antipsychotics mean less dopamine to inhibit prolactin

47
Q

What are the side effects of antipsychotics causing Hyperprolactinaemia?

A

Decreased fertility
Reduced libido
Amenorrhoea
Galactorrhoea
Long term, osteopenia/osteoporosis

48
Q

Why is it difficult to treat people with schizophrenia?

A

They lack insight (don’t believe they’re unwell)
Medication adherence is therefore often poor

49
Q

How can antipsychotic medications be administered with schizophrenics?

A

PO
Short acting IM
Depot

50
Q

What are some good prognostic factors for schizophrenia?

A

Absence of FHx
Good premorbid function
Acute onset
Mood disturbance
Prompt treatment
Maintenance of initiative and motivation

51
Q

What are some long term complications of schizophrenia?

A

Mortality is twice as high as in general population
Shorter life expectancy (-ve symptoms so unlikely to make healthy choices and drugs given increase CVS risk)
Higher CVS disease, resp and cancer incidence
Inc suicide risk
Substance misuse problems
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Y2 - CNS (21 decks)

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