Module 4 psychotic disorders Flashcards
What are persecutory delusions?
belief that one is going to be harmed or harassed by an individual or group
What is a grandiose delusion?
an individual believes he has exceptional abilities
What are erotomanic delusions?
believes falsely someone else is in love with them
What is referential delusions?
Everything around them has meaning to them or refers to them
What is nihilistic delusions?
The thought that a maor catastrophe will occur
What is a somatic delusion?
Preoccupation with health and organ function
What are bizarre delusions?
Clearly implausible, not understandable based on cultural context, includes:
Thought withdrawal, thought insertion, or delusions of control of mind or body by outside force
What is the most common type of hallucination?
auditory
Tell me about auditory hallucinations as you fall asleep.
They are considered normal
What is included in disorganized thinking (speech)?
derailment or loose associations (one topic to another) or word salad (severely disorganized)
What is catatonic behavior?
decreased reactivity to environment, can occur in many mental, medical disorders
What are the 5 negative symptoms?
Affective blunting, avolition, anhedonia, alogia, asociality
What does affective blunting mean?
decreased range of emotions
What does avolition mean?
Reduced desire, motivation, persistence
What is anhedonia
reduced ability to experience pleasure
What does alogia mean?
poverty of speech
What does asociality mean?
reduced social drive and interaction
What are some observable signs of negative symptoms?
reduced speech, poor grooming, limited eye contact
What are some identified signs of negative symptoms with questioning?
reduced emotional responsiveness, reduced interest, reduced social drive
What symptoms are considered part of schizophrenia? (5)
delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms
How long should symptoms last in schizophrenia?
6 months
In schizophrenia, how long should predromal or residual symptoms as well as criterion A be present?
1 month
How many criterion A symptoms must be present in schizophrenia?
2
How many Criterion A must be present in schizophreniform be present?
2 or more
How long should symptoms be present in schizophreniform be present?
greater than 1 month but less than 6 months
What is the difference of impairment between schizophrenia and schizophreniform?
In schizophrenia, function must be severely impaired while schizophreniform may be impaired but it is not criteria
What is the prevalence of schizophrenia?
0.3-1%
What are the biggest indicators of brief psychotic disorder?
Sudden onset, does not include negative symptoms, and lasts longer than 1 day but less than 1 month, returns to premorbid function
What is the prevalence of brief psychotic disorder?
9% of first onset psychosis, twice as common in females, average onset in mid 30’s
What are the biggest indicators of delusional disorder?
presence of 1 or more delusions for more than 1 month, hallucinations are only related to theme and not prominent if present, function is not markedly impaired
What is the prevalence of delusional disorder?
0.2%
What psychotic symptoms are present in substance/medication induced psychotic disorder?
hallucination and delusion
When do symptoms occur with substance/medication induced psychotic disorder?
during or soon after substance intoxication withdrawal, or after exposure to a medication
What is the level of impairment with substance/medication-induced psychotic disorder?
significant impairment or distress in various functional domains
What symptoms indicate schizoaffective disorder?
2 or more symptoms present in schizophrenia criterion A, delusions or hallucinations for 2 or more weeks without a major mood episode during the lifetime of the illness.
What is the function level of a person with pschizoaffective disorder?
impaired, but not as impaired as schizophrenia
Explain specified/ unspecified schizophrenia disorder
Specified: significant distress in various functional domains but doesn’t meet full criteria for disorder and the clinician explains the reasoning. Unspecified: same but the clinician does not explain the reasoning
What setting would specified schizophrenia disorder occur in?
outpatient settings with initial visit
What setting would specified schizophrenia disorder occur in?
ED with insufficient historical information
Catatonia is associated with what 5 other disorders?
neurodevelopmental, psychotic, bipolar, depressiv
What are the essential features of catatonia?
marked psychomotor disturbance; ranges from marked unresponsiveness to marked agitation
What are some of the features of catatonia?
stupor (severe motor immobility); cataplexy (passive induction of a posture held against gravity); waxy flexibility (slight even resistance to positioning by examiner); mutism (no, or very little response); negativism (opposition or no response to instructions or external stimuli); posturing (spontaneous and active maintenance of a posture against gravity); mannerism (add, circumstantial caricature of normal actions); stereotypy (repetitive, abnormally frequent, non-goal-directed movements); grimacing; echolalia (mimicking another’s speech); echopraxia (mimicking another’s movements)
How many of the features of catatonia must be present to qualify?
3 or more
What are abnormal brain structures of schizophrenia?
enlarged ventricles, smaller frontal temporal lobes, cortical atrophy, decreased cerebra blood flow, hippocampal and amygdala reduction
Positive symptoms include (7)
delusions, hallucinations, distortions/exaggerations in language and communication, disorganized speech, disorganized behavior, catatonic behavior, agitation
The mesocortical dopamine pathway is responsible for what types of symptoms in treated and untreated psychosis?
Treated and untreated
what is the consequence of neurodevelopmental abnormalities in NMDA system?
Mesocortical Dopamine pathway
In treated psychosis, the mesolimbic is…..
normal
In treated psychosis, the mesocortical is….
normal or continued low, depending on medication chosen
In treated psychosis, what happens to the nigrostriatal pathway?
normal or low resulting in extrapyramidal side effects EPS) depending on medication
What is tardive dyskinesia the result of?
result of chronic D2 blockade in the nigrostriatal pathway
How does D2 cause tardive dyskinesia?
compensatory upregulation of dopamine receptors with compensatory increase in dopamine release
What is the treatment of tardive dyskinesia?
dopamine blockers, withdrawal of D2 antagonist, different D2 antagonist (SGA)
What happens to the tuberoinfundibular pathway with treatment?
normal or low dopamine levels resulting in elevated prolactin depending on the medication
What is glutamate?
Major excitatory neurotransmitter, controls many other NT’s including DA
There are 3 glutamate receptors. What is the most relevant one to psychotic symptoms?
NMDA
What is the relation of release of glutamate and dopamine?
If there is too much glutamate, there is too much dopamine
What glutamate pathway includes the mesolimbic and mesocortical DA pathways?
Cortico-brainstem
What symptoms are related to the cortico brainstem glutamate pathway?
positive and negative
The cortico-brainstem dopamine pathway projects to what neurotransmitter centers?
Raphe Nucleus, VTA and SN, and Locus Coerelus
Which NT is found in the Raphe Nucleus?
Seratonin
Which NT is found in the VTA and SN?
Dopamine
Which NT is found in the Locus Coerelus?
Norepinephrine
What type of pathway is the cortico brainstem dopamine pathway?
descending from top to bottom and outer to inner brain
What type of receptor is the NMDA receptor?
ligand gated ion channel
What blocks the gate of the ion channel in the NMDA receptor?
Magnesium
What is necessary for a ligand gated ion channel to work properly?
glutamate must be in the receptor, glycine or D-serine, and both are synthesized by neighboring glial cells for depolarization
What symptoms are produced in untreated psychosis in the VTA to VMPFC in the mesocortical dopamine pathway?
negative and affective symptoms due to hypoactive pathway
What symptoms are produced in untreated psychosis in the VTA to DLPFC in the mesocortical dopamine pathway?
negative and cognitive symptoms due to hypoactive pathway
What is the difference in the nigrostriatal dopamine pathway with treated and untreated schizophrenia?
the pathway is normal i untreated psychosis. The pathway is abnormal with treated.
What is the pathway in the nigrostriatal dopamine pathway?
substantia nigra to basal ganglia
What is the pathway in the tuberoinfundibular dopamine pathway?
hypothalamus to anterior pituitary
What is the function of the tuberoinfundibular dopamine pathway in treated and untreated psychosis?
pathway is normal in untreated psychosis and abnormal in untreated psychosis
In untreated psychosis, what is the activity in the 4 dopamine pathways?
mesocortical is underactive, mesolimbic is overactive, nigrostriatal is normal, tuberfundibular is normal
What is the function of the dopamine pathways with treated psychosis?
mesolimbic is normal, mesocortical is normal or continued low depending on the medication, Nigrostriatal is normal or low resulting in EPS or TD depending on the medication, Tuberoinfundibular is normal or low, resulting in elevated prolactin level depending on medication
WHat is the moa in first generation antipsychotic agents
pure D2 antagonists in all DA pathways
What is the result of blocking D2 receptors?
decreases positive symptoms but blocks “the pleasure center and does not treat negative symptoms or co-occuring substance abuse
What 2 drugs are considered high metabolic risk?
Clozaril, Zyprexa
What 4 drugs are considered moderate metabolic risk?
Risperdal, Invega, Seroquel, Fanapt
Which 6 drugs are considered low metabolic risk?
Geodon Abilify, Latuda, Fanapt, Saphris, Rexulti, Vraylar
