Neurobiology and clinical features of psychosis Flashcards
What is psychosis?
- a loss of boundaries with reality and loss of insight (aware that something is wrong with them)
Psychosis is a loss of boundaries with reality and loss of insight (aware that something is wrong with them). What are the primary features of psychosis?
- delusions
- hallucinations
- conceptual disorganisation
- negative symptoms (flat affect (mood), low motivation, social skills)
- cognitive disorder
Neurodevelopmental trajectories are longitudinal developmental patterns captured by behavioural features such as motor function and language, in the general population as a whole. Which neurotransmitter is proposed to excite the pre-frontal synapses that may prime a patient into developing psychosis?
1 - serotonin
2 - dopamine
3 - acetylcholine
4 - glutamate
4 - glutamata
When we talk about patients hearing voices, we can hear the examples where people say it was 2nd and 3rd person. What does 2nd and 3rd person mean in terms of psychosis?
- 2nd = when someone refers to you. For example: ‘you can wait here’
- 3rd = when you are being talked about. For example: ‘he is being unreasonable’
What are hallucinations?
1 - patient is able to sense (hear, smell, taste etc) something that doesn’t exist, but no external stimulus
2 - patient has false and fixed belief that doesn’t keep with non social grounding
3 - loses touch with social surroundings like not there but looking from outside through glass
4 - loses touch with social surrounding and no longer interacts with society
1 - patient is able to sense (hear, smell, taste etc) something that doesn’t exist, but no external stimulus
Hallucinations are where someone sees, hears, smells, tastes or feels things that don’t exist outside their mind (only they experience this), with no external stimulus. Essentially patients experience a perception without a stimulus. What does it mean to have a perception, but no stimulus?
1 - neurons in brain fire, telling the brain something is there, but there is no auditory stimulus
2 - neurons in brain do not fire, but brain thinks something is there, no auditory stimulus
3 - neurons in brain fire, telling the brain something is there, with auditory stimulus
1 - neurons in brain fire, telling the brain something is there, but there is no auditory stimulus
- auditory processing of the brain is firing and hearing something
- no auditory stimulus was provided in the first place, so auditory processing of the brain is working without an auditory stimulus
What does it mean when a patient has insight into psychosis?
- they are aware of their condition
- they are aware what is happening (voices etc) are abnormal
- do they think their condition requires treatment
What is schizophrenia?
- form of psychosis
- patient may not always be able to distinguish their own thoughts and ideas from reality
In clinical practice symptoms of psychosis are often grouped into 3 categories. What are the 3 categories?
1 - good, bad, cognitive
2 - positive, neutral and negative
3 - positive, negative and cognitive
4 - negative, positive and neutral
3 - positive, negative and cognitive
In clinical practice symptoms of psychosis are often grouped into 3 categories:
1 - positive symptoms
2 - negative symptoms
3 - cognitive symptoms
Positive symptoms are those that are most well known. What are the 3 positive symptoms?
1 - hallucinations, delusions, disordered thoughts
2 - flat affect, poor motivation, loss of social skills, poverty of thought
3 - flat affect, poor motivation, disordered thoughts
4 - hallucinations, delusions, loss of social skills
1 - hallucinations, delusions, disordered thoughts
In clinical practice symptoms of psychosis are often grouped into 3 categories:
1 - positive symptoms
2 - negative symptoms
3 - cognitive symptoms
What are the 4 negative symptoms?
1 - hallucinations, delusions, disordered thoughts
2 - flat affect, poor motivation, loss of social skills, poverty of thought
3 - flat affect, poor motivation, disordered thoughts
4 - hallucinations, delusions, loss of social skills
2 - flat affect, poor motivation, loss of social skills, poverty of thought
- flat affect (lack of expression)
- poor motivation
- loss of social skills
- poverty of thought
In clinical practice symptoms of psychosis are often grouped into 3 categories:
1 - positive symptoms
2 - negative symptoms
3 - cognitive symptoms
What are the 3 cognitive symptoms?
1 - hallucinations, delusions, disordered thoughts
2 - flat affect, poor motivation, loss of social skills, poverty of thought
3 - flat affect, poor motivation, disordered thoughts
4 - poor attention, poor memory, poor planning ability
4 - poor attention, poor memory, poor planning ability
Psychosis is an illness characterised by a loss of boundaries with reality and loss of insight, with primary features of delusions, hallucinations, conceptual disorganisation, negative symptoms and cognitive disorder. A psychotic episode must include any of these symptoms with a significant severity, delusions, hallucinations, conceptual disorganisation, negative symptoms and cognitive disorder). How long does a psychotic episode need to last to be called a psychotic episode?
1 - 1 episode = >1 week
2 - 1 episode = >2 weeks
3 - 1 episode = >3 weeks
4 - 1 episode = >4 weeks
1 - 1 episode = >1 week
What is a delusion?
1 - patient is able to sense (hear, smell, taste etc) something that doesn’t exist, but no external stimulus
2 - patient has false and fixed belief that doesn’t keep with non social grounding
3 - loses touch with social surroundings like not there but looking from outside through glass
4 - loses touch with social surrounding and no longer interacts with society
2 - patient has false and fixed belief that doesn’t keep with non social grounding
What is the difference between hallucinations vs delusions?
- BOTH are part of a false reality
- hallucination is a sensory perception
- delusion is a false belief
Hallucinations and delusions are BOTH part of a false reality. However, hallucination are a sensory perception and delusion are a false belief. Give an example of a hallucinations and delusion?
- hallucinations can involve seeing someone who isn’t there or hearing people talking when there is no one around
- delusions, on the other hand, can involve someone thinking they are a celebrity when they’re not, for example
During imaging of auditory hallucinations, oddly which part of the brain involved with speech has been shown to be activated?
1 - brodmanns areas 1, 2 and 3
2 - brodmanns area 4
3 - brodmanns area 17
4 - brodmanns areas 44 and 45
4 - brodmanns area 44 and 45
- commonly referred to as Brocas area and are important for hearing
The figure below shows data where patients listened and thought about words after in controls and patients with schizophrenia who are prone to auditory hallucinations. What does the figure tell us?
- both groups have similar neuronal activity when listening to an external stimulus
- controls switch off neuronal parts when thinking about words, but schizophrenia patients have higher activity suggesting this may be due to increase neuronal activity
- THIS COULD PRESENT AS AN AUDITORY HALLUCINATION, AS THEY HAVE A STIMULUS IN THEIR HEADS ONLY
The superior longitudinal fascicules is a white matter tract that connects what?
1 - frontal cortex t auditory areas
2 - frontal speech with auditory areas
3 - motor cortex with auditory areas
4 - occipital cortex with auditory areas
2 - frontal speech with auditory areas
- important in patient who have auditory hallucinations
If you are a monozygotic twin (identical twins result from the fertilisation of a single egg that splits in two), is the genetic risk of schizophrenia high?
1 - 10%
2 - 25%
3 - 50%
4 - 99%
3 - 50%
- other 50% is proposed to be environmental factors
What are neurodevelopmental trajectories?
- longitudinal developmental patterns captured by behavioural features such as motor function and language, in the general population as a whole
Neurodevelopmental trajectories are longitudinal developmental patterns captured by behavioural features such as motor function and language, in the general population as a whole. Which neurotransmitter is proposed to inhibit the pre-frontal synapses that may prime a patient into developing psychosis?
1 - dopamine
2 - serotonin
3 - glutamate
4 - GABA
4 - GABA
Neurodevelopmental trajectories are longitudinal developmental patterns captured by behavioural features such as motor function and language, in the general population as a whole. Around 23 years of age there are 2 key things that happen to neuronal activity that may predispose patients into developing psychosis?
1 - excessive inhibitory and reduced interneuronal activity
2 - excessive inhibitory and reduced interneuronal activity
3 - excessive excitatory and increased interneuronal activity
4 - excessive excitatory and reduced interneuronal activity
4 - excessive excitatory and reduced interneuronal activity
- reduced interneuron activity, brains ability to inhibit could lead to positive symptoms
- excessive excitatory pruning performed when young as we generally have too many (could account for negative and cognitive symptoms)
There are some theories that suggest psychosis is due to an abnormal neurodevelopment disorder and interferences in the normal neural development. The first phase is called the premorbid phase, what does this mean?
- refers to an individual’s social, interpersonal, academic, and occupational functioning prior to the onset of psychotic symptoms
- said to be a measure of how likely it is a patient will develop psychosis
There are some theories that suggest psychosis is due to an abnormal neurodevelopment disorder and interferences in the normal neural development. The second phase is called the prodromal phase, what does this mean?
- where a patient starts to experience changes in themselves
- BUT have not yet started experiencing clear-cut psychotic symptoms
There are some theories that suggest psychosis is due to an abnormal neurodevelopment disorder and interferences in the normal neural development. The third phase is called the progression phase, what does this mean?
- patients symptoms may go up and down as they age
- they can become stable or relapse
What is functional MRI?
- MRI that measures brain activity
- brain activity is detected by changes blood flow
Functional MRI is an MRI that measures brain activity by detecting changes in blood flow. How can this be useful in psychosis and schizophrenia?
- can monitor patients brains when they are having hallucinations
- when they hear voices we can see activity in the auditory cortex
- so patients brains are active during hallucinations
