NPch24 - Neuropsychiatry Flashcards
What is neuropsychiatry?
- Neuropsychiatry is a field of medicine in which neurology, and by extension neuroscience, is necessary or at least helpful in the understanding and management of mental and behavioral illness.
- It is best viewed as an integrative specialty combining psychiatry, neurology, and neuropsychology
- Concerned with the study of psychiatric illnesses or symptoms associated with brain abnormalities
What is an example of the commonality in disease models between neurology and psychiatry mentioned in the Koliatis et al. article?
A prime demonstration of commonality in disease models and hypotheses between neurology and psychiatry is the discovery of compounds that modulate dopamine neurotransmission and the use of such compounds in psychotic patients first and then, inspired by the side effects of that use, for the treatment of Parkinson disease
- how first trials with Leva Dopa stared
- Psychosis is one condition in which such an interaction between psychology and biology is well-suited
What are 5 patient types according to neuropsychiatry?
- Type 1: Behavioural Neurology model - neuropathology is both a necessary and sufficient cause of neuropsychiatric disease and the knowledge of it is key to understand and manage psychopathology
↪ organic deficit directly related to the behavioural phenomena (e.g. behaviour of patients with traumatic brain injruy is directly related to the injury) - Type 2: Neurology as a ‘meme’ - neuropathology is probably not necessary and certainly not sufficient for symptom formation (e.g. conversion disorder - symptoms present that can’t be fully explained by organic deficit)
- Type 3: Interactive model - Neuropathology is necessary, but not a sufficient cause of symptoms and not sufficient to understand/manage psychopathology
- Type 4: Neuropsychiatry of Pain and the Autonomic Nervous System - Neuropathology originates within the peripheral nervous system & the autonomic nervous system and is related to somatoform and visceral symptoms
- Type 5: Neuropsychiatry of Psychotropic Drug Use - Psychopathology and side effects are mediated via psychotropic drugs, requiring careful differential diagnosis and management to distinguish between medication effects and disease symptoms
How can individual patient be viewed as multiple types?
A single epileptic patient can be viewed as type I (simple partial seizures arising in the temporal lobe can present with psychic phenomena), as type II (epileptic seizures commonly coincide with nonepileptic seizures), as type III (in alternative psychosis, treatment of epilepsy may bring about psychotic episodes), and as type V (the antiepileptic drug levetiracetam may cause mental status changes with aggression)
What are the different psychotic disorders in DSM-5?
Schizophrenia Spectrum and Other Psychotic Disorders
- Schizophrenia
- Delusional Disorder
- Brief Psychotic Disorder
- Schizophreniform Disorder
- Schizoaffective Disorder
- Substance/Medication-Induced Psychotic Disorder
- Psychotic Disorder Due to Another Medical Condition
Depression/bipolar disorder with psychotic features
↪ The diagnosis depends on what symptoms are on the foreground
What are DSM-5 criteria of Schizophrenia?
A. Two (or more) of the following, significant proportion of time during 1-month (at least one is 1, 2, or 3):
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behaviour
5. Negative symptoms (e.g. reduced emotional expression / avolition)
B. Reduced functioning in one or more major areas
C. Continuous signs of disturbance for at least 6 months
D. Other diagnoses ruled out (e.g. depressive disorder)
E. Not due to effects of substance or other medical condition
F. If history of autism, then delusions/hallucinations must be present
Some stats on schizophrenia
Recovery:
- 25% made full recovery
- 50% recovered at least partially
- 25% required long-term care
Support:
- Only 10% receive full course of CBT
- 24 mil. people worldwide are affected by schizophrenia, more than 50% are not receiving appropriate care
- People with schizophrenia die 15-20 yrs earlier than average, mostly die to preventable physical conditions
Treatment:
- Psychological and psychosocial treatments: CBT, arts therapy, family therapy
- Pharmacological treatments: anti-psychotic medication (serious side effects)
What is meant by psychosis spectrum?
Psychosis can be considered a spectrum through experience, symptoms, disorder
- Experience: attention captured by passing on greens all the time when biking
- Symptom: Start to create ideas about the experience such as ‘it’s a message from someone higher’
- This may develop into a disorder when you notice it all the time with everything and it causes you considerable distress
Individuals with the disorder will usually have an:
- increased conviction of experiences/idea
- increased frequency
- increase distress
How can we best predict psychosis?
Strong risk factor for psychotic disorder (20% develop PD) can be identified in clincal practice
- Psychological interventions available
- Staging model - different stages in which you can be exposed to experiences that increase your risk and vulnerability of developing PD
How do you rate perceptual abnormalities? What is an interesting thing about this scale?
Using global rating scale that has 6 ratings whith the 6th one saying:
True hallucinations which the subject believes are true at the time of, and after, experiencing them. May be very distressing
- There are visual illusions that could be considered hallucinations (the triangle)
What are purposes of biomarkers for schizophrenia?
- To help with diagnoses - combination of biomarkers, family history, symptoms presentation… the combination of these can help in better prognosis
- Prognosis
- Treatment response: precision medicine/personalised medicine
However, schizophrenia is heterogeneous and overapls with other conditions
What disorders does schizophrenia overlap with?
Looked at single nuclotide polymorphism as a genetic marker and what is the correlation in those between different disorders:
1. Bipolar and schizo - 0.7
2. Schizo and MD - 0.34
3. …
What is Research Domain Criteria (RDoC)?
Attempt to (re-)map clinical conditions from the bottom-up
- From genes, molecules, cells, to behaviour and experience
- Look at two levels at a time that are close to each other and not including all of it at once and assuming that there is a general genetic component
- Might be better suited to capture the complex nature of psychopathology
What is the dopamine hypothesis of schizophrenia
- Based on studies showing effects of dopamine receptor agonists (activates) & antagonists (blocks)
- D2 receptor is the receptor of interested in psychosis
- First antipsychotics (antagonist) blocked the receptors so that the signal doesn’t flow to the post-synaptic cell
Occurence of pos. symptoms is caused by hyperdopaminergia (too much dopamine activity) - This is good if you can be very selective about which symptoms you block however this is not the reality
- The cell can respond in creating more receptors so you have to increase the dose
- Lot of negative side effects: motor symptoms, metabolic syndrome (increased blood sugar, heart rate)…
What happens if there is too much dopamine in the synapse?
Experience of salience - something really stands out
↪ This is what happens if you give dopaminargic meds/drugs (cocaine, ritalin, metaphetamine)
- The hypothesis is based on this salience which is trying to be solved by decreasing dopamine
