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NSB > Psychosis > Flashcards

Psychosis Flashcards

1
Q

What is psychosis?

A

Illness characterised by loss of boundaries with reality and loss of insight, with primary features of delusions, negative symptoms and cognitive disorder

1 week duration at significant severity = psychotic episode

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2
Q

Delusion:

A

Belief that is fixed, false and not keeping with socio-cultural milieu

held firmly, not affected by evidence to the contrary

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3
Q

Conceptual Disorganisation:

A

thought processes are confused and disconnected as demonstrated by what they say

observed (not complained of by patient)

aka loosing of associations of thought

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4
Q

Hallucination:

A

perception experienced in the absence of an external stimulus

in any sensory modality but most common is auditory

due to internal pereception attribution error

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5
Q

What are the three categories of symptoms of psychosis?

A
  • positive symptoms (gain)
  • negative symptoms (loss)
  • cognitive symptoms
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6
Q

Psychosis Symptoms:

A
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7
Q

Auditory Hallucinations in Schizophrenia:

A
  • 60-70% of patients
  • usually, derogatory voices
  • 25% patients made a suicide attempt
    in response to these voices
  • refractory to treatment in 25-30%
    patients
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8
Q

Neural Activity during auditory hallucinations shows

A

speech generation areas active likely misperception of inner thought

left superior temporal gyrus

failure to attenuate somatosensory cortex during self speech; hence perceived as other speech

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9
Q

White Matter Connections:

A

superior longitudinal fasciculus connects speech areas to temporal auditory perception areas

connects brocas and wernickers
broca = generation

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10
Q

Risk factors for Psychosis:

A
  • obstetric complication
  • childhood trauma
  • immigration status
  • cannabis use
  • male gender

genetic risk of schizophrenia

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11
Q

Risk factors for schizophrenia are bot

A

environmental and genetic and same as psychosis

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12
Q

Why does schizophrenia present between late teens and early twenties?

A
  • deficient myelination
  • reduced interneuron activity
  • excessive excitatory pruning

more inhibitory synapses and less excitatory synapses at this developmental stage

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13
Q

Trajectory of Psychosis: Stages:

A
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14
Q

How many dopaminergic pathways are ther in the brain?

A

4

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15
Q

Dopaminergic Pathways:

A
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16
Q

Dopaminergic Pathways: Mesolimbic:

  • function (2)
  • function 1 relation to
    psychosis/symptoms
  • function 2 relation to psychosis
A
  • regulates the limbic system, which is
    involved in reward processing
    (pleasure) and salience (threat
    evaluation)
  • psychosis = dysfunction of the salient
    part of the mesolimbic pathway;
    generally hyperactive mesolimbic
    pathways hence delusions
  • drugs of abuse target the reward
    processing pathway, creating feelings
    of pleasure
  • chronic drug use can lead to the
    dysregulation of the salient part,
    causing drug-induced psychosis
17
Q

Which dopamine receptor is most linked to psychosis?

A

D2

18
Q

Which dopaminergic system is depicted below?

A

The Mesolimbic system

19
Q

Dopaminergic Pathway: Mesocortical System:

  • function
  • psychosis
  • symptoms
A
  • regulates the prefrontal cortex, which
    is involved in: cognition, motivation,
    social engagement
  • psychosis = dysfunction of
    mesocortical system = hypoactive
  • results in reduced stimulation of the
    prefrontal cortex causing the negative
    symptoms of psychosis (cognitive
    impairment and social withdrawal)
20
Q

Which dopaminergic pathway is depicted below?

A

Mesocortical System

21
Q

Dopaminergic Pathway: Nigrostriatal System:

*not involved in developing symptoms
of schizophrenia but are targeted by
antipsychotics

A
  • regulates the basal ganglia, which is
    involved in movement and initiation of
    movement
  • antipsychotics can interfere causing
    impaired movement ->parkinsonian symptoms (ridgidity, akinesia, tremor)
22
Q

Which dopaminergic pathway is depicted below?

A

Nigrostriatal System

23
Q

Dopaminergic Pathway: Tuberoinfundibular Syystem:

*not involved in developing symptoms
of schizophrenia but are targeted by
antipsychotics

A
  • regulates HPA, which is involved in
    control of endocrine system; sex and
    growth hormones
  • antipsychotics can interfere causing
    hormonal problems
24
Q

Which dopaminergic pathway is depicted below?

A

Tuberoinfundibular System

25
Q

Antipsychotics:
- mechanism of action
- effects
- effect

A
  • post-synaptic dopamine antagonists
  • all antipsychotics modulate the
    dopaminergic system
  • to have an effect must block 60-70% of
    dopamine receptors
26
Q

Effects of antipsychotic drugs on the mesolimbic system:

A
  • suppress both pleasure (reward
    processing) and threat evaluation

side effect = dysphoria (loss of pleasure
in life)
hence patients may not comply

27
Q

Effects of antipsychotic drugs on the mesocortical system:

A
  • suppresses the mesocortical system
    further
  • worsens negative symptoms (social
    withdrawal etc)
  • good for positive symptoms which are
    from mesolimbic dysfunction
28
Q

Newer atypical antipsychotics target

A

suppression of mesolimbic, whilst stimulating mesocortical

29
Q

Differences between first and second generation antipsychotic side effects:

A
  • second gen do not cause movement
    and hormonal problems
  • second gen cause cardio-metabolic
    symptoms like early onset diabetes
    and CVDtypical = dopamine antagonist
    2nd gen/atypical = dopamine and serotonin antagonist
    3rd gen/atypical = partial dopamine antagonist (aripiprazole)
30
Q

Why do second generation antipsychotics cause less side effects?

A
  • more dynamic with ‘off-time’
  • doesn’t block the postsynaptic
    dopaminergic receptors for as long
  • blocks 5HT receptors (sertonergic)
    which slows the release of dopamine
31
Q

Core Drug: Clozapine:
- type of antipsychotic
- used for
- why

A
  • atypical
  • reserved for treatment-resistant
    illness (two other drugs must fail)
  • side effects: sedation, toxic effect of
    low white cell counts hence requires
    intensive blood monitoringneutropenia (low neutrophils), constipation
32
Q

Long-term Effects of Antipsychotics:

A
  • sensitisation
  • if dopamine receptors keep being
    blocked, sometimes cells respond by
    increasing the number of receptors
  • bigger response from endogenous
    dopamine if medication is stopped
33
Q

Antipsychotic Drugs: Side Effects:

A

**- anticholinergic = dry mouth, dilated
pupils
- antiadrenergic
- antihistaminergic **

Blocking nigrostraiatal pathway:
** - acute dystonia = sharps muscle
spasms in face and neck
- akathisia: sense of inner
restlessness
- parkinsonism
- tardive dyskinesia: long term
abnormal movements of mouth and
lips**

Impact on hypothalamus affecting satiety hence patients commonly overeat hence prone to develop type II diabetes and causes CVD

direct impact on functioning of the heart -> contractility

lengthens QTc interval -> cardiac arrest
hence ECG monitoring before and during drug usage

34
Q

Non-Pharmalogical Treatments for Psychosis:

A
  • CBT: reduce distress related to
    symptoms, reduce intensity of
    abnormal beliefs by understanding the
    links between thoughts, feelings and
    actions
  • art therapies -> learn to relate to other
    ppl
  • family intervention -> manage home
    life
35
Q

Glutametergic Theory of Schizophrenia:

A

ketamine as an NMDA receptor antagonist to cause schizophrenia like system
affects inhibitory neurons, disinhibtiion of glutamate

increases excitatory activity in the prefrontal cortex

NSB (50 decks)

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