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Psychosis Flashcards

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1
Q

Neuropsychopathology of Psychosis

A

neuro-psychopathology syndrome affecting the function of the frontal/temporal lobes and the associated dopaminergic projections to these areas resulting in poor filtering of external/internal stimuli—thinking, mood, behavior, reality perception

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2
Q

Glutamate excitatory neurotranmitter (NMDA-glutamate receptors)

A

Restores and promotes neuroplasticity/synapse maintenance/interconnections

Hypofunction of NMDA receptors can result in negative, positive and cognitive symptoms

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3
Q

Gama-Aminobutyric Acid (GABA)

A

inhibitory neurotransmitter

Decreased levels can produce psychotic-like symptoms

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4
Q

Mesolimbic dopamine hyperactivity

Mesocortical dopamine hypoactivity

A

Mesolimbic dopamine hyperactivity
Positive symptoms

Mesocortical dopamine hypoactivity
Negative symptoms

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5
Q

Domains in schizophrenia/psychosis spectrum

A 
Hallucinations
Delusions
Disorganized thinking/speech/writing
Negative symptoms 
Abnormal behavior including catatonia
Depression
Impaired Cognition
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6
Q

What is the definition of psychosis?

A

Impaired reality perception, manifested by hallucinations, delusions, thought disorganization, affective instability, psychomotor changes and cognitive impairment.

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7
Q

What is schizophrenia?

A

is a disorder that lasts for at least 6 months and includes at least 1 month of active-phase symptoms (i.e., two or more of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms)

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8
Q

5 subtypes of schizophrenia

A 
Paranoid
Disorganized
Catatonic
Undifferentiated
Residual
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9
Q

Schizophreniform Disorder

A

characterized by a symptomatic presentation that is equivalent to Schizophrenia except for its duration: 1 to 6 months with or without decline in functionin

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10
Q

Schizoaffective Disorder

A

periodic manifestations of Major Depression and or Mania overlap with symptoms of Schizophrenia. Schizophrenia is the underlying psychopathology. Overlapping mood d/o

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11
Q

Delusional Disorder

A

is characterized by at least 1 month of non-bizarre or bizarre delusions without other active-phase symptoms of Schizophrenia.  functional and does not have to be hallucinations

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12
Q

brief psychotic disorder

A

lasts more than 1 day and remits by 1 month

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13
Q

Psychotic Disorder, NOS

A

included for classifying psychotic presentations that do not meet the criteria for any of the specific Psychotic Disorders defined in this section or psychotic symptomatology about which there is inadequate or contradictory information.

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14
Q

Types of delusional disorders

A 
Erotomanic think someone is in love with you
Jealous
Presecutory
Grandiose  speak to the dead
Somatic intestines removed
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15
Q

Treatment for delusional disorders

A

No other psychotic symptoms
Remains fairly functional at work, family, socially
Antipsychotics are indicated, but have modest effect
Best to begin with psychotherapy
Some will progress to schizophrenia

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16
Q

different types of Schizoaffective d/o

A

Uninterrupted Schizophrenia with periodic overlapping mood disorder
1. Bipolar Type
Better response to meds
2. Depressive type
Substandard response to meds
3. Functional impairment
Greater variability compared with Schizophrenia

17
Q

Treatment for schizoaffective d/o

A 
Atypical antipsychotics
Addresses; psychosis, mood stabilizer, mania 
Mood stabilizers
Lithium, valproate, carbazepine
Anti-depressants
18
Q

Treatments and risk factors for brief psychotic d/o

A

pre-existing psych dx: personality disorders (schizoid, schizotypal, borderline, paranoid)
Treatment
Excellent response to antipsychotics (atypical are 1st line)
Benzodiazepine for acute agitation
Hospitalize until stable

19
Q

Drug/disease induced psychosis

A 
Intoxication
Cocaine
Phencyclidine
Ecstasy
Bath Salts
LSD
Marijuana
Amphetamines

Withdrawal
Alcohol (most common cause of drug related hallucinations)

20
Q

Medical Conditions that can induce psychosis

A 
Alcoholic encephalopathy
Herpes encephalopathy
Systemic Lupus Erythematosus
Complex partial seizures
Alzheimer’s Dementia
Huntington’s Disease
CNS infection
CNS tumor
CVA
Hepatic/renal failure
Hyperthyroidism
21
Q

epidemiology of schizophrenia

A

Incidence
10-40 new cases/100,000 in the US
1.5 new cases/10,000 world-wide
men more than women

Life Time Prevalence
1% world-wide will develop schizophrenia in their life time
>2,000,000 people are affected in the US
Less than ½ have received some treatment
25,000,000 affected world-wide

22
Q

Etiology for schizophrenia

A 
genetics
Advanced paternal age at conception
1st-2nd trimester viral infection
Toxoplasmosis exposure in utero
Infant Starvation/maternal deprivation
Prenatal: toxic exposure, anoxia, birth trauma
DOB : late winter-early spring
Anatomical:
Smaller brains w/ cortical thinning, ventricular enlargement
Psychoactive drugs
influence of family and society
23
Q

What are the 4 A’s for schizophrenia

A

Autism
Ambivalence
Affectivity
Association

24
Q

Clinical presentation of Schizophrenia?

A

Hallucinations, including all sensory systems
Delusions: fixed beliefs, mostly paranoid/grandiose/control/guilt/somatic/thought insertion/withdrawal/broadcasting
Disorganized thoughts/behaviors
Cognitive impairment
Negative symptoms
Personality changes

25
Q

Emotion/ Function/ Thought content/ Form of thought for Schizophrenia?

A
  1. Emotional
    Blunted, flat affect, silly, labile, inappropriate
    Withdrawn or hypersensitive to environmental stimuli
  2. Functional
    Decline in functioning, personal care, responsibilities
  3. Thought content
    Intrusive, Psychotic thinking, poverty of thought
    Impaired concentration distracted by psychotic thinking
  4. Form of thought
    Loosening assoc, incoherence, illogical
    Language idiosyncrasies: neologisms, echolalia
  5. Perception
    Hallucinations
    Illusions
26
Q

What are positive symptoms

A

Acute symptoms due to dopamine dysregulation
w/ increased D2 in mesolimbic system
Hallucinations/delusions/disorganized thought/cognition impairment
Potentially reversible
Respond best to neuroleptics

27
Q

What are negative symptoms?

A 
Social withdrawal
Flat/blunted affect
Poverty of speech
Avolition
Enlarged lateral/3rd ventricles
Reduced volume in:
          Amygdala
          Basal ganglia/cerebellum
           Prefrontal cortex
Reduced symmetry in:
         Frontal
         Temporal
          Occipital
28
Q

Disorganized (hebephrenia) Schizophrenia

A 
walks back and forth--> needs to be institutionalized for life
Incoherence
Disorganized behavior
Blunted, inappropriate of silly affect
Poor functioning/adaptation
Early, insidious onset
Chronic severe course
29
Q

Catatonic Schizophrenia

A

Restless catatonia (purposeless excitement w/ injury risk)
Stupor, rigid catatonia
Mutism or echopraxia
Can maintain awkward position for hours

30
Q

Paranoid Schizophrenia

A

most common w/ most favorable Px
Good prognosis, quite functional
Delusions of persecution, suspiciousness, grandeur
Hostility, tense, guarded
Are generally intact intellectually, cognitively
Onset may be later than the other subtypes
The later the onset the better the prognosis

31
Q

Residual Schizophrenia

A

Has had at least 1 schizophrenic episode
Still has negative symptoms or milder positive symptoms
Eccentric behaviors, delusions, language eccentricities
Needs consistent out-patient psych care
Is borderline independently function w/o strong psych support/social services

32
Q

undifferentiated schizophrenia

A

Severely disorganized behavior
Psychotic—incoherent, hallucinatory, delusional
But does not fit any of the other subtype criteria

33
Q

First phase of treatment for schizophrenia

A

acute phase
Reduction of harmful symptoms
May need hospitalization

34
Q

Second phase of treatment for schizophrenia

A

behavior stabilization
Case management is key to link back to community
Working, educating family, patient, friend is crucial
Promote trust to foster treatment adherence

35
Q

Third phase of treatment for schizophrenia

A 
Stable phase
Goal is to minimize relapse
Monitor adherence
Monitor side effects and Rx-Rx interactions
Engage pt in community/vocational wk
36
Q

What is the first line therapy for schizophrenia/ psychosis

A

Atypical Antipsychotics (Second Gen Antipsychotics)
then:
antipsychotics
psychotherapy

37
Q

Comorbidities associated with schizophrenia

A 
substance use= MC***
Social anxiety
PTSD
OCD
Depression
10-15% will commit suicide
38
Q

Suicide and mortality for Schizophrenia

A

Suicide
Paranoid schizophrenic has highest risk
Life time risk 10-15%
Mortality rate is younger than average

Psych (6 decks)

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