Psychosis Flashcards
Define psychosis
- Impaired reality perception (loss of contact w/reality)
- Manifested by hallucinations, delusions, affective instability
Define delusion
- Strongly held false belief not typical of patient’s cultural or religious background
- Can be categorized as bizarre or non-bizarre
Define hallucination
Wakeful sensory experiences of content that is not actually present
Define illusion
Distortion or misinterpretation of real sensory stimuli
Define alogia
- Type of thought disorganization a/w psychosis
- Very little information conveyed by speech (poverty of content)
Define thought blocking
- Type of thought disorganization a/w psychosis
- Suddenly losing train of thought, exhibited by abrupt interruption in speech
Define loosening of association
- Type of thought disorganization a/w psychosis
- Speech content notable for ideas presented in sequence that are not closely related
Define tangentiality
- Type of thought disorganization a/w psychosis
- Answers to interview questions diverging increasingly from the topic being asked about
What is tangentiality called if eventually the answer returns to the original topic?
Circumstantiality
Define circumstantiality
- Type of thought disorganization a/w psychosis
- Answers a question and diverges from the topic being asked but eventually returns to the topic
Define clanging
- Type of thought disorganization a/w psychosis
- Using words in a sentence that are linked by rhyming or phonetic similarity
Define word salad
- Type of thought disorganization a/w psychosis
- Real words are linked together incoherently, yielding nonsensical content
Define perseveration
- Type of thought disorganization a/w psychosis
- Repeating words or ideas persistently often even after the interview topic has changed
What are examples of medical conditions that can induce psychosis?
- Endocrine
- Hepatic encephalopathy
- HIV, syphilis, Lyme
- SLE, MS
- Alzheimer’s
- Head trauma
- B12 deficiency
What drugs can induce psychosis?
- Cocaine
- Ecstasy
- LSD
- Marijuana
- Amphetamines
- Withdrawal from alcohol
What is the MC cause of drug related hallucinations?
Withdrawal from alcohol
Define delirium
Confusional state characterized by increased vigilance with psychomotor and autonomic overactivity
Diagnostic features of delirium
- Disturbance in attention and awareness
- Develops over short period of time
- Disturbance in cognition
- Not better explained by another neurocognitive disorder
- Caused by a medical condition, substance intoxication/withdrawal, med side effect or multiple etiologies
Etiologies of delirium
- Fluid and electrolyte disturbances
- Infections (UTI)
- Drugs/alcohol or withdrawal
- Metabolic disorders
- Low perfusion states
- Post-op esp elderly
Treatment of delirium
Treat underlying condition
What is schizophrenia?
Psych disorder involving chronic or recurrent psychosis
Define schizophreniform disorder
Equivalent to schizophrenia’s clinical presentation but duration is 1-6 months with or w/o decline in functioning
Define schizoaffective disorder
Periodic manifestations of major depression and/or mania overlap with symptoms of schizophrenia
Define delusional disorder
At least 1 month of non-bizarre OR bizarre delusions W/O other active phase symptoms of schizophrenia
Define brief psychotic disorder
Psychosis that lasts more than 1 day but resolves by 1 month
Epidemiology of schizophrenia
- Males slightly MC
- Women diagnosed later in life
- Possibly worse prognosis in males
- Younger onset, worse prognosis
- Rarely occurs over 45 yo
Define downward drift
Psychosis is more likely to be diagnosed in poorer patients
Neuropsychopathology of psychosis
- Frontal/temporal lobes affected
- Mesolimbic DA hyperactivity
- Mesocortical DA hypoactivity
- Glutamate excitatory
- GABA inhibitory
What is the major CNS inhibitory neurotransmitter?
GABA
Relation of ACh and schizophrenia
- Increased smoking is seen in people w/schizophrenia
- Has led to hypothesis that nicotine (which stimulates ACh receptors) may ameliorate some of their symptoms
Diagnosis of schizophrenia
2 or more of the following (at least 1 has to be of the first 3 listed) for 1 month or more:
- Hallucinations
- Delusions
- Disorganized thinking/speech/writing
- Grossly disorganized behavior or catatonia
Subtypes of schizophrenia
- Paranoid
- Disorganized
- Catatonic
- Undifferentiated
- Residual
What are “positive” symptoms of schizophrenia?
- Acute symptoms d/t DA dysregulation (increased DA in mesolimbic system)
- Hallucinations, delusions, disorganized thought
- Potentially reversible (respond best to neuroleptics)
What are “negative” symptoms of schizophrenia?
- Insidious and progressive due to “deficit syndrome” of DA in mesocortical system
- Social withdrawal, flat affect, poverty of speech, avolition
Poor prognosis of schizophrenia
- Negative symptoms
- Impaired cognition
Negative symptoms of schizophrenia are related to what physiologically?
Deficit syndrome of DA in mesocortical system
Positive symptoms of schizophrenia are related to what physiologically?
Increased DA in mesolimbic system
Genetic factors of schizophrenia?
- Monozygotic twin studies 40-50% concordance
- MC polymorphism is on chromosome 22
Risk factors for schizophrenia
- Advanced paternal age at conception
- 1st-2nd trimester viral infection
- Toxoplasmosis in utero
- Infant starvation
- Late winter-early spring DOB
- Psychoactive drugs
Anatomic risk factor for schizophrenia
Smaller brain w/cortical thinning, ventricular enlargement
Family influences on schizophrenia
Families don’t cause schizophrenia, but degree of emotional conflict increases relapse
Clinical presentation of schizophrenia
- Hallucinations
- Delusions (fixed beliefs)
- Disorganized thoughts
- Personality changes
- 4 As (Autism, Ambivalence, Affectivity, Association)
Describe disorganized schizophrenia
- Incoherence
- Blunted, inappropriate affect
- Early, insidious onset
- Chronic severe course
Describe catatonic schizophrenia
- Restless catatonia (purposeless excitement w/injury risk)
- Stupor, rigid catatonia
- Mutism or echopraxia
- Can maintain awkward position for hours
MC subtype of schizophrenia?
Paranoid
Describe paranoid schizophrenia
- MC w/most favorable prognosis
- Delusions of persecution, suspiciousness, grandeur
- Generally intact intellectually/cognitively
- Onset may be later (later is better prognosis)
Describe residual schizophrenia
- Under treatment and mostly stable
- Has had at least 1 schizophrenic episode
- Still has negative symptoms or milder positive symptoms
Describe undifferentiated schizophrenia
- Severely disorganized behavior
- Psychotic (incoherent, hallucinatory)
- Does not fit any other subtype
Phases of schizophrenia treatment
- Acute (reduce harm - hospitalize)
- Behavior stabilization (case management to link back to community)
- Stable (minimize relapse)
Drug classes used in schizophrenia
- Antipsychotics (increases mortality in elderly)
- Atypical antipsychotics (2nd generation)
1st line drug treatment of schizophrenia
Atypical antipsychotics (2nd generation - risperdal, zyprexa, seroquel, clozapine)
Role of psychotherapy in schizophrenia?
May be useful in higher functioning patients (but often does not help)
MC comorbidity with schizophrenia?
Substance use (including smoking - 75% of pts)
Violence and schizophrenia
- Schizophrenia itself is NOT an independent factor for violence
- Substance use and hx of violence/abuse are predictive
