Psychosis-Kirkpatrick Flashcards
What is a hallucination?
a perception of something w/ no external cause (visual or auditory)
What is a delusion?
a fixed, false belief that is not shared by other members of a person’s subculture
What is disorganized speech?
irrelevance and incoherence of verbal productions ranging from simple blocking and mild circumstantiality to total loosening of associations
What would you call the perception that someone has implanted something in your brain that you can feel?
tactile hallucinations
What do you call it that the patient thought his friends worked for MI5?
persecutory delusions
What is thought insertion?
people are putting thoughts into my head
What is thought broadcasting?
the belief that others can hear your thoughts
What is thought blocking?
people’s speech suddenly interrupted by silences when certain subjects approached
What is thought disorder?
disorganized speech & behavior
similar sometimes to fluent aphasia
What is catatonia?
physical immobility
little or no speech
autonomic overactivity: fever, tachycardia
What is catatonic excitement?
aimless overactivity
Catatonia is somewhat common in which disorder?
affective disorder
What is the treatment for catatonia?
antipsychotics + lorazepam
electroconvulsive therapy
What is malignant catatonia?
completely immobile comatose fever, tachycardia can die **no other medical conditions
What are negative symptoms related to psych?
decreased or absent normal behavior or experience
blunted affect–facial expression, voice modulation
poverty of speech
anhedonia
asociality
amotivation
lack of normal distress
Which disorders can include psychosis?
dementia
serious depression
mania
delirium
What’s the deal with diagnosing schizophrenia?
idiopathic psychosis
not an affective disorder w/ psychosis
What are the criteria for schizophrenia? Criterion A
2 or more of the following for 1 month. *delusions *hallucinations *disorganized speech grossly disorganized or catatonic behavior negative symptoms
What are other important criteria for schizophrenia diagnosis?
decline in level of fcn continuous signs for at least 6 mo affective disorder exclusion: no depression or mania w/ Criterion A no drug abuse, meds, medical condition autism spectrum exclusion
What is the schizophrenia spectrum?
Schizophrenia Brief psychotic disorder Schizophreniform disorder Schizoaffective disorder Psychotic disorder not otherwise specified Schizotypal personality disorder Schizoid personality disorder Delusional disorder -delusions only
What are some risk factors for schizophrenia?
Low birth weight Obstetrical complications Winter birth for schizophrenia as a whole Summer birth for one subgroup Gestational diabetes Prenatal famine Prenatal stress, including infections Maternal inflammation advanced paternal age cannabis use by patient physical or sexual abuse in childhood of the patient immigration
What’s the deal with the Gambia story?
babies born during the hungry season died earlier (delayed affect)
probably due to prenatal metabolic programming–immune system
What’s the deal with the birth weight back in the day & development of diabetes?
8X risk of having adult diabetes if you were born a small baby
What are the genetics of schizophrenia?
some known genes: DISC1, neuregulin 1
**shared risk factors for autism, intellectual disability
T/F For many patients schizophrenia starts in utero.
True. This professor says it starts then.
What is the evidence for schizophrenia in childhood?
Abnormal motor and cognitive development in high-risk toddlers (children of mothers with schizophrenia
During childhood, adults with schizophrenia have abnormal motor & social function
What is the idea behind multiple causal pathways?
many different ways to contract a disease, including schizophrenia
genes, prenatal stress, cannabis use, abuse in childhood
When do you see the onset of psychosis in schizophrenia patients?
typically–>late adolescence, early adulthood
When do you see negative symptoms in schizophrenia patients?
detectable in childhood
+ cognitive impairment (preschool age)
Average age of onset of schizophrenia?
28-29 but could show up in 50s!
What are the risk factors for relapse after 1st schizophrenic episode?
not taking antipsychotic-med non adherence
persistent substance abuse
home life stressful–critical, mean comments
poor premorbid adjustment-before diagnosis struggling
What is the usual model of schizophrenia?
- *Schizophrenia is synonymous with the presence of psychotic symptoms (hallucinations, delusions, disorganized thought and behavior)
- *Pathophysiology is synonymous with abnormal regulation of dopamine
Why is the usual model of schizophrenia insufficient?
more than just dopamine! Other NT involved, complex process
more than just psychosis–other neuropsychiatric problems
other anatomic abnormalities & metabolic issues
What is the relationship b/w cognitive impairment & schizophrenia?
almost all patients w/ schizophrenia have cognitive impairment across every cognitive domains
**impairments also seen in other family members
T/FCognitive function a better predictor of a patient’s level of function than is the severity of psychotic symptoms
TRUE!
Are there a bunch of high functioning people w/ schizophrenia?
Less common than other conditions. It happens, though.
Depression is common in patients with schizophrenia. Explain the stats.
30-35% — 2 or 3x that of the general population
Which risk factors do depression & schizophrenia share?
low birth weight
prenatal famine
winter birth
Substance abuse is more common in schizophrenia. What’s the stats.
34% of subjects with schizophrenia had a lifetime diagnosis of alcohol abuse or dependence
47% had a lifetime diagnosis of any substance abuse or dependence
increased prior to onset of psychosis.
increased in relatives too.
What is the main link b/w schizophrenia & substance abuse?
marijuana–>schizophrenia
meth creates psychosis symptoms & can exacerbate.
Which anxiety disorders are common in patients with schizophrenia?
obsessive-compulsive syndrome
panic attacks
post-traumatic stress disorder
generalized anxiety disorder
Which anxiety disorder is a precursor to schizophrenia?
OCD
What are other neuropsychiatric syndromes seen in schizophrenia patients?
neurological signs
dyskinetic movements
oculomotor dysfunction
polydipsia-can push electrolytes down–arrhythmias–die
Which of the neuropsychiatric signs just mentioned are seen in first degree relatives of schizophrenia patients?
neurologic signs
dyskinetic movements
oculomotor dysfunction
Describe how schizophrenia is a medical condition.
die 20-25 years earlier
cardiovascular disease causes a lot of deaths
antipsychotic meds–associated w/ diabetes & weight gain
high prevalence of smoking, sedentary lifestyle etc.
**also digestive diseases, suicide etc. Die more of everything!!
What is the #1 killer of schizophrenia patients?
cardiovascular death
Subtle anatomic abnormalities in people with schizophrenia are present, including what?
head eyes ears mouth hands feet slighter shorter & thinner than general population.
What did the glucose tolerance test show for schizophrenia patients?
didn’t have very good tolerance for glucose
appears to be familial
What were the results for the following with schizophrenia patients v. other patients?
pulse pressure (indicative of HTN)
free androgen index
telomere content
pulse pressure: higher in patients
free androgen index: lower in patients
telomere content: lower in patients
What are state markers? What was shown w/ schizophrenia patients?
state markers change during exacerbations of their condition
see more IL-1beta
IL-6
TGF-beta
What are trait markers of illness? What was shown w/ schizophrenia patients?
markers that get elevated at first clinical contact & remain elevated IL-12 IFN-gamma TNF-alpha sIL-2R
Schizophrenia patients almost seem to have accelerated aging. WHat are the things that support this?
Increased mortality pattern Pattern of cognitive dysfunction Abnormal glucose tolerance Increased inflammation Increased pulse pressure Shortened telomere Abnormal signaling for adult circulating stem cells (mesenchymal stem cells) Decreased free testosterone in males
What is the significance of adult circulating stem cells & SDF-1alpha?
cells w/ broad differentiation potential involved in normal repairs & reside in bone marrow usu
SDF1alpha is a chemokine that controls their movement.
Diabetes messes w/ this chemokine
What were schizophrenic patient’s SDF1-alpha levels like?
lower than other patients
What are brain abnormalities seen in patients with schizophrenia?
Decreased volume in many brain areas
Neurons have decreased neuropil (dendrites & axons)
**increased density of neurons, but less neurons in some areas
increased dopamine in some regions
abnormal expression of NMDA receptor subunits
decreased white matter volumes w/ abnormal orientation of fibers
Which substances when administered aggravated the psychosis of schizophrenic patients?
cannabis
serotonin agonist
NMDA antagonist
What is the current treatment for schizophrenia?
antipsychotics treat the other syndromes: depression, anxiety etc psychosocial family interventions cognitive remediation-computer assisted
What is involved in family interventions?
expressed emotion increases risk of relapse
reduce these critical & intrusive comments
Cognitive remediation worked best for which domains?
social cognition
then general cognition
small effect on: verbal memory, working memory, attention/vigilance, speed of processing
**may help real life function
T/F Schizophrenia is a psychotic disorder.
False. It is a disorder of every brain function & other parts of the body. Psychosis is present, not a psychotic disorder.
T/F Schizophrenia is primarily consistent w/ psychosis w/ many other comorbid conditions.
False. These comorbid conditions are a part of the disease. Sometimes the anxiety consistent with schizophrenia is more damaging than their psychosis.
What is the duration of a brief psychotic episode? What is the duration of schizophreniform disorder?
Brief Psychotic Episode: less than 1 mo
Schizophreniform: 1-6 mo
