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Mental Health > Psychosis Pathophysiology > Flashcards

Psychosis Pathophysiology Flashcards

1
Q

Schizophrenia is described as…

A

A complex syndrome of disorganized bizzare thoughts, hallucinations, delusions, inappropriate affect, and impaired social functioning

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2
Q

Schizophrenia is diagnosed by…

Duration? Symptoms?

A

Duration of 6+ months, and 1 month of 2+ symptoms which needs to include delusions, hallucinations, or disorganized speech.
Other symptoms may involve disorganized/catatonic behaviour, negative symptoms, decline in social/occupational functioning

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3
Q

Psychosis is described as the presence of…

A

Gross impairment of reality testing

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4
Q

Evidence of psychosis involves…

A

Delusions, hallucinations, markedly incoherent speech
Disorganized and agitated behaviour without apparent awareness of incomprehensibility of behaviour

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5
Q

Schizophrenia is considered treatment resistant when…

A

No significant improvement in symptoms despite treatment with 2+ AP’s from 2 different AP classes at optimal dosing, for 6-8 weeks

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6
Q

Schizophreniform disorder is classified by…

A

Same sx’s as schizophrenia; 1-6 months
Social/occupation functional impairment is not required

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7
Q

Schizoaffective disorder is classified as…

A

2+ weeks of delusions/hallucinations without mood sx’s + uninterrupted period of illness containing either MD or manic episode with concurrent sx’s diagnostic of schizophrenia

Social/occupation functional impairment not required

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8
Q

Brief psychotic disorder is classified as…

A

1 day to 1 month of 1+ delusions, hallucinations, or disorganized speech, patient returns to premorbid functioning

If period extends longer than a month or impairs functioning, this would be considered schizophreniform

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9
Q

Delusional disorder is classified as…

A

1+ month of delusions, hallucinations not prominent. Function only mildly impaired, behaviour not blatantly bizarre

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10
Q

Substance induced psychosis is classified as…

A

Hallucination or delusion development during or within 1 month of substance use/withdrawal

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11
Q

Duration of untreated psychosis refers to…

A

Time from manifestation of first psychotic symptom to initiation of adequate treatment

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12
Q

The biggest risk factor for developing schizophrenia is…

A

Genetic heritability

Others include life stress, cannabis use, urban upbringing, immigrant ethnic groups, perinatal/early childhood

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13
Q

A high-risk but common substance used in schizophrenic patients is…

A

Smoking

Comorbid SUD is very common

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14
Q

Non-adherence rates are high in schizophrenic patients. Common factors include…

A

Adverse effects - negative symptoms from AP
Personal attitude toward treatment
Financial constraint/homelessness

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15
Q

The key theory underlying pathophysiology of psychosis is…

A

Dopamine dysregulation

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16
Q

Besides dopamine, these neurotransmitters are also involved in psychosis…

A

Serotonin dysregulation (modulates dopamine)
Glutamate, GABA

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17
Q

The 4 dopamine tracts in the brain are…

A

Nigrostriatal
Mesolimbic
Mesocortical
Tuberoinfundibular

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18
Q

The function of the nigrostriatal tract is…

A

Motor coordination
Posture control

19
Q

When dopamine is blocked by AP, nigrostriatal function is affected how?

A

Movement disorders (EPS)

20
Q

The function of the mesolimbic system is…

A

Pleasure, reward, desire, response to stimuli, and motivational behaviour

INVOLVED IN DISEASE

21
Q

Dopamine excess in the mesolimbic system will…

A

Increase positive symptoms - psychosis

22
Q

When dopamine is blocked by AP, mesolimbic function is affected how?

A

Relief of psychosis (positive symptoms)
May reduce pleasure, enjoyment

23
Q

The function of the mesocortical tract is…

A

Cognition, motivation, communication, social function, emotional response, problem solving

24
Q

Dopamine deficiency in the mesocortical tract leads to…

A

Increase in negative symptoms

25
Q

When dopamine is blocked by AP, mesocortical function is affected how?

A

Dopamine deficiency increases negative symptoms
Akathsia (restlessness)

26
Q

Treatment of negative symptoms could possibly be through ____, but…

A

5HT2a blockade, but many patients still have negative symptoms regardless

27
Q

The function of the tuberoinfundibular tract is…

A

Regulation of prolactin release

28
Q

When dopamine is blocked by AP, tuberoinfundibular function is affected how?

A

Hyperprolactinemia

29
Q

Hyperprolactinemia symptoms involve hormonal effects, such as…

A

Gynecomastia
Galactorrhea
Amenorrhea
Hirsutism
Weight gain
Osteoporosis
Sexual dysfunction, Erectile dysfunction

30
Q

Schizophrenia patients often have prodromal features, which includes…

A

Markedly peculiar behaviour, abnormal affect, unusual speech, bizarre ideas, strange perceptual experiences

31
Q

The 4 symptom clusters in schizophrenia are…

A

Positive symptoms (psychosis)
Negative symptoms
Cognitive symptoms
Mood symptoms

32
Q

Cognitive symptoms involve…

A

Memory imapriment, concentration impairment
Impaired exectuve function

33
Q

Mood symptoms involve…

A

Dysphoria, depression
Excitement, mania

34
Q

Positive symptoms of schizophrenia include…

A

Delusions
Hallucinations
Disorganized thinking
Disorganized/abnormal motor behaviour
Catatonia

35
Q

Delusions are defined as…

A

Fixed beliefs that are not amenable to change in light of conflicting evidence

Common themes = persecutory, referential, somatic, religious, grandiose

36
Q

Hallucinations are defined as…

A

Perception-like experiences that occur without external stimuli - vivid and clear with full force and impact, not under voluntary control

Can occur in any sensory modality, but auditory is most common

37
Q

Catatonia is defined as…

A

Marked decrease in reactivity to the environment - can range from resistance to instructions, maintaining rigid/inappropriate posture, to complete lack of verbal/motor response

38
Q

Negative symptoms include…

A

Dysfunction of:
communication
affect
socialization
capacity for pleasure
motivation

39
Q

Lab + diagnostic work-up is often done for patients in psychosis in the hospital, to…

A

Scan for physical health abnormalities

40
Q

Common drugs that induce psychosis include…

A

Alcohol, amphetamine, cocaine, ketamine use and withdrawal
Caffeine, cannabis
Bupropion
BZD withdrawal
Chloroquines
Steroids

41
Q

A good scale to determine response is…

A

PANSS - positive and negative syndrome scale

42
Q

More psychosis episodes leads to…

A

More neurochemical dysregulation, potentially neurodegenerative
Lead to worsening severity of signs and symptoms

43
Q

Goals of treatment for schizophrenia include…

A

Prevent harm to patient and to others and decrease intensity and duration of active psychotic symptoms
Improve patient functioning
Optimize medications/treatments, minimize AE’s, promote adherence and compliance to therapy
Prevent relapses
Educate patient and family

44
Q

Non-pharm treatment often involves…

A

Exercise, healthy diet, adequate sleeo
Decrease substance use; caffeine, nicotine, alcohol
Service interventions; shared decision making to improve adherence
CBT - community-case management

Mental Health (8 decks)

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