Psychosis Pathophysiology Flashcards
Schizophrenia is described as…
A complex syndrome of disorganized bizzare thoughts, hallucinations, delusions, inappropriate affect, and impaired social functioning
Schizophrenia is diagnosed by…
Duration? Symptoms?
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
Psychosis is described as the presence of…
Gross impairment of reality testing
Evidence of psychosis involves…
Delusions, hallucinations, markedly incoherent speech
Disorganized and agitated behaviour without apparent awareness of incomprehensibility of behaviour
Schizophrenia is considered treatment resistant when…
No significant improvement in symptoms despite treatment with 2+ AP’s from 2 different AP classes at optimal dosing, for 6-8 weeks
Schizophreniform disorder is classified by…
Same sx’s as schizophrenia; 1-6 months
Social/occupation functional impairment is not required
Schizoaffective disorder is classified as…
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
Brief psychotic disorder is classified as…
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
Delusional disorder is classified as…
1+ month of delusions, hallucinations not prominent. Function only mildly impaired, behaviour not blatantly bizarre
Substance induced psychosis is classified as…
Hallucination or delusion development during or within 1 month of substance use/withdrawal
Duration of untreated psychosis refers to…
Time from manifestation of first psychotic symptom to initiation of adequate treatment
The biggest risk factor for developing schizophrenia is…
Genetic heritability
Others include life stress, cannabis use, urban upbringing, immigrant ethnic groups, perinatal/early childhood
A high-risk but common substance used in schizophrenic patients is…
Smoking
Comorbid SUD is very common
Non-adherence rates are high in schizophrenic patients. Common factors include…
Adverse effects - negative symptoms from AP
Personal attitude toward treatment
Financial constraint/homelessness
The key theory underlying pathophysiology of psychosis is…
Dopamine dysregulation
Besides dopamine, these neurotransmitters are also involved in psychosis…
Serotonin dysregulation (modulates dopamine)
Glutamate, GABA
The 4 dopamine tracts in the brain are…
Nigrostriatal
Mesolimbic
Mesocortical
Tuberoinfundibular
The function of the nigrostriatal tract is…
Motor coordination
Posture control
When dopamine is blocked by AP, nigrostriatal function is affected how?
Movement disorders (EPS)
The function of the mesolimbic system is…
Pleasure, reward, desire, response to stimuli, and motivational behaviour
INVOLVED IN DISEASE
Dopamine excess in the mesolimbic system will…
Increase positive symptoms - psychosis
When dopamine is blocked by AP, mesolimbic function is affected how?
Relief of psychosis (positive symptoms)
May reduce pleasure, enjoyment
The function of the mesocortical tract is…
Cognition, motivation, communication, social function, emotional response, problem solving
Dopamine deficiency in the mesocortical tract leads to…
Increase in negative symptoms
When dopamine is blocked by AP, mesocortical function is affected how?
Dopamine deficiency increases negative symptoms
Akathsia (restlessness)
Treatment of negative symptoms could possibly be through ____, but…
5HT2a blockade, but many patients still have negative symptoms regardless
The function of the tuberoinfundibular tract is…
Regulation of prolactin release
When dopamine is blocked by AP, tuberoinfundibular function is affected how?
Hyperprolactinemia
Hyperprolactinemia symptoms involve hormonal effects, such as…
Gynecomastia
Galactorrhea
Amenorrhea
Hirsutism
Weight gain
Osteoporosis
Sexual dysfunction, Erectile dysfunction
Schizophrenia patients often have prodromal features, which includes…
Markedly peculiar behaviour, abnormal affect, unusual speech, bizarre ideas, strange perceptual experiences
The 4 symptom clusters in schizophrenia are…
Positive symptoms (psychosis)
Negative symptoms
Cognitive symptoms
Mood symptoms
Cognitive symptoms involve…
Memory impairment, concentration impairment
Impaired exectuve function
Mood symptoms involve…
Dysphoria, depression
Excitement, mania
Positive symptoms of schizophrenia include…
Delusions
Hallucinations
Disorganized thinking
Disorganized/abnormal motor behaviour
Catatonia
Delusions are defined as…
Fixed beliefs that are not amenable to change in light of conflicting evidence
Common themes = persecutory, referential, somatic, religious, grandiose
Hallucinations are defined as…
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
Catatonia is defined as…
Marked decrease in reactivity to the environment - can range from resistance to instructions, maintaining rigid/inappropriate posture, to complete lack of verbal/motor response
Negative symptoms include…
Dysfunction of:
communication
affect
socialization
capacity for pleasure
motivation
Lab + diagnostic work-up is often done for patients in psychosis in the hospital, to…
Scan for physical health abnormalities
Common drugs that induce psychosis include…
Alcohol, amphetamine, cocaine, ketamine use and withdrawal
Caffeine, cannabis
Bupropion
BZD withdrawal
Chloroquines
Steroids
A good scale to determine response is…
PANSS - positive and negative syndrome scale
More psychosis episodes leads to…
More neurochemical dysregulation, potentially neurodegenerative
Lead to worsening severity of signs and symptoms
Goals of treatment for schizophrenia include…
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
Non-pharm treatment often involves…
Exercise, healthy diet, adequate sleeo
Decrease substance use; caffeine, nicotine, alcohol
Service interventions; shared decision making to improve adherence
CBT - community-case management
