Psychosis & Schizophrenia Flashcards
What are 3 disorders in which there is problem with dopaminergic pathway?
- schizophrenia,
- bipolar disorder,
- schizoaffective disorder
What characterises psychosis?
Loss of ability to distinguish between subjective experience and objective reality,
Loss of insight
WHat are 7 symptoms of psychosis?
- hallucinations
- ideas of reference
- delusions
- formal thought disorder
- thought interference
- passivity phenomena
- loss of insight
What is a perception that occurs in the absence of an external stimulus, feels real & is not subject to conscious manipulation?
Hallucinations
What are ideas of reference?
Finding meaning or hidden messages in everything e.g. newspaper, tv
What is the meaning of paranoia in psychiatry? What term is this often confused with?
The sense that external events are related to oneself in some way
Often confused with persecutors ideas e.g. people are coming to get them
What is a delusion?
A fixed, false held belief held with unshakeable conviction & don’t accept logic, more about reason they believe it as opposed to the belief itself
What is the difference between primary and secondary delusions?
Primary arrives fully formed without need for explanation
Secondary are often attempts to explain other psychotic experiences such as hallucinations, passivity phenomena or thought insertion
What are these themes all types of?
Paranoid, persecutory, grandiose, religious, misidentification, guilt, sin, poverty, erotomanic (public figure is in love with you), jealousy, of reference
Delusions
List 6 disorders of thought.
- clanging and punning
- loosening of associations
- knight’s move thinking
- neologisms
- verbigeration/word salad
- circumferentiality/tangentiality
List 4 thought interferences.
Thought insertion
Thought withdrawal
Thought broadcasting
Thought blocking
Describe 3 types of passivity problems.
- passivity of volition: made actions,
- passivity of affect: made feelings,
- passivity of impulse: made urges
What is loss of insight?
Reality testing is faulty - i.e. you can’t tell that anything’s wrong but everyone is telling you so. Normally our brains reality test all the time & filter the world through senses and construct a reality
What is the characteristic symptom of schizophrenia?
3rd person auditory hallucinations
Self-referential delusions are specific to acute psychosis. True/false?
False - not specific to any particular diagnosis
Define delirium
Acute, transient disturbance from the person’s normal cognitive function caused by insult to brain e.g. infection, medical/surgical patients, hypoglycaemia, encephalitis, stroke, SOL, drugs
List some of the drugs that can cause delirium with drug intoxication and list a drug that can cause delirium when it is withdrawn.
Drug intoxication: Steroids, digoxin, diuretics, anticholinergics
Drug withdrawal: benzodiazepines
What are the hallmarks of delirium?
Clouding of consciousness (drowsiness - unresponsive, disorientation, worse at night) Impaired concentration/memory Visual hallucinations Persecutory delusions Psychomotor disturbance Agitation
Drug—induced psychosis is not the same as drug intoxication or withdrawal effects. True/false?
True - drug induced psychosis is more long lasting and has bigger effect on brain
PAtients with depressive psychosis present with what kind of delusions and hallucinations and what is the most extreme symptom?
Delusions and hallucinations will be depressive e.g. delusions of worthlessness, hallucinations of accusing/threatening voices typically 2nd person
Most extreme delusion - Cottard’s syndrome where patient believes they are already dead and body needs to keep up
Patients with mania with psychosis present with what types of delusions and hallucinations and what thought disorder is it often associated with?
Delusions tend to be of grandeur/special ability
Hallucinations tend to be 2nd person and auditory e.g. hearing god’s voice
Flight of ideas
What is the criteria for schizophrenia diagnosis?
1 month of At least 1 of: thought disorder, delusions of control, passivity phenomena, hallucinatory voices giving running commentary, persistent culturally inappropriate delusions, OR, At least 2 of: persistent hallucinations, neologisms, catatonic behaviour, negative symptoms
WHat type of schizophrenia do 80% of schizophrenia patients have?
Paranoid schizophrenia generally more positive syndromes
What are two sub-types of schizophrenia and describe.
Hebephrenic - often young, not communicating, messing around, fragmentary hallucinations
Catatonic - movement disorder that can range from stupor and hyperkinesis
What is persistent delusional disorder?
A type of paranoid psychosis in which fixed delusions are the only or major feature
What is schizotypal disorder?
Type of paranoid psychosis that is similar in ways to schizophrenia except only occasional psychotic episodes with hallucinations and primary feature is social skill deficit and eccentric behaviours.
What is acute and transient psychotic disorder?
Type of paranoid psychosis in which schizophrenic symptoms last only one month
What is induced delusional disorder?
Type of paranoid psychosis - two types folie a deux, folie a plusiers
What is difference between schizophrenia and schizoaffective disorder?
Schizoaffective disorder patients have some of schizophrenia symptoms but not full range of full rank symptoms to justify a diagnosis. They do have prominent affective change e.g. elated/depressed mood
What is the typical age group of onset of schizophrenia
20s - early and late onset schizophrenia are rare
What is the inheritance pattern of schizophrenia and does it have high or low heritability?
Polygenetic inheritance
High heritability
What is the lifetime risk of developing schizophrenia if both parents have it?
45%
Why is it that your lifetime risk of schizophrenia is only 12.5% if you have a 1st degree relative with it but is 17.5% if you have a dizygotic twin with it?
Because dizygotic twins have more similar environmental factors than between siblings
What is the biggest known risk factor of schizophrenia?
Positive family history
What are 5 risk factors for schizophrenia?
positive family history,
2nd trimester viral illness,
obstetric problems e.g. pre-eclampsia, fetal hypoxia, emergency c-section,
childhood viral CNS infection (increases risk by 50%) e.g. mumps,
substance misuse
What changes can be seen on brain imaging of patients with schizophrenia?
Enlarged lateral ventricles
Reduced fronto-temporal volume (maybe due to reduced cortical brain regions and arborisation of neurons)
Reduced activation of prefrontal areas on specific tasks e.g. executive function
Dysfunctional neurotransmitters
How might a patient with poor prognosis of schizophrenia show on brain imaging?
reduced frontal lobe volume
reduced frontal lobe grey matter
enlarged lateral ventricle volume
In patients with prominent negative symptoms what is reduced in the brain?
White matter
What 3 neurotransmitters/receptors are thought to be involved in schizophrenia?
dopamine
serotonin receptors
glutamate receptors
What is the Dopamine hypothesis?
Theory that schizophrenia is partially caused by excess dopamine so hyperactive dopamine pathway
Drugs that cause dopamine release or D2 receptor agonists can produce a psychotic state. Name an example of each of these.
Cause dopamine release: amphetamine
D2 receptor agonist: apomorphine
What are 3 major dopaminergic pathways in the brain and their function?
Nigrostriatal: extrapyramidal motor system,
Mesolimbic/cortical: motivation and reward systems,
Tuberoinfundibular: control of prolactin release
D1 receptor family are the most abundant receptors in the brain. What is their function and what are the two types?
function: stimulate cAMP
Types: D1 and D5
D2 receptor family are in the brain & pituitary gland. These are more pharmacologically important. What are the functions (3) of the D2 receptor family and what are the types (3)?
Functions: -inhibit adenylyl cyclase -inhibit voltage-activated Ca2+ channels -open K+ channels Types: D2, D3, D4
What receptor does clozapine target and what is it used for?
D4,
treatment resistant schizophrenia
What class of drugs are used to treat the symptoms of schizophrenia?
Dopamine antagonists
Direct evidence for overactivity of dopamine pathways in brain is poor however increased dopamine in ____ tracts is important, especially in acute psychosis.
Mesolimbic tracts
What are 3 identified gene alterations that are thought to cause schizophrenia & what are they involved in?
neuregulin (signalling protein)
dysbindin (needed for adaptive neural plasticity)
DISC-1 (neurite outgrowth & cortical development)
There is no gliosis in schizophrenia and ventricle enlargement is non-progressive. True/false?
True
Children who later develop schizophrenia show no impaired behaviour, motor and intellectual development from infancy. True/false?
False - they have identifiable impairments in these areas
Why do patients with schizophrenia have lower life expectancy (10-20 years earlier than general population)?
Illness factors: poverty, poor diet, chronic health conditions, poor concentration, higher smoking rates, co-morbid drug use etc
What are poor prognostic factors of schizophrenia? (Pre-morbid personality and features of illness)
Family history Personality - shy, solitary, eccentric Home relationships - tend/stormy Work/school record - poor Loss of insight into their symptoms No precipitating event Insidious onset
