Psychosis (Tobia) - 10/19/16

Question 1

What neurotransmitter is implicated in all psychoses?

Answer 1

Dopamine

Question 2

Dopamine Neuroanatomy: Long Tracts and Short Tracts

Answer 2

• Long tracts
  
  • Nigrostriatal tract
    
    • Extrapyramidal motor system
    • Synthesizes most of the CNS dopamine
    • Project to D2 receptors of the striatum (caudate nucleus + putamen)
    • Integral in neurocognitive deficits
      
      • ABC STAMP LICKER
  • Mesolimbic tract
    
    • Cell bodies found in VTA of midbrain
    • Project to D4 receptors in limbic system
    • Hyperactivity results in positive symptoms
  • Mesocortical tract
    
    • Cell bodies found in VTA of midbrain
    • Project to frontal cortex and cingulate and prfrontal gyri
    • Largely HYPOactivity (D2 receptor antagonism)
    • Worsens negative symptoms, mood and cognition (memory)
• Short tracts
  
  • Tubero-infundibular tract
    
    • Connects hypothalamus w/ pituitary
    • Suppresses prolactin secretion
  • Retina and adrenal medulla

Question 3

What are the psychotic disorders (5)

Answer 3

Question 4

Schizophrenia

Description

Answer 4

Chronic mental disorder w/ periods of psychosis, disturbed behavior and thought, and decline in functioning

Lasting > 6 months

Associated w/ inc. dopaminergic activity, dec. dendritic branching

Question 5

Schizophrenia

Diagnosis

Answer 5

Requires at least 2 of the following symptoms:

• Positive symptoms
  
  • Delusions
  • Hallucinations
  • Disorganized speech
  • Disorganized or catatonic behavior
• Negative symptoms (should be there but aren’t)
  
  • APathy/Avolition
  • ALogia - inability to speak b/c of mental defect
  • Affective flattening
  • ANhedonia
  • ATtention deficit/Asociality
    *

Question 6

The defense mechanism that best characterizes the symptoms of schizophrenia

Answer 6

Projection

Question 7

What is a brief psychotic disorder?

Answer 7

Lasting < 1 month, usually stress related

only need 1 of the schizophrenic symptoms

+

NO NEGATIVE SYMPTOMS (5 A’s - PLANT)

Question 8

Schizophreniform disorder

Answer 8

Same criteria as schizophrenia

BUT unlike schizophrenia, only lasts 1-6 months

Question 9

Schizoaffective disorder

Answer 9

2 weeks of hallucinations or delusions without major mood episode (major depression or mania) –> or just window of time where individaul has only psychotic symptoms before mood symptoms

+

Periods of concurrent major mood episode w/ schizophrenic symptoms

aka experiencing CO-OCCURRING PSYCHOTIC AND MOOD SYMPTOMS

Remember! Schizoaffective disorder is a PRIMARY PSYCHOTIC disorder. For MDD + psychotic features, the initial problem –> one’s mood

Question 10

Mood Disorder, Severe

Answer 10

Abnormal range of moods or internal emotional states and loss of control over them

Includes:

1. MDD
2. Bipolar disorder
3. Dysthymic disorder
4. Cyclothymic disorder

• Without psychotic features
• With psychotic features
  
  • Hallucinations or delusions appear in the context of a mood episode
  • Hallucinations or delusions do NOT appear in absence of mood symptoms

Question 11

Delusional Disorder

Answer 11

Fixed, persistent, false belief system

Lasting > 1 month.

Functioning otherwise not impaired (e.g., a woman who genuinely believes she is married to a celebrity when, in fact, she is not)

No prior history of schizophrenia

Question 12

Catatonia

Answer 12

• Marked behavioral (psychomotor) disturbance
• Abnormal motor activity
  
  • Decreased
  • Excessive (or peculiar)
    
    • Simple - agitation
    • Complex - sterotypy, mannerism
• Decreased engagement

Question 13

Substance-Induced Psychotic Disorder

Intoxication - all substances except:

Withdrawal:

Answer 13

Intoxication

• Caffeine
• Nicotine
• Opioids

Withdrawal

• Alcohol
• Sedatives