psychotic d/o Flashcards
alogia
poverty of speech
avolotion
inability to initiate and persist life activities
SCHIZOPHRENIA
mood in MDD v psychotic
MDD = mood congruent sx psychotic = not so much
dopamine hypothesis of schizo
too much - basal ganglia
too little - prefrontal cortex
dopamine in schizo:
mesocortical
negative, cognitive, mood
dopamine in schizo:
tuberoinfundibular
inhibits prolactin release
dopamine in schizo:
mesolimbic
positive sx d/t hyperactivity
dopamine in schizo:
nigrostriatal
extrapyrimidal (tardive dyskinesia)
glutamate in schizo
insufficient signaling leads to positive and negative sx
glutamate in schizo
frontal cortex
since glutamate amplifies dopa, too little glutamate produces sx similar to having too little dopa
glutamate in schizo
basal ganglia
? but same as if too much dopa
PCP/NMDA model of schizo
PCP blocks NMDA receptors
- causes schizo-like sx
- maybe endogenous NMDA blocks cause schizo
Note: NMDA is a glutamate receptor
Glycine transport inhibitor and schizo
Normally glycine transporters protect NMDA from high levels of glycines
-inhibiting these transporters removes the protection
Chromosome involved in schizo
6
-specifically component 4 which controls Ca channel, glutamate signaling
extremely negativism
movement resistance
catalepsy
waxy
pruning
normal in kids, in schizo may keep going in adulthood
random things that might increase risk of schizo
- birth trauma brain damage
- viral infection 2 and 3 trimester
- nutritional issues
- maternal stress
- parent dies in childhood
- low SES
- urban area, northern hemisphere, winter birth month
stages of schizo
prodrome (negative)
acute (positive)
recovery/residual
prognosis stats for schizo
30% functional
30% intermittent hospitalization
30% incapacitated
10% suicide
better prognostic factors for schizo
late onset sudden onset female more positive sx higher baseline level of function paranoid subtype (as opposed to disorganzied)
side effects of typical antipsychotics
high potency: extrapyramidal prolactin sedation, wt gain (anti H1) blurry vision, drymouth, conspitation, urinary retention, memory probs (anti M1)
low potency:
arrhythmia, skin discoloration, seizure
low potency and high potency example
high - haloperidol
low - chlorpromazine
extrapyramidal
dystonia
akathisia (rocking, pacing, mvmt compul)
parkinsonism
tardive dyskinseia
torticollis
dystonia where your neck is bent to one side
opisthotonos
arched back like in tetanus
side effects of atypical antipsychotics
wt gain increased blood glucose increased triglycerides possible sedation prolonged QT
brief psychotic episode
like schizo but lasts 1d-1mo
- increased risk if woman, personality d/o
schizophreniform
like schizo but 1mo-6mo
delusion d/o
delusions lasting >1 mo
rare hallucinations
functioning unaffected
no disorganized thought/behavior
schizoaffective
schizo sx + mood psychotic sx in absence of mood sx psychotic sx last 2 weeks or more prognosis slightly better more common in women
schizoid
detached from social relationships
restricted emotion in social settings
(nothing psycho)
schizotypal
v uncomfortable w close relationships
maybe cognitive distortions
maybe eccentric behavior
(nothing psycho)
cognitive probs in psychosis
working mem
executive functioning
attention
learning
appraisal and anticipation (anxiety)
appraisal in cortex
parietal - threatening?
frontal - what do i do?
anticipation
deeper structure, fight/flight
arousal (anxiety)
NE, sympathetic
Panic d/o
fear of panic attack itself
misinterpet things - i’m dying
Social phobia
6+ mo
negative expectations
negative interpretation of others’ response
PTSD
memory
overestimation of risk will recur
nightmare
normal stress response path
hypothalamus pituitary adrenal cortex cortisol > negative feedback
GAD
6+ months, 3/6 criteria
restless, fatigue, conc, irritable, muscle tense, sleep disturbed
agoraphobia
fear 2+
open space, enclosed space, in line/crowd, outside your home alone
panic attack (d/o is repeated attacks)
4+ of the following
racing heart, sweat, trembling, SOB, choking, angina, nausea, dizzy, chills, tingling, derealization/depersonalization, fear of going crazy, fear of dying
d/o = 1 mo worrying you’ll have another
Simple phobia
6+ mo
arousal examples
panic, tonic, flushing, tension, HA
GAD epi
females, 30+
4-7% of population
simple phobia epi
females, 12%
usually resolves by adulthood
social phobia epi
male = female, onset <25
3-5% pop
panic epi
females, <30
3 CBT approaches for anxiety
exposure
systematic desensitization (close eyes)
flooding
deep breathing explanation for anxiety tx
shallow breathing = more CO2, brain thinks it’s suffocating
deep breathing = more O2, stops this response
central neurotransmitters (2)
gaba, glutamate
monoamine (2)
seratonin, NE “fight/flight”
MAPPSS-CO
mood anxiety psychotic personality substance somatic cognitive obsessions
1 in _ teens have d/o
5
Suicide is __ cause of death overall
__ cause of death 10-34
10, 2
3 techniques ending in -ation for a psych interview
normalization
continuation
redirection
4 Ps
predisposing
precipitating
perpetuating
protective
stereotypy
repetition of senseless speech or movement (autism, schizo)
catatonia
immobile/weird positioning
dystonia
painful involuntary muscle contractions
dyskinesia
difficulty performing voluntary movements
circumstantiality
include too many details
derailment
sentences don’t make sense
flight of ideas
move rapidly from idea to idea
neologism
new words or using words differently
distractable though
during discussion, pt changes course due to something unrelated in the environment
word salad
literally makes no sense, just random words
tangentality
you give an appropriate response to the question but don’t answer the question
alogia, preoccupation, delusion
circumstantiality are disorders of
thought content
ideas of influence
another person/force is controlling one’s behavior
nihilistic
think self, part of self, world does not exist
jealousy
everyone wants what they have
attention
WORLD backwards
concentration
serial 7s
calculation
serial 7s (also assess concentration)
interlocking pentagons difficulty
constructional apraxia
SIGECAPS
sleep interest guilt energy concentration appetite psychomotor suicide
brain structure hyperactive in dpn
hypothalamus-pituitary-adrenal axis
monoamine in neocortex
concentration
monoamine in striatum
sluggish movement
monoamine in amygaloid body
anxiety
monoamine in hypothalamus
sleep and appetite
monoamine in hippocampus
memory problems
manic episode
1 week
significant impairment in functioning
hypomanic
4 days or less
not significant impairment in functioning
disruptive mood d/o tx
CBT
disruptive mood d/o
sx began at age 10 or before
dx can only be made from 6-18
sx last 12+ mo
persistant depressive d/o
2 years
psychotic features in depressive are mood ___
congruent
ecstasy - appearance
euphora, diminished fear, self-confident
ecstasy - mechanism
release monoamines
hallucinogens - appearance
dilated pupils, synesthesia
- LSD, hallucinations
- mescaline, visual geometricization
hallucinogens - mechanism
seratonin agonist
PCP - appearance
Rage Erythema Dialated pupils Delusions Amnesia Nystagmus Excitation Skin dryness
PCP - side effects
memory loss, liver probs, dpn, psychosis
PCP - mechanism
NMDA antagonist, hallucinations
cannabis - mechanism
GPCR receptor for THC, inhibits cAMP in hippocapmus, basal ganglia, cerebellum
cannibis - appearance
perceptual disturbance, anxiety, paranoia, infection, tachycadic, dry mouth, increased appetite
