Psychotic Disorder Flashcards
Does psychosis describe symptoms or a diagnosis?
described symptoms
What symptoms occur in psychosis?
Hallucinations
Delusions
What is a hallucination in the context of psychiatry?
perception without a stimulus
can be any sensory modality
(visual hallucinations are usually organic - brain or eye issue)
When can hallucinations occur in patients not suffering from psychosis?
hypnogogic - going to sleep
hypnopompic - waking up
What is a delusion in the context of psychiatry?
abnormal belief, outside of the cultural norms
(need to consider the strong beliefs held by some cultures/religious groups)
Name 3 potential causes of organic psychosis
delerium caused by infection
delerium tremens
alcohol / drug intoxicartion
hypercalcaemia
post-ictal psychosis
List 3 (first rank) symptoms of schizophrenia
- auditory hallucinations
- passivity experiences
- thought withdrawl, broadcast or insertion
- deusional perceptions
- somatic hallucinations
What types of auditory hallucinations may be experienced by patients with schizophrenia?
Thought Echo
hearing thoughts aloud
Running Commentary
voice talking about them in the third person, providing a commentary of their every move
(e.g. he’s brushing his teeth, he’s sitting down)
What are ‘passivity experiences’ that may be reported by patients suffering form psychosis?
patients feeling that an action or feeling is due to an external force
(e.g. MI5 have been moving my leg)
Whare are the following symptoms that may be reported by patinets with schizophrenia:
Thought Withdrawl
Thought Broadcast
Thought Insertion
Thought Withdrawl
thougths are being taken out of thier mine
Thought Broadcast
thougths are being made known to others e.g. by radio
Thought Insertion
thoughts are being inserted into their mind by others
What is delusional perception in a patient with schizophrenia?
attribution of a new meaning to a normally percepved object
e.g. as the traffic lights are red, I knew aliens were going to be landing soon
What are somatic hallucination?
feelings from inside the body
e.g. feeling that they have a snake in their abdomen
What is the ICD10 criteria for diagnosis of schizophrenia?
At least one of the following
- Thought echo, insertion, withdrawal, broadcast
- Delusions of control, influence or passivity, clearly referred to body/limb movements or specific thoughts actions or sensations, delusional perception
- Hallucinatory voices giving a running commentary on the patient’sbehaviour, or discussing them between themselves, or other typesof hallucinatory voices coming from some part of the body
- Persistent delusions of other kinds that are culturally inappropriateand completely impossible
Do patients with schizophrenia have insight?
Normally LACK Insight
What is the role of the mesolimbic pathway in the brain and is it believed to be overactive or unactive in schizophrenia?
involved in motivation and reward
believed to be OVERACTIVE in schizophrenia
What changes in the ventricles of the brain are seen in patients with schizophrenia?
enlarged ventricles
What is the Anti-NMDA encephalitis autoimmune hypothesis for schizophrenia?
patients develop antibodies to the NMDA receptor in the brain
commonly associated with ovarian teratoma
antibioides cause receptors to be internalised > hypofunction results
treated with corticosteroids and immunoglobulin
What is the function of the mesocortical pathway and it is believed to be overactive or underactive in patinets with schizophrenia?
involved in cognition, mood and emotional response
thought to be UNDERACTIVE
What type of GPCR is linked to the dopamine D2 receptors in the brain (which are targetted to treat schizophrenia)?
Gi coupled receptors
decrease addenylyl cyclase activity > decrease cAMP > decrease protein kinase A
(decrease AC > decrease cAMP > decrease PKA)
What adverse drug reaction may result following administration of a new antipsychotic?
Acute Dystonic Reaction
(sustained muscle contractions, frequently causing twisting, repetitive movements or abnormal postures)
Why do patinets taking long term (older) antipsychotics commonly present with parkinson type symptoms of slowness of movement?
Dopamine Antagnosits Reduce Glutamate to the Cortex
reduced stimulation of putamen > reduced inhibition of GPi/SNr > increased inhibition of thalamus > reduced stimulation of cortex
What is the difference between typical and atypical antipsychotics and what is their primary mechanism of action?
block D2 receptors > decreasing cAMP
typical antipsychotics (chlorpromazine)
block all CNS dopaminergic pathways
atypical antipsyhotics (olanzapine)
low affinity for D2 receptors > rapidly dissocaite
What is the prognosis like for patinets with schizophrenia?
shorter life expectancy
higher incidence of CVD, respiratory disease and cancer
suicide risk x9 higher than general population
What is drug induced psychosis and what is the ICD10 diagnostic criteria?
psychosis induced by a psychoactive substance
ICD10:
- onset of psychotic symptoms within two weeks of use
- persistnace of psychotic symptoms for more than 48 hours
* (if not then acute intoxication of drugs)* - duration of disorder not exceeding 6 months
(e.g. methamphetamine, cannabis, cocaine, LSD)
What is effective psychosis?
psychotic expereinces that are congruent (linked to) mood
manic patients = grandiose delusions
depressed patients = delusions of guilt
Post partum psychosis only presents in females with a previous psychiatric history?
TRUE / FALSE
FALSE
can affect any female in post partum period
(more common if previously diagnosed bipolar/psychotic illness, or mother/sister suffered)
