Psychotic Disorders Flashcards
what is psychosis
state in which the person’s thoughts, affective response, ability to recognize reality, and ability to communicate and relate to others are sufficiently impaired
out of touch with reality!
common characteristics of psychosis
- hallucinations
- delusions
- disorganized thinking
- disorganized behavior
five domains of psychosis
- delusions
- hallucination
- disorganized thinking
- disorganized behavior
- negative symptoms
what are delusions
- false belief
- unshakable
- not consistent with person’s background
- not amenable to change in light of conflicting evidence
types of delusions
- persecutory, paranoid!!
- referential
- grandiose
- erotomanic
- infidelity or jealousy
- nihilistic
- somatic
- bizarre
- folie a deux (shared by two)
what are hallucinations
- false sensory perceptions without any external stimuli
hallucinations involve:
hearing, vision, touch, smell, taste
what is disorganized thinking
disturbance in flow and content of thoughts
what is magical thinking
thoughts, words, or actions that assume power
what is neologisms
new words coined by patient or old words with new meanings
what is looseness of association
unrelated or unconnected ideas that shift from one subject to another
what is perseveration
repetition of the same verbal response to different questions
what is circumstantiality /tangientiality
patient digresses or answers to questions may be unrelated
what is clang association
words are associated by the sound of the word rather than meaning (punning and rhyming)
echolalia
repeating of words or phrases heard
characteristics of disorganized behavior
- talking/whispering to self
- abnormal gesturing
- catatonia
- hebephrenia
diminished emotional expression is prominent in ___
schizophrenia
what is avolition
decrease in motivated self-initiated purposeful activities such as work, studies, and self care
what is alogia
diminished speech output
what is ahedonia
decreased ability to experience pleasure from positive stimuli
what is associality
lack of interest in social interaction
psychotic disorders
- schizophrenia
- schizophreniform
- brief psychotic disorder (schizotypal, delusional, schizoaffective)
- psychotic disorder due to substance
- psychotic disorder due to medical condition
what is schizoprenia
- before age 25
- persists throughout lifetime
- based on history and mse (no lab test)
- psychosis 6 mos or greater
biological basis of schizophrenia
- genetics: largest risk factor, dopaminergic and glutamatergic neurons
- biochemical hypotheses: dopamine hypothesis and glutamatergic hypothesis
- neuropathology
dopamine vs glutamatergic hypothesis
dopamine:
- too much dopaminergic activity
- too much dopamine
- too many dopamine receptors
- hypersensitivity to dopamine
glumatine:
- hypofunctioning signaling
dopamine pathways
- nigro-striatal pathway
- meso-limbic pathway: reward pathway and positive symptoms
- meso-cortical pathway: motivation, emotions, and negative symptoms
- tubulo-infundibular pathway
most abundant excitatory neurotransmitter
glutamate
- concentrated in hippocampus and amygdala
neuropathologies in schizophrenia
- neurochemical abnormalities
- loss of brain volume
- presence of lateral and third ventricular enlargement and some reduction in cortical volume
psychoanalytic theories in schizophrenia
- sigmund freud
- margaret mahler
- harry stack sullivan
learning theories in schizophrenia
- learning from parents with emotional problems and adverse circumstances
- avoid punishment
family theories in schizophrenia
- schism (division) between the parents
- skewed (distorted) relationship between child and one parent
outcomes in schizophrenia
- 20% favorable outcome
- require constant daily living support
- progressive deterioration
what is schizophreniform disorder
- 1-6 mos!
- unknown cause
- no prodromal phase
- functional impairment during episode
- no deterioration after episode
what is brief psychotic disorder
- <1 month
- sudden acute transient psychosis
- full recovery
- not due to drugs, medical illness, or mood disorder
characteristics of schizotypal personality disorder
- unusual perceptual distortions
- eccentricities of behavior
- ideas of reference
- odd beliefs, magical thinking
- odd thinking and speech
what is delusional disorder
- exhibits non-bizarre delusion at least 1 month duration
- no other psychiatric disorders
- no other features
- person is generally functional with some relationships
what is schizoaffective disorder
- features of both schizophrenia and affective disorders
- psychosis and major mood episode
psychosis from general medical condition
- dementia: delusions can occur early in the course
- delirium: hallucinations, fluctuation consciousness, confusion, impaired cognitive abilities
typical antipsychotics (1st gen)
- dopamine receptor antagonists
- inhibit dopaminergiic transmission or high affinity antagonism of dopamine d2 receptors
- more neurologic side effects
- chlorpromazine, haloperidol, levopromazine, fluphenazine
what is neuroleptic malignant syndrome
- potentially fatal side effect
- extreme hyperthermia, muscular regidity and dystonia, akinesia, increased pulse rate and bp -> cardio collapse
- lab: inc wbc, creatinine, liver enzymes, plasma myoglobin, myoglobinuria
- evolves over 24-72 hours
- untreated syndrome: 10-14 days
what are extrapyramidal symptoms
- tardive dyskinesia
- adverse effect of long-term antipsychotic treatment (10-20 years after)
- irreversible
treatment for extrapyramidal symptoms
ex bi tri di
- biperiden
- benztropine
- trihexyphenidyl
- diphenhydramine
what are atypical antipsychotics (2nd gen)
- selective dopamine receptor antagonists
- more metabolic side effects (increased weight, sugar, lipids)
- targets both negative and positive symptoms
