Psychotic Disorders Flashcards
Schizophrenia patients develop illness at what age range? (Males vs females)
18-25 males
21-30 females
Schizophrenia patients have trouble with?
Thinking clearly
They often don’t want to take their meds becasue they don’t have insight into their illness
DSM criteria for scizophrenia
two or more each present during a 1 month period. at least one must be the first 3
delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, negative symptoms (diminished emotional expression)
must have deterioration in function
signs of disturbance last for 6 months
rule out schizoaffective, depressive, and bipolar or other condition/medication
If ASD, must have hallucinations or delusions for >1 month
Positive symptoms of schizophrenia
hallucinations, delusions, disorganized thought, disorganized behavior (would notice if on a bus)
delusions: fixed false beliefs regardless of evidence
hallucinations- perception experience without stimulus. schizo typically auditory
Types of delusions
(beliefs by the schizophrenic patient)
grandiose, nihilistic (death), persecutory (being treated wrongfully), somatic (organs have stopped functioning), sexual (other people think they are a rapist or prostitute), religious
Qualities of disorganized though
tangentiality, circumstantiality, word salad, perseveration, loose associations, clanging (rhyming everything), neologisms (make up new words), blocking (stop talking mid sentence).
non goal directed behavior (silliness to unpredictable agitation)
Negative symptoms of schizophrenia
diminished emotional expression, avolition (lose ability to imitate goal directed behavior)
reduced speech, poor grooming, limited eye contact, less emotional responsiveness, reduced interest, reduced social drive
Mental status Exam findings in schizophrenia
appearance/behavior- disheveled, poor hygiene
speech- increased latency, monotone
affect- constructed, blunted or flat
thought process and content- disorganized, thought blocking, poverty of though, hallucinations, thought insertion, though broadcasting
judgement- poor
insight- lack of
Worldwide prevalence of schizo is ____
(Strong/Weak) genetic predisposition
0.5-1%
strong. concordance with monozygotic, strong inheritance if both parents schizo
multiple hit hypothesis (genetic predisposition + other risk factors)
Risk factors: paternal age, season of birth (winter), birth complications, urban birth, migration, cannabis use, trauma
In schizophrenia patients, what comes first: negative symptoms or positive
negative comes first. positive symptoms tend to diminish over life course
Drugs that enhance _____ transmission to limbic system lead to or worsening psychotic symptoms
dopamine. drugs that block dopamine D2 receptors are used to treat psychotic symptoms
don’t let patients do cocaine or meth
What brain pathway leads to the positive symptoms of schizophrenia?
mesolimbic hyperactivity pathway
ventral tegmentum->nucleus accumbens
What brain pathway leads to the negative and cognitive symptoms of schizophrenia?
mesocortical underactivity (ventral tegmental-> DA to dorsal lateral PFC and ventral medial PFC)
Dopamine pathways that are involved with schizophrenia
mesolimbic (pos), mesocortical (neg), nigrostriatal (EPS (movement problems) when blocked by antipsychotics), tuberoinfundibulnar (hyperprolactinemia when antipsychotics)
Pathophysiology role of glutamate NMDA receptors in schizophrenia
NMDA hypofunction-> increased symptoms-> mesolimbic and mesocortical paths NMDA antagonists (PCP and ketamine)-> schizolike symptoms in health and exacerbate preexisting symptoms in pts with schizophrenia. These interact with dopamine pathways
Besides NMDA and dopamine, what are other neurotransmitters involved in schizophrenia
5ht: increased. some antipsychotics block 5-HT2a
GABA: decreased activity in schizo
Ach: decreased-> smaller density of muscarinic and nicotinic receptors
How many patients with schizophrenia attempt and die by suicide
⅓, 1/10
What is associated with better prognosis with schizophrenia
later onset, social support, mood symptoms, female, good premorbid functioning, no FH, no SU (many schizophrenic patients either increase or decrease psychosis with substances)
Medical causes of Psychosis (there are 9 here)
substance use, withdrawal, medication induced, infections, metabolic and endocrine disorders, tumor stroke brain trauma, temporal lobe epilepsy, autoimmune disorder, toxic illness
What are 4 other psychiatric disorders that schizophrenia must be distinguished from (other things that should be on the differential)
schizoaffective, mood disorder, delusional disorder, personality disorder
(should also look into schizophreniform disorder, brief psychotic disorder, factitious disorder with psych symptoms, malingering)
Treatments for schizophrenia
pharmacotherapy (treat aggressively), ECT, CBT, transcranial magnetic stimulation), community treatment, psychosocial and vocational rehab, family therapy, appropriate housing
Name the psych disorder
uninterrupted period of illness with a major mood episode, delusions or hallucinations for 2 or more weeks w/o mood episode, mood episode must be majority of active duration
not attributable to substance
DSM criteria for schizo affective disorder
Schizoaffective disorder prognosis and treatment
Prog: better than schizophrenia, worse than mood disorder
Treatment: target mood and psychotic symptoms (one drug: second gen antipsychotic). first gen used for psychotic symptoms. mood stabilizers/antidepressants often needed. combo drug and non drug treatments
Name the disorder
one or more delusions with >1month duration
does not have schizophrenia
behavior is not bizarre or odd
could have manic or depressive but must be brief
not attributable to any other medical condition
DSM criteria for delusions disorder
Name the disorder based on epidemiology, age, prevalence etc:
0.2%, persecutory type is most common, no gender differences. onset middle to late adult life. familial relationship with schizo.
generally employed and self supporting
Delusional Disorder
Delusional disorder medications
antipsychotics but response poor (lower anxiety but still delusions)
SSRIs
Relationship building-> then gently challenge delusional beliefs
Name the psychotic disorder psychotic symptoms last >1 day, <1 month others ruled out 2x as common in women, hospitalization may be helpful antipsychotics helpful if agitated
Brief psychotic disorder
Typical schizophrenia but >1month and <6 months, ruled out other med conditions.
if symptoms last more than 6 months, changed diagnosis
Schizophreniform disorder
Thought process that wanders from the point but does eventually get to the point
circumstantial thought process
Blocking/partial agonist the D2 receptors in the mesolimbic pathway relieves the ________ symptoms of schizophrenia, but may _______ the negative symptoms from mesocortical
positive
worsen
-this may lead to aboral movements from nigrostriatal (extrapyramidal side effects)
D2 receptor activity is how you treat schizophrenia but there might be effects at _______ and ______ that might cause what?
nigrostriatal- EPS. treat with anticholinergic medications (d2 block->up Act release)
tuberinfundibular- block d2->up prolactin release->sexual dysfunction, gynecomastia, dysmenorrhea, amenorrhea
What effect do the 5HT2A receptors have in schizophrenia? 5HT2A antagonism has decreased risk of ______ and _____
downstream effect on glutamate-> reduce DA in mesolimbic.
EPS and prolactinemia
