Psychotic Disorders (4-14-14) Flashcards
3 main categories of psychosis?
hallucinations
delusions
manifestations of thought disorder
emphasized negative symptoms
Bleuler
emphasized positive symptoms
Schneider
general prevalence of schizophrenia
1%
1 schizophrenic parent –> chance in offspring?
12%
2 schizophrenic parents –> chance in offspring?
40%
lifetime prevalence worldwide of schizophrenia?
1%
downward drift hypothesis
affected people move into or stay in low socioeconomic group
social causation hypothesis
stresses that members of low socioeconomic groups experience contribute to their development of schizophrenia
dopamine hypothesis
Over-activity or excess of dopamine system
came from 2 supporting observations:
-efficacy of dopamine receptor antagonists
-psychotomimetic effects of dopamine agonists
relevant dopamine pathways
mesolimbic -> positive symptoms
mesocortical –> negative symptoms
nigrostriatal –> extra-pyramidal symptoms (EPS)
tuberoinfundibular –> prolactin secretion
serotonin system
- 5HT2 antagonism –> stop psychotic symptoms
- serotonin has inhibitory relationship w/ dopamine
neuroanatomy findings
none are diagnostically specific or clinically useful
- reduced brain volume
- small amygdala, hippocampus, parahippocampus
- large lateral and 3rd ventricle
positive symptoms
formal thought disorder hallucinations bizarre behaviors delusions** catatonia
negative symptoms
fewer spontaneous movements
speech blocking
avolition = apathy, poor grooming, anergia, anhedonia, attention deficits
pre-morbid phase of illness
early on in life
problems in maturation, cognition, emotional/social life
attention deficits
magical thinking, day dreaming, can’t maintain relationshios
**none of these can predict future schizo
prodromal phase
hard to diagnose wrongfully labeled as depressed vagueness in thinking abnormal preoccupations perceptual disturbances
psychotic phase
positive symptoms
convalescent phase
starts when symptoms stop after treatment
high risk to relapse (if stop Rx)
stable phase
phateau after 2-3 yrs
chronic disease w/ relapsing nature
criteria A to diagnose, need 2 or more in at least 1 month. Exceptions?
delusions hallucinations disorganized speech disorganized/catatonic behavior negative symptoms
Only need 1 if delusions= bizarre or haullicinations = voices
good prognostic factors
low emotion female acute onset affective symptoms positive symptoms married confusion
poor prognostic factors
high emotion male slow onset substance use no affective symp. negative symp. never married clear sensorium
schizophreniform vs. brief psychotic disorder
schizophreniform
-1 month –> 6 months
brief psychotic
- 1 day –> 1 month
- no stressor needed
schizoaffective disorders
symptoms of schizophrenia + mood disorders (depression + mania)
symptoms at least 2 weeks
low potency neuroleptic
chlorpromazine (thorazine)
thioridazine
mesoridazine
