Psychotic Disorders Flashcards
What is Psychosis?
The presence of hallucinations or delusions
A set of symptoms, not a diagnosis
What are Hallucinations?
What frequently causes visual hallucinations?
Compare the 2 types of noon-pathological hallucinations
- A perception without an accompanying stimulus (any sensory modality)
- Organic pathologies (tumour, eye disease)
- Hypnogogic: When going to sleep
- Hypnopompic: When waking up
What are Delusions?
- A fixed, false belief which is unshakable
- Outside of cultural norms
Schizophrenics do not have a ‘split mind’ or multiple personalities. They are no more dangers than any other patient.
List the 5 First Rank symptoms of Schizophrenia (used to diagnose)
- Auditory hallucinations
- Passivity experiences
- Thought withdrawal/ broadcast/ insertion
- Delusional perceptions
- Somatic hallucinations
Describe the Auditory Hallucinations one may get in Schizophrenic
- Thought echo, hearing thoughts aloud
- Running commentary, on what individual’s doing
- 3rd person, multiple voices talking about patient
Describe the Passivity Experiences one may get in Schizophrenic
Belief than an action/ feeling is caused by external force
Describe the Thought withdrawal/ broadcast/ insertion one may get in Schizophrenic
Withdrawal: Belief that thoughts are being taken out of their mind
Broadcast: Belief that everyone knows what patient is thinking
Insertion: Belied that thoughts are being implanted by others
Describe the Delusional Perceptions one may get in Schizophrenic
Attribution of a new meaning to a normally perceived object
E.g Traffic lights went red means aliens are landing, blinking fire alarm means that police are watching
Describe the Somatic Hallucinations one may get in Schizophrenic
The sense of being touched when no one is there/ feeling of movement from inside of body
Schizophrenic symptoms can be classified as Positive or Negative
List 4 positive symptoms (something ‘added’)
- Delusions
- Hallucinations
- Lack of insight
- Thought disorder
Schizophrenic symptoms can be classified as Positive or Negative
List 5 negative symptoms (something ‘taken away’)
- Underactivity
- Low motivation
- Social withdrawal
- Emotional flattening
- Self neglect
List 3 theories of the pathophysiology of Schizophrenia
- Changes in Dopamine
- Structural brain changes
- Possible changes in Limbic system, including basal ganglia (some have emotional and motor symptoms)
Describe the Dopamine theory of Schizophrenia
Thought to be due to excess Dopamine
Evidence;
- Drugs that increase Dopamine induce Psychosis (Amphetamines)
- Drugs that antagonise Dopamine treat Psychosis (especially those acting at D2 receptors)
There are 4 DA pathways in the brain.
List them
- Nigrostriatal
- Tuberoinfundibular
- Mesolimbic
- Mesocortical
Is the Mesolimbic pathway thought to be under or over active in Schizophrenia?
Describe its route
- Mesolimbic pathway is thought to be Overactive in Schizophrenia
- From: Ventral Tegmental area
- To: Limbic structures and Nucleus Accumbens
Is the Mesocortical pathway thought to be under or over active in Schizophrenia?
Describe its route
- Mesocortical pathway is thought to be Underactive in Schizophrenia
- From: Ventral Tegmental area
- To: Frontal and Cingulate Cortices
Describe the route of the Nigrostriatal pathway
From: SnpC
To: Striatum (Caudate nucleus and Putamen)
List 7 structural brain changes in a patient with Schizophrenia
- Enlarged ventricles
- Decreased grey matter and brain weight
- Decreased temporal lobe volume
- Reduced size of Prefrontal Cortex and Limbic structures (Amygdala, Hippocampus, Basal Ganglia, Thalamus, HypoT, Cingulate Gyrus)
- Changes at synapses
- Less Oligodendrocytes
- Less Thalamic neurones
Compare the 2 pharmacological treatments of Schizophrenia
Typical Antipsychotics;
- Block D2 Receptors throughout CNS
- Inhibition of Mesolimbic and Mesocortical pathways
Atypical Antipsychotics;
- Lower affinity for D2 Receptorss, so milder side effects
- Also block 5HT2 Receptors, so some action on Serotonin systems
Side effects of Antipsychotics come from their action on other non-targeted pathways.
Suggest some Dopamine-related side effects
- Can effect movement via Nigrostriatal pathway-> Parkinsonism
Increased PRL levels leading to;
- Amenorrhea
- Galactorrhea
- Decreased fertility
- Decreased libido
- Osteoporosis
What can untreated Schizophrenic patients develop?
Hypokinetic movement disorders (Catatonia)
May be caused by reduced GABA binding-> Loss of inhibitory effect
Describe the route of the Tuberoinfundibular pathway
Involved in Dopamine’s inhibition on PRL release
From: Arcuate and Perientricular Nuclei of Hypothalamus
To: Infundibular region of Thalamus
One of the challenges in treating Schizophrenia is that patients tend to lack insight, which can affect compliance.
(Don’t believe they’re sick, so won’t take medication)
How can we get around this?
Medication can be given in different ways
IM, Oral, Depot injection- Can last weeks to months
Describe the Prognosis of Schizophrenia
- Good outlook if treatment started early
- 50% do well in the long term
List 6 factors that are associated with a good prognosis of Schizophrenia treatment
- No family history
- Good permorbid function
- Acute onset
- Mood disturbance
- Prompt treatment
- Maintenance of motivation
List 7 long-term consequences of Schizophrenia
- Mortality twice as high as general population
- Shorter life expectancy
- Higher incidence of CVS, Respiratory disease and Cancer
- 9x greater suicide risk than general population
- 2x greater risk of violent death than general population
- Substance misuse is common
- Many patients smoke
List some Serotonin-related side effects of Atypical Antipsychotics
- Reduced glucose tolerance-> Diaebtes
- Weight gain
- Hypercholesterolaemia
- Impaired cardiac conduction-> Prolonged QT and Arrhythmias
