Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

3. Psychosis > Psychotic Disorders--General + Stahls Minibook + Trials > Flashcards

Psychotic Disorders--General + Stahls Minibook + Trials Flashcards

1
Q

what defines the family of disorders known as the “schizophrenia spectrum and other psychotic disorders” (i.e what abnormalities must be present)

A

defined by abnormalities in ONE or MORE of the following FIVE domains:

delusions

hallucinations

disorganized thinking (speech)

grossly disorganized or abnormal motor behaviour (including catatonia)

negative symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are delusions

A

FIXED beliefs that are not amenable to change in light of conflicting evidence

“fixed false belief”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what types of themes might characterize delusions?

which are most common?

A

persecutory
referential
somatic
religious
grandiose
erotomanic
nihilistic
somatic

PERSECUTORY is most common (referential also common)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

define persecutory delusion

A

belief that one is going to be harmed, harassed, and so forth by an individual, organization, or other group

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

define referential delusions

A

belief that certain gesture, comments, environmental cues and so forth are directed at oneself

–also common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

define grandiose delusions

A

when individual believes has exceptional abilities, wealth or fame

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

define erotomanic delusions

A

when individual believes falsely that another person is in love with him or her

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

define nihilistic delusions

A

involve conviction that a major catastrophe will occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

define somatic delusions

A

preoccupations regarding health and organ function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

under what conditions are delusions deemed “bizarre”

A

if they are clearly implausible and not understandable to same-culture peers and do not derive from ordinary life experiences –> delusions that express a loss of control over mind or body are generally thought to be bizarre

i.e belief that an outside force has removed his or her internal organs and replaced with someone elses organs without leaving any wounds or scars

NONbizarre would be –> belief one is under surveillance by the police despite lack of convincing evidence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

give some examples of delusions that involve loss of control over mind/body that are generally thought to be bizarre in nature

A

thought withdrawal (thoughts removed by outside force)

thought insertion (alien thoughts inserted into ones own mind)

delusions of control (ones body or actions beying acted upon or manipulated by some outside force

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how do you distinguish between a delusion and a strongly held belief

A

sometimes are to make this distinction

depends in part on the degree of conviction with which the belief is held despite clear or reasonable contradictory evidence regarding its veracity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

define hallucination

A

perception like experiences that occur without an external stimulus

they are VIVID and CLEAR with the FULL FORCE AND IMPACT of normal perceptions and NOT under voluntary control

may occur in any sensory modality –> AH most common in SCZ

**must occur in context of a CLEAR SENSORIUM*

may be normal part of some religious/cultural contexts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how are auditory hallucination usually experienced

A

as voices–> can be familiar or unfamiliar

perceived as distinct from one’s own thoughts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

define hypnagogic hallucination

A

hallucination that occurs in the process of falling asleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

define hypnapompic hallucination

A

hallucination that occurs in the process of waking up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

are hypnagogic and hypnapompic hallucinations true hallucinations?

A

no–> considered within the range of normal experience

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how is thought form disorder usually inferred clinically

A

from persons speech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

define derailment/loose associations

A

individual switches from one topic to another

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

define tangentiality

A

answers to questions may be obliquely related or completely unrelated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

define incoherence/”word salad”

A

speech that is so severely disorganized is it nearly incomprehensible and resembles receptive aphasia in its linguistic disorganization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

how severe must disorganized speech be to make you consider psychosis

A

severe enough to impair effective communication (mildly disorganized speech is common and nonspecific)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

how might grossly disorganized or abnormal motor behaviour manifest

A

in a variety of ways

i.e childlike “silliness” to unpredictable agitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

define catatonic behaviour

A

marked DECREASE in REACTIVITY to the environment

ranges from resistance to instructions (negativism)–> maintaining rigid, inappropriate or bizarre posture–> complete lack of motor response (mutism/stupor)

can also include purposeless and excessive motor activity without obvious cause (catatonic excitement)

other features–> repeated stereotyped movements, staring, grimacing, mutism, echoing of speech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
are catatonic symptoms always/only seen in schizophrenia?
NO often associated with this but catatonia is NONSPECIFIC and may occur in other mental disorders (i.e bipolar, depressive disorders) and in medical conditions
26
what types of symptoms account for a substantial portion of the morbidity associated with schizophrenia
negative symptoms
27
do you often see negative symptoms with other psychotic disorders
no not as much
28
which two negative symptoms are particularly prominent in SCZ
diminished emotional expression + avolition
29
define "diminished emotional expression" as a negative symptom
includes reductions in the expression of emotions in the face, eye contact, intonantion of speech (prosody), and movements of hands, head, face that normally give emotional emphasis to speech
30
define avolition
decrease in motivated self-initiated purposeful activities may sit for long periods of time and show little interest in participating in work or social activities
31
list all the negative symptoms
diminished emotional expression avolition alogia anhedonia asociality
32
define alogia
diminished speech output
33
define anhedonia
decreased ability to experience pleasure from positive stimuli or a degradation in recollection of pleasure previously experienced
34
define asociality
apparent lack of interest in social interactions
35
is schizotypal PD considered within the schizophrenia spectrum
yes but abnormalities of beliefs, thinking, and perception are below threshold for dx of psychotic disorder
36
which 2 disorders are defined by abnormalities limited to one domain only of pschosis
delusional disorder (delusions only) catatonia only
37
list disorders that can be accompanied by catatonia
neurodevelopmental psychotic bipolar depressive other
38
how do you assess severity of psychotic disorders
there are "assessment measures" included in the DSM that can help assess for severity to help with treatment planning, prognostic decision making and research there are also dimensional assessments for primary symptoms of psychosis like delusions and hallucinations
39
is schizoaffective disorder considered a distinct nosological category
there is growing evidence that it is NOT
40
define psychosis
narrowest and current definition: hallucinations and delusions, with lack of reality testing or insight
41
what conditions should you suspect if someone presents with olfactory hallucinations
schizophrenia spectrum disorders temporal lobe seizures brain neoplasms Parkinsons disease
42
what is the most common type of hallucination in primary psychiatric disorders
AH
43
are command hallucinations an independent predictor of suicide attempts?
no---> only individuals who were previously predisposed to suicide attempts have a higher risk of completed suicide
44
what are the most common single cause of visual hallucinations and illusions
migraines
45
what type of dementia can be characterized by visual hallucinations
dementia with lewy bodies
46
what is charles bonnet syndrome
common non psychiatric condition among people with serious vision loss ie due to macular degeneration, glaucoma, and diabetic retinopathy and is characterized by temporary visual hallucinations
47
what sleep disorder can be characterized by visual hallucinations
narcolepsy
48
what are cenesthetic hallucinations
a type of somatic delusion involving the visceral organs i.e patient with SCZ reporting pushing sensation of blood or that their brain is on fire can also be seen in parkinsons patients on dopaminergic agents
49
in what population are nihilistic delusions common
psychotic depression in the elderly
50
in what population are delusions of theft common
can be a prodrome for neurodegenerative conditions like alzheimer's when individuals have in fact misplaced their belongings
51
what is abulia
*not in the 5 negative symptoms* restriction in motivation and initiation/inability to make goals and decisions
52
what is avolition
inability to initiate and persist in self directed activities
53
is psychosis a diagnosis
NO "psychosis" is a syndrome, not a diagnosis in and of itself
54
why do we think there is a dopamine deficit in the mesocortical pathway in schizophrenia
COULD result from ongoing DEGENERATION due to gutamate excitotoxicity or from a NEURODEVELOPMENTAL impairement in the glutamatergic system
55
what other neurotransmitters have been hypothesized to be implicated in the etiology of schizophrenia in addition to dopamine
glutamate serotonin
56
which dopamine pathway is responsible for the development of the positive symptoms of schizophrenia
mesolimbic
57
which dopamine pathway is responsible for the development of the negative symptoms of schizophrenia
mesocortical (to the DLPFC and VMPFC)
58
which dopamine pathway is responsible for the development of the affective symptoms of schizophrenia
mesocortical to the VMPFC
59
which dopamine pathway is responsible for the development of the cognitive symptoms of schizophrenia
mesocortical to the DLPFC
60
what is the NMDA receptor theory of schizophrenia
theory that NMDA receptor hypofunction may be related to symptoms of schizophrenia based on observation that ingestion of PCP--an NMDA receptor antagonist--basically causes same sx of schizophrenia, including positive sx, affective sx like blunted affect, negative sx like social withdrawal and cognitive sx like executive dysfunction
61
how does glutamate interact with dopamine in the mesolimbic pathway
bascially: TONIC INHIBITION of dopamine in mesolimbic pathway descending cortico-brainstem glutamate pathway normally acts as BRAKE for mesolimbic dopamine pathway via GABA interneurons --> tonic inhibition if glutamate projections are HYPOACTIVE --> brake released--> hyperqactive mesolimbic dopamine system--> may explain positive sx schizophrenia a theory!
62
how does glutamate normally interact with the mesocortical pathway
basically: usually TONICALLY EXCITE mesocortical dopamine pathway act as dopamine neuron accelerators in this pathway if glutamate is hypoactive in this pathway--> no tonic excitation--> hypoactive dopamine in mesocortical pathway a theory!
63
where do ascending 5HT projections originate from in the brain
raphe nucleus in brainstem
64
how does stimulation of 5HT1A receptors affect dopamine release
increases dopamine release
65
how does stimulation of 5HT2A receptors affect dopamine release
inhibits dopamine release (dopamine "brake")
66
how does stimulation of 5HT1A receptors affect glutamate release
inhibits glutamate release (glutamate "brake")
67
what was the research questions in the CATIE phase 1 trial
are there measurable differences in effectiveness between antipsychotics (risperidone vs olanzapine vs ziprasidone vs quetiapine vs perphenazine) in the treatment of patients with schizophrenia?
68
when was CATIE phase 1 trial published
2005
69
how was CATIE phase 1 run?
patients with schizophrenia were randomized to one of the 5 APs in the trial double blind
70
what was the primary endpoint for the CATIE trial phase 1
all cause discontinuation (meant to try and incorporate both participant and clinician considerations in determining efficacy in treatment) secondary outcomes: scores on the PANSS and "successful treatment time"
71
what % of people discontinued treatment with the medication they were randomized to prior to the end of the first phase of the trial
74%
72
what does CATIE stand for
clinical antipsychotic trials of intervention effectiveness
73
what were the results of the CATIE trial phase I (beyond the 74% that discontinued)
--time to discontinuation for any reason was longest for olanzapine (not significant) --time to discontinuation due to lack of efficacy was longest for olanzapine --no difference between meds in time to discontinuation due to SEs though rates of d/c due to SEs were highest for olanzapine and lowest for risperidone --"successful tx time" = longest for olanzapine --those on olanzapine less likely to be hospitalized due to worsening psychotic sx and biggest improvement in PANSS --olanzapine had ore weight gain, dyslipidemia --no significant diff in EPS between meds though those on perphenazine more likely to stop due to PES
74
summarize the implications of the CATIE trial
nearly 3/4 of patients with schizophrenia stopped or changed their AP within 18 months of initiation ppl remained on olanzapine for longer compared to others the FGA (perphenazine) was overall comparable to the SGAs in the study olanzapine seemed to be most effective but most intolerable
75
what dud the CUTLASS trial stand for
cost utility of atypical antipsychotics
76
what was the research questions in the CUTLASS trial
are SGAs better than FGAs for those with schizophrenia needing an antipsychotic CHANGE also, are there improvements in quality of life and savings in health service use to justify the additional costs of SGAs over FGAs
77
what is a summary of the CUTLASS trial findings
"in people with SCZ whose medication is changed for clinical reasons, there is no DISadvantag... in using FGAs rather than NONCLOZAPINE SGAs"
78
what was the primary endpoint in the CUTLASS trial
total score on the quality of life scale with a 5 point difference considered meaningful clinically

3. Psychosis (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions