Psychotic Disorders-Kirkpatrick Flashcards
What is this:
a perception of something (as a visual image or a sound) with no external cause
hallucination
What is this:
a fixed, false belief that is not shared by other members of the person’s subculture
delusion
What is this:
irrelevance and incoherence of verbal productions ranging from simple blocking and mild circumstantiality to total loosening of associations
Disorganized speech
Disorganized speech is on a continuum of (blank) and is similiar in some instances to fluent (blank)
severity
aphasia
***fluent aphasia AKA wernickes, can produce words without grammatical error just doesn’t make sense
What is aimless overactivity?
catatonic excitement
What are the most common forms of catatonia?
physical immobility or little or no speech
catatonia can be associated with (balnk) overactivity. What will this result in?
autonomic
fever, tachycardia
catatonia is found in multiple conditions but may be more common in (blank) disorder
affective
What is the treatment for catatonia?
- lorazepam
- antipsychotics
- ECT
Malignant catatonia can include (blank) and can be (blank)
delirium
fatal
What are negative symptoms?
decrease or absence of a normal behavior or experience
What are the negative symptoms found in schizophrenia?
- Blunted affect (decrease in facial expression, expressive gestures/body language, modulation of speech/pitch/volume of voice)
- Poverty of speech (alogia: few words spoken, little information conveyed)
- Anhedonia (decreased experience of pleasure)
- Asociality
- Amotivation
- Lack of normal distress
What are the disorders that can have psychosis (other than schizophrenia)?
dementia
serious depression
mania
delirium
Is schizophrenia an affective disorder?
NO!
It is an idiopathic psychosis (not due to another disorder)
What is the DSM criteria for schizophrenia?
2 or more of the following for one month (less if treated)
- Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms (diminished emotional expression or avolition)
- Decline in function
- continuous signs for 6 months
- affective DISORDER EXCLUSION
- not due to drugs, meds, or other med condition or autism
What are the disorders in the schizophrenia spectrum?
Schizophrenia Brief psychotic disorder Schizophreniform disorder Schizoaffective disorder Psychotic disorder not otherwise specific Schizotypal personality disorder Schizoid personality disorder Delusional disorder
There is an 8 fold risk of having adult diabetes if you are a (Blank) baby
small weight
People who were conceived during the famine in holland were at increase risk of (blank) and (blank), they had a more athergenic plasma lipid profile, were more responsive to stress and had a doubled rate of coronary heart disease AND had more type 2 diabetes
schizophrenia
depression
What are risk factors for schizophrenia?
Low birth weight Obstetrical complications Winter birth for schizophrenia as a whole Summer birth for one subgroup Gestational diabetes Prenatal famine Prenatal stress, including infections
The most valid animal model for schizophrenia?
Prenatal stress in rats
Advanced (paternal/maternal) age
Paternal
For schizophrenia:
Is Cannabis use a risk factor?
Physic and sexual abuse in childhood/early adolescence?
Immigration?
Yes
Yes
Yes
What are some known genes that are risk factors for schizophrenia?
DISC1, neuregulin 1
-> having to many number variants cause it
Several of the genetic risk factors for schizophrenia are also risk factors for (blank and blank)
autism and mental retardation
For many patients, schizophrenia starts in (blank). How can you tell?
utero
- abnormal motor and cognitive development in high-risk toddlers (children of mothers with schizophrenia)
- During childhood, adults with schizophrenia have abnormal motor and social function
When is the onset of schizophrenia?
in utero
T or F
More broadly, prenatal & perinatal events can increase the risk of several diseases that are first apparent in adult life
T
The development of schizophrenia can occur through (blank) pathways
multiple causal pathways
In regards to schizophrenia:
When do you see the negative symptoms?
When do you see cognitive impairment?
When do you see psychosis?
- detectable in childhood
- detectable in preschool children at high risk for psychosis
- typically late adolescence/early adulthood
(blank) in schizophrenic patients usually brings people to first clinical contact
psychosis
(women/men) have later onset of schizophrenia
women
At what age do most schizophrenic patients have their first admission?
in their 20’s
Is relapse common for schizophrenics?
Why?
Yes Medication non-adherence (4x) Persistent substance use (3x) Carers' critical comments (but not overall expressed emotion) (2.3x) Poorer premorbid adjustment (2.2)
(blank) is synonymous with the presence of psychotic symptoms (hallucinations, delusions, disorganized thought and behavior)
Schizophrenia
The usual model of schizophrenia has a pathophysiology that is synonymous with abnormal regulation of (blank). What tells us that this may not be true?
dopamine
-dopaminergic agents may not always solve the problem, other neurotransmitters may be involved, just because some dopamine agonist work doesnt mean that it works because schizophrenics lack it
People with schizophrenia have (blank) problems as well as psychosis and significant problems outside the brain such as (blank and blank)
neuropsychiatric
anatomical abnormalities and metabolic problems
People with schizophrenia on average die (blank) years earlier than the general population. What causes the majority of these disease?
What contributes to these problems?
15-25
CV disease
Antipsychotic medications-> associated with diabetes and weight gain
High prevalence of smoking, sedentary lifestyle, etc.
cognitive impairment is strongest predictor of (blank) is schizophrenics (NOT PSYCHOSIS)
level of function
What can we treat in schizophrenia?
psychosis
T or F
some degree of impairment may be present in every patient with schizophrenia
T
When is cognitive impairment present in people with schizophrenia? Are impairments found in the family?
What is the most significant impairment?
prior to onset of psychosis
YES
processing speed
Estimates of the lifetime prevalence of major depression in schizophrenia are typically (blank) percent — 2 or 3x that of the general population
30-35%
Depression and schizophrenia may share risk factors, what are three of them?
What else do these two disorders share?
- low birth weight
- prenatal famine
- winter birth
aspects of pathophysiology
(blank) percent of subjects with schizophrenia had a lifetime diagnosis of alcohol abuse or dependence
(blank) percent had a lifetime diagnois of any substance abuse or dependence
Is SUD increased prior or post psychosis?
What substance may increase the risk of schizophrenia?
Who else is SUD increased in, in relation to the schizophrenic patient?
34%
47%
Prior
marijuana
family members
What anxiety disorders are in increased prevalence in patients with schizophrenia?
obsessive-compulsive syndrome
panic attacks
post-traumatic stress disorder
generalized anxiety disorder
T or F
obsessive-compulsive syndrome was a risk factor for subsequent schizophrenia
T
What are four neuropsychiatric syndromes that are related to schizophrenia?
- neurological signs*
- dyskinetic movements*
- oculomotor dysfunction*
- polydipsia
- Increased prevalence of these symptoms in first degree relatives who do not have schizophrenia
T or F
The presence of a “comorbid” syndrome is so common as to be the rule rather than the exception in schizophrenia
T
Comorbid syndromes with schizophrenia probably share what?
environmental risk factors and common biology
People w/ schizophrenia are dying earlier of (blank) except what 2 things? What could be the cause?
everything
stroke and cancer
accelerated aging
People with schizophrenia have anatomical (blank) compared to the general pop. (i.e head, eyes, ears, mouth, hands feet THey are also slightly (Shorter/taller) and (thinner/fatter)
differences
short and thinner -> small body mass index (BMI)
People with psychosis have what kinds of glucose regulation?
What about siblings of schizophrenic patients that do not have schizophrenia?
People with schizophrenia have impaired glucose tolerance and pre-diabetes
The also have impaired glucose tolerance and pre-diabetes
**For schizophrenics and schizophrenic siblings: Both normal at baseline but after 2 hours have impaired glucose
What is the blood pressure like in schizophrenic patients?
increased BP so increased prevalence of vascular disease
Patients with schizophrenia have decreased (blank) which is associated with accelerated aging
androgen (decreased free testosterone in males) and telomere content
Durign exacerabation of schizophrenia, what cytokines increase?
IL-1B
IL-6
TGF-beta
What are trait markers of schizophrenia (are elevated even when there is not exacerabation)?
IL-12
IFN-y
TNF-a
sIL-2R
Whats up with stem cells of schizophrenic patients?
abnormal signaling for adult circulating stem cells (mesenchymal stem cells)
What is the main chemokine that controls the movement of adult circulating stem cell?
What pathophysiology messes with this?
Stromal-derived factor 1-alpha (SDF1-alpha)
diabetes (and diabetes is hella prevalent in schizophrenics)
and schizophrenics
What is this:
Cells with broad differentiation potential
Involved in normal repairs processes
Reside much of the time in the bone marrow, but can be mobilized and localized to other organs
adult circulating stem cells
What are the abnormalities of the brain shown in schizophrenics?
What does this tell us?
- decreased volume of brain
- decreased neuropil
- decreased volume of neurons
- increased densitiy of neurons
- decreased number of neurons
- increased dopamine release
- abnormal expression of NMDA receptor subunits
- decreased white matter volumes with abnormal orientation of fibers
That schizophrenia is not a neurodegenerative disease it is an abnormal development -> thus you just make less neurons and less synapses and less NMDA receptors
Administration of what three drugs can cause a mild increase in psychotic symptoms in people with schizophrenia?
- cannabis
- serotonin agonist
- NMDA antagonist
What are the tx’s for schizophrenia?
- antipsychotics
- tx for other neuropsychiatric syndormes (depression, anxiety)
- psychosocial tx
Does psychoeducation work and what is it?
- yes, it reduces relapse
- educating the person about the illness
T or F
schizophrenia isnt a psychotic disorder
T
It is a disorder of essentially every brain function
T or F
Schizophrenia isn’t a brain disorder;
T
it is a disorder of the entire body in which psychosis is present
T or F
It is misleading to consider neuropsychiatric syndromes such as abnormal movements “comorbid” with schizophrenia;
T
they are part of the disorder
T or F
equate schizophrenia with dopamine dysregulation because psychosis responds (variably) to dopamine antagonists is like saying bubonic plague is a disease of aspirin insufficiency.
T
schizophrenia responds to dopamine, it isnt caused by dopamine depletion
What is the purpose of care for schizophrenia?
- To improve & maintain quality of life
- To extend life
- To deal with disability, discomfort or death
(blank) is a behavioral treatment that uses drill and practice, compensatory and adaptive strategies to facilitate improvement in targeted cognitive areas like memory, attention and problem solving.
Cognitive remediation
Does Cognitive remediation work for schizophrenics?
yes a little bit in:
general cog, social cog, verbal memory, working memory, attention, processing speed, real-life function
(blank) is the critical, hostile, and emotionally over-involved attitude that relatives have toward a family member with a disorder.
What does this behavior increase?
How do you reduce this behavior and what happens if you do reduce this?
Expressed emotion
Risk of relaspse
Family interventions
- decrease frequency of relapse
- reduce hospital admission
- increase med adherence
- increase general social function
