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SA Clinical Neuroscience > S12) Psychotic Disorders > Flashcards

S12) Psychotic Disorders Flashcards

1
Q

What is psychosis?

A
  • Psychosis is the presence of hallucinations or delusions
  • It describes symptoms, not a diagnosis in itself
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2
Q

What are hallucinations?

A
  • Hallucinations are a perception without a stimulus
  • It can be in any sensory modality (visual hallucinations are organic)
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3
Q

What are some hallucinations experienced in the ‘normal’ population?

A
  • Hypnogogic –experienced when going to sleep
  • Hypnopompic – experienced when waking up
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4
Q

What is a delusion?

A

A delusion is an abnormal belief, outside of cultural norms (unshakeable)

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5
Q

Identify five organic causes of psychosis

A
  • Delirium caused by infection
  • Hypercalcaemia
  • Acute drug/alcohol intoxication
  • Post-ictal psychosis
  • Hyperthyroidism
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6
Q

Identify some iatrogenic causes of psychosis

A
  • Steroids
  • L-Dopas
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7
Q

Identify the first rank symptoms of schizophrenia

A
  • Auditory hallucinations
  • Passivity experiences
  • Thought withdrawal, broadcast or insertion
  • Delusional perceptions
  • Somatic hallucinations
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8
Q

what are some features of auditory hallucinations

A

o Thought echo – hearing thoughts aloud
o Running commentary
o Third person – multiple voices talking about thepatient

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9
Q

what is passivity hallucinations

A

Belief that an action or feeling is caused by external force eg psychotic person moving limbs but feel like they’re watching

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10
Q

what are delusional perceptions

A

Attribution of a new meaning to a normally perceived object

eg red light means the earth will end

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11
Q

what are somatic hallucinations

A

the sense of being touched when no one is

there

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12
Q

Distinguish between thought withdrawal, broadcast and insertion

A
  • Thought withdrawal – thoughts are being taken out of the mind
  • Thought broadcast – thoughts are being made known to others e.g. via radio
  • Thought insertion – thoughts implanted by others
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13
Q

Identify some positive symptoms of schizophrenia

A

Positive symptoms – added symptoms:

  • Delusions
  • Hallucinations
  • Thought disorder
  • Lack of insight
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14
Q

Identify some negative symptoms of schizophrenia

A

Negative symptoms – symptoms that take away from the patient:

  • Underactivity
  • Low motivation
  • Social withdrawal
  • Emotional flattening
  • Self neglect
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15
Q

In the ICD10 diagnosis of schizophrenia, a patient with schizophrenia must present with at least one of which symptoms?

A

A) Thought echo, insertion, withdrawal, broadcast

B) Delusions of control, influence or passivity

C) Hallucinatory voices

D) Persistent delusions that are culturally inappropriate and completely impossible

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16
Q

In the ICD10 diagnosis of schizophrenia, a patient with schizophrenia must present with at least two of which symptoms?

A

E) Persistent hallucinations in any modality, occurring every day for at least one month

F) Neologisms, breaks or interpolations in the train of thought, resulting in incoherent/irrelevant speech

G) Catatonic behaviour

H) Negative symptoms e.g. marked apathy, paucity of speech, incongruity of emotional responses

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17
Q

Identify the different types of schizophrenia

A
  • Paranoid schizophrenia
  • Simple schizophrenia
  • Hebephrenic schizophrenia
  • Undifferentiated schizophrenia
  • Catatonic schizophrenia
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18
Q

What is paranoid schizophrenia?

A

Paranoid schizophrenia – delusions or hallucinations prominent

19
Q

What is simple schizophrenia?

A

Simple schizophrenia:

  • Loss of drive and interest, aimlessness, idleness, self absorbed attitude and social withdrawal
  • No hallucinations/delusions
20
Q

What is hebephrenic schizophrenia?

A

Hebephrenic schizophrenia – definite and sustained flattening or shallowness of affect or incongruity/inappropriateness of affect, aimless and disjointed behaviour or thought disorder affecting speech

21
Q

What is undifferentiated schizophrenia?

A

Undifferentiated schizophrenia – insufficient symptoms to meet criteria of any subtypes or so many symptoms fit more than one criteria

22
Q

In the pathophysiology of schizophrenia, which two brain pathways are thought to change?

A
  • Mesolimbic pathway – thought to be overactive in schizophrenia
  • Mesocortical pathway – thought to be underactive in schizophrenia
23
Q

Describe the course of the mesolimbic pathway

A
  • From: ventral tegmental area
  • To: limbic structures (amygdala, septal area, hippocampal formation) and nucleus accumbens
24
Q

Describe the course of the mesocortical pathway

A
  • From: ventral tegmental area
  • To: frontal cortex and cingulate cortex
25
Q

Describe the brain changes observed in schizophrenia

A
  • Enlarged ventricles
  • reduced grey matter, temporal lobe reduction
  • fewer oligodendrocytes and fewer thalamic neurones
  • Reduced hippocampal formation, amygdala, parahippocampal gyrus and prefrontal cortex
26
Q

What are the two options for treating schizophrenia?

A
  • Typical antipsychotics
  • Atypical antispychotics
27
Q

Describe the mechanism of action of typical antipsychotics in the treatment of schizophrenia

A
  • Block D2 receptors in all CNS dopaminergic pathways
  • Main action as antipsychotics is by inhibiting mesolimbic and mesocortical pathways
  • main side effects come from blocking other dopamine pathways that you don’t want to block
28
Q

Describe the mechanism of action of atypical antipsychotics in the treatment of schizophrenia

A
  • Low affinity for D2 receptors
  • Milder side effects as dissociate rapidly from D2 receptor

– also block 5HT2 receptors

29
Q

What is drug induced psychosis?

A

Drug induced psychosis is a form of psychosis induced by a psychoactive substance

30
Q

Provide examples of drugs that can induce psychosis

A
  • Methamphetamine
  • Cannabis
  • Cocaine
  • Amphetamines
  • Ketamine
31
Q

What is the ICD10 criteria for drug induced psychosis?

A
  • Onset of psychotic symptoms during or within two weeks of substance use
  • Persistence of the psychotic symptoms for more than 48 hours
  • Duration of the disorder ≤ six months
32
Q

what is the dopamine theory

A

Evidence for involvement of dopamine in schizophrenia (dopamine too high in schizophrenia)

o Drugs that increase dopamine levels (e.g.amphetamines) induce psychosis

o Drugs that antagonise dopamine treat psychosis (especially those acting at D2 receptors)

33
Q

what are some side effects of taking anti-psychotic medication

A
  • affect movement due to involvement of nigrostriatal pathways (similar to Parkinson’s disease)
  • However, untreated patients can also develop hypokinetic movement disorders (catatonia): Might be caused by involvement of GABA
34
Q

what are some endocrine side effects of taking anti-psychotic meds

A

o Since dopamine normally inhibits prolactin release, antipsychotics can lead to increased prolactin levels

▪ Amenorrhea
▪ Galactorrhoea
▪ Decreased fertility

▪ Decreased libido

▪ Osteoporosis (long term)

35
Q

what are some challenges to treating schizophrenia

A

→ patients lack insight so just give depot injection

36
Q

factors associated with good prognosis of schizophrenia

A

(50% of people do well long term)

No family history

Good premorbid function

Acute onset

Mood disturbance

Prompt treatment

Maintenance of motivation

37
Q

long term complications of schizophrenia

A
  • mortality twice as high as general population
  • Shorter life expectancy
  • Higher incidence of cardiovascular, 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 (contributing to cardiovascular disease etc.)
38
Q

describe the nigrostriatal pathway

A
39
Q

overall what does a reduction in dopamine do to motility

A

reduces motility

40
Q

what is Catatonia

A

→ state at which someone is awake but does not seem to respond to other people and their environment. They have little reaction to their surroundings.

due to less GABA so less inhibition

41
Q

what is the criteria for the diagnosis of Catatonia

A

→ more than 2 weeks of either:

  • Stupor / mutism
  • Excitement
  • Posturing
  • Negativism
  • Rigidity
  • Waxy flexibility
  • Command automatism
42
Q

what is the Tuberoinfundibular pathway

A
43
Q

pathways of dopamine involved in schizophrenia

A

SA Clinical Neuroscience (23 decks)

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