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NB3 > Schizophrenia And Sp3ctrum 2 > Flashcards

Schizophrenia And Sp3ctrum 2 Flashcards

1
Q

Describe the brain as a narrative making machine

A
  • Corpus collosum severed – no signals between left and right hemispheres
  • Right hemisphere detects visual images on the left of the body
  • Left hemisphere detects visual images on the right of the body
  • Left hemisphere controls speech
  • Left hemisphere sees chicken claw and points to a picture of a chicken. Right hemisphere sees a snow scene and points to a picture of a snow shovel. Both hemispheres see the chosen pictures.
  • “…the chicken claw goes with the chicken,”
  • “You need a shovel to clean out the chicken shed”
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2
Q

Describe the etiology of schizophrenia

A
  • Dopamine (DA) pathway & consequent neuromodulation disruption
  • Too much DA = positive symptoms

• Disconnect between “normal” cognition (i.e., internal dialogue)
and perception of that dialogue

• Too little DA in frontal areas = negative symptoms & cognitive
impairment (25% of patients)

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3
Q

What’s the impact of dopamine in schizophrenia etiology?

A
  • DA = motivational salience to internal/external stimuli (i.e., what “grabs attention” and directs behavior)
  • Schizophrenia = increased DA release in absence of stimuli

• Attribution of salience to random stimuli by temporal association
(brain = narrative machine)

• Social adversity leads to paranoid biases and a persecutory
nature to the narrative

• Delusion is crystallization of the narrative

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4
Q

What is the Mesolimbic dopamine pathway?

A

Mesolimbic Pathway (positive
symptoms)
• Projectionsfromventraltegmental area (VTA) to Nucleus Accumbens (NA)
• Reward,reinforcement,motivation, motor function)

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5
Q

What are mesocortical pathways?

A 
Mesocortical Pathway (negative
            symptoms)
• Projections from VTA to DLPFC
• Executive functions
• Projections from VTA to VMPFC 
• Emotions & affect
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6
Q

What is the nigrostriatal dopamine pathway?

A 
(Extrapyramidal Syndrome with
some antipsychotics)
• Projectionsfromsubstantianigrato
striatum (caudate and putamen)
• Stimulationofpurposefulmovement)
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7
Q

What is the tuberoinfundibulnar dopamine pathway?

A 
Tuberoinfundibular Pathway
(Increased prolactin Release
with some antipsychotics)
• Projections from the hypothalamus to the infundibular region
• Normally inhibits prolactin release
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8
Q

Describe dopamine not being the entire story of schizophrenia

A
  • Dopamine not the entire story:
    • 33% of patients do not respond to “typical” antipsychotics
    • More than just dopaminergic excess
    • Non-dopaminergic sub-type of schizophrenia?
  • Reduced glutamate in frontal lobes and glutamine increase = cognitive impairment
  • Viral infection in utero increases risk
  • Diathesis-Stress model? Perhaps with coping….
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9
Q

How is Schizophrenia treated?

A

Antipsychotic drugs are the mainstay treatment
• First generation neuroleptics (e.g., chlorpromazine)
• Second generation neuroleptics (e.g., clozapine)

All are D2 receptor antagonists but some block D2 receptors:
• More potently
• Less selectively

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10
Q

What are the effects and examples of First Generation antipsychotics?

A
  • Examples:
  • Chlorpromazine (1st antipsychotic), haloperidol
  • Mechanism of Action: D2 antagonist

• Effect: Relieves positive symptoms

• Side Effects: Extrapyramidal
syndrome, Neuroleptic
Malignant Syndrome

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11
Q

What tracts are involved in extrapyramidal syndrome?

A
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12
Q

What is involved in extrapyramidal syndrome?

A

1) Dystonia
• Sustained muscle contractions of
the head and neck
• Often develops in the first week

2) Parkinsonism
• Tremor and shuffling
• Often develops in first few months

3) Akathisia
• Excessive movements due to “inner restlessness”
• Often develops in the first few months

4) Tardive Dyskinesia
• Repetitive, involuntary, purposeless
movements of the face and
extremities
• Develops as a long-term side effect
after years of medication
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13
Q

What Is neuroleptic malignant syndrome?

A

Characterized by tachycardia, hypertension, rapid respiration, fever, extreme rigidity, delirium, &
death

• Usually occurs within first 2 weeks of
starting medication or increasing
dosage

• Likely results from a precipitous drop
in dopamine that impacts hypothalamic function

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14
Q

Describe the second generation (atypical) antidepressants

A

Examples:
• Clozapine
• Risperidone
• Olanzapine

  • Mechanism of Action: D2, 3, 4 and 5-HT2A receptor antagonist
  • Effect: Relieves positive and negative symptoms
  • Side Effects:
  • Agranulocytosis (only clozapine)
  • Lowered risk of extrapyramidal syndrome
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15
Q

What are additional side effects of antipsychotic effects?

A

Additional side effects of all antipsychotics:
• weight gain
• sedation
• sexual dysfunction

Due to side effects, medication compliance can be a problem

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16
Q

How is schizophrenia treated?

A 
Psychosocial Environmental Support
• Housing and social support
 • Vocational rehabilitation
• Individual psychotherapy
• Family education

ECT Augmentation
• Used for medication-refractory
schizophrenia (e.g., catatonic type)

17
Q

Describe Schizophreniform disorder diagnosis

A

Identical symptoms and diagnostic criteria to schizophrenia but distinguished by duration
• Total duration of symptoms 1+ month but less than 6 months

• Sometimes provisional for schizophrenia until 6-month symptom duration is reached
– Delusions
– Hallucinations
– Disorganized speech
– Disorganized or catatonic behavior
– Negative symptoms (i.e., diminished range of emotional expression)

18
Q

Describe brief psychotic disorder diagnosis

A
  • At least 1 CORE psychotic domain symptom (i.e., delusions, hallucinations, disorganized speech)
  • Episode lasts less than 1 month
  • Person returns to full premorbid functioning
  • Specify trigger of episode:
  • with marked stressor
  • without marked stressor
19
Q

Describe schizoaffective disorder diagnosis

A
  • Active Phase of schizophrenia occurs concurrently with a major mood episode (MDE or manic episode)
  • Active Phase lasts 2+ weeks without mood symptoms
  • Mood symptoms are present for “the majority of the total duration” of symptomatic periods of the illness
20
Q

Describe the shorthand approach to schizoaffective disorder diagnosis. What are the subtypes?

A 
Shorthand Approach to Diagnosis
□ Concurrent psychosis & mood?
□ Psychosis alone?
□ Mood symptoms duration proportional with psychotic symptoms
duration?

Subtypes:
• Bipolar Type (if mania is experienced)
• Depressive Type (if depression is experienced without mania)

21
Q

Describe delusional disorder diagnosis

A
  • The presence of a delusion
  • Symptom must last 1+ month
  • No other psychotic domain symptoms
  • No functional impairment aside from the direct impact of the delusion

Specify if Delusional Disorder is with bizarre content

– Non-bizarre delusion: A belief that involves something that could occur in real life; is physically possible.
– Bizarre delusion: A belief that is clearly implausible and not derived from ordinary life experiences.

22
Q

What is shared psychotic disorder?

A
  • A delusion may develop in the context of a close relationship with a psychotic individual
  • Partner comes to believe the same delusion as the psychotic individual
  • The person is also diagnosed with Delusional Disorder (formerly “Shared Psychotic Disorder”)
23
Q

What are the delusional disorder subtypes?

A
  • Persecutory Type: Belief of malevolent treatment
  • Grandiose Type: Belief of having some great (but unrecognized) talent or insight or having made some important discovery
  • Erotomanic Type: Belief that someone else is in love with the individual
  • Jealous Type: Belief of infidelity by partner
  • Somatic Type: Belief involving bodily functions/sensations, such as parasitosis, malodorous, organ dysfunction
  • Differentials:
  • Body dysmorphic disorder (BDD) with absent insight
  • (delusional belief): In BDD, delusion is appearance-related

• Illness anxiety disorder (IAD): IAD patients worry about health
but they are not delusional Unspecified Type (theme is none of the above)

24
Q

Describe the etiology of Delusional Disorder

A 
Delusional Disorder (DD)
• Genetic-DD is more. common in people. who have family members with DD or schizophrenia
  • Dopamine and seroton inimbalance
  • Environmental/psychological-Triggered by stress.Isolation,alcohol and drug abuse might contribute
25
Q

What is the etiology of Schizoaffective disorder ?

A 
Schizoaffective Disorder (SD) 
• Form of schizophrenia?
26
Q

What are the treatments of delusional disorder?

A

Delusional disorder (DD):

• Antipsychotic medications

• Cognitive-behavioral therapy (CBT) to recognize and change thought
patterns and behaviors – while taking medication

• Family therapy to help families deal more effectively with a loved one

Close relationship delusion disorder treatment:
• Trial separation from partner

• Increasing sources of reality testing (e.g., CBT) to recognize and
change thought patterns and behaviors

27
Q

Why is the brain a narrative making machine?

A
  • The brain is a narrative-making, association machine
  • It does this to predict the future and increase the odds of survival
  • Connecting this with physiology allows us to understand symptomatology in patients
  • Schizophrenia is a disease of neurotransmitter function that relies on physiological intervention
  • May be multiple types of disease underlying psychosis

NB3 (33 decks)

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