Schizophrenia Spectrum and Other Psychotic Disorders Flashcards
What does the term Psychotic imply?
A break from reality in thinking/perceptions and are known as “thought disorders”
What are the Psychotic Symptom Domains? There are 5.
Which ones are CORE symptoms?
- Delusions
- Hallucinations
- Disorganized Speech
- Grossly Disorganized or Catatonic Behavior
- Negative Symptoms
1,2,3
What is a Delusion?
What are some examples?
There are 5
A fixed belief that is not amenable to change, even in light of conflicting evidence
- Grandeur
- Persecution
- Control: External force that’s controlling behavior
- Reference: Outside action-televsion commercial is referring to the person directly or has special message for that person.
- Broadcasting: Thoughts are being transmitted to others
What is a Hallucination?
What are typical features of a hallucination?
A sensory perception without an external stimulus
Auditory, single voice/voices conversing, running commentaries, “command” hallucinations often violent, derogatory
What is Disorganized Speech
What is this also known as?
Speech (thinking) that lacks normal, logical, connections between thoughts
Formal thought disorder/loose associations in speech/thinking
What do these types of Disorganized Speech mean?
- Tangentiality
- Flight of Ideas
- Derailment
- Clang Association
- Word Salad
Is prononciation okay?
- Shifting to a slightly related topic
- Rapid shifting of thoughts with discernible links between ideas (extreme tangentiality)-still have some logical connection
- Derailment-no logical connections between ideas
- Rhyming
- No relationship between words
Yes.
What is
- Grossly Disorganized?
- Catatonic Behavior?
- Unable to take care of themselves and activities of daily living, inappropriate mood/affect
- Catatonia: multiple motor/behavioral abnormalities that reflect diminished reactivity to the environment, such as posturing, waxy flexibility, stereotypes, non-responsiveness, mutism
Negative Symptoms
- Diminished emotional expression: verbal and nonverbal
- Avolition: decrease in self-initiated, purposeful activities
- Alogia: diminished speech output
- Anhedonia
- Asociality: disinterest in social interactions
What is Schizophrenia?
- Acute Phase for 1 or more months
- At least 2 symptoms, 1 must be a CORE symptom (delusion, hallucination, disorganized speech)
- At least 1 symptom must be for 6 or more months
What is the neuropathology associated with Schizophrenia?
There are 3
Overactivity of Mesolimbic DA relates to positive symptoms (VTA to basal forebrain)
Underactivity of Mesocortical DA relates to negative symptoms (VTA to prefrontal cortex)
Nigrostriatal pathway: motor pathways
What is a Neurostructural change?
What are Neurofunctional changes?
What are Neurocognitive effects?
- Enlarged lateral ventricles (ventriculomegaly)
- Cortical and hippocampal atrophy
- Decreased volume of the thalamus
- Hypofrontality (decreased prefrontal metabolism)
- Impairment in multiple areas including attention, memory, executive functions, etc.
Neurodevelopmental theory?
Evidence?
Is there genetic component?
-A “lesion” occurs during early brain development-and effects are seen as the affected structures mature and can be influenced by environmental factors such as stress, etc throughout maturation
- Hippocampal cellular disorganization: pyramidal cells are weird)
- Increased neurological soft signs: confusing L & R, astereognosis, agraphaesthesia
- Increased minor physical anomalies: curved-fit fingers, wide-set eyes, adherent ear lobes
Yes.
Treatment for Schizophrenia?
What are two examples and what do they treat?
Antipsychotics: specifically D2 receptor antagonists
Haldol, Thorazine (Chlorpromazine)
Positive symptoms
What are the side effects?
EPS: extrapyramidal symptoms due to nigrostriatal D2 blockade
What are the side effects? There are 5.
- Dystonia often developing within the first week
- Parkinsonism: developing within the first month
- Akathisia: inner restlessness-first few months
- Tardive Dyskinesia: repetitive, involuntary, purposeless movements, often of face and extremities, developing as a long-term (yrs)
- Neuroleptic Malignant Syndrome: look catatonic but also have either tachycardia, htn, rapid respiration, fever, delirium or death-within first 2 weeks of starting meds
What are Atypical Antipsychotics?
Clorazil (Clozapine)
Risperidone (Risperdal)
Olanzapine (Zyprexa): Antagonists of D2,3,4 and serotonin (5-HT2A) receptors
Positive AND Negative Symptoms
What are other side effects of Antipsychotics?
Weight Gain, Sedation, Sexual Dysfunction
Compliance to meds can be a problem
When is ECT used?
For medication refractory schizophrenia especially the catatonic type
When is psychosurgery used?
OCD
What is Schizophreniform Disorder?
How long do they last?
What is the criteria?
At least 1 month of Active-Phase symptoms that last less than 6 months
Need the same criteria as Schizophrenia
What is Brief Psychotic Disorder
How long does it last?
What is called when it lasts more than 1 month but less than 6 months?
Need at least 1 CORE symptom (Delusions, Hallucinations, Disorganized Speech)
Less than 1 month
Unspecified
What is a Delusional Disorder
How long does it last?
Delusion that lasts 1 or more months with no other psychotic symptoms and there’s no other direct impact of the delusion
What are the different subtypes?
There are 7.
- Persecutory type: malevolent treatment
- Grandiose: have some great, unrecognized talent
- Erotomanic: belief of somebody being in love with the individual
- Jealous: belief in infidelity by partner
Somatic type: parasitosis, malodourous, organ dysfunction
-not BDD because BDD is about vanity.
-not IAD because IAD is not delusional - Unspecified
- Non-Bizarre (could happen) vs. Bizarre (could never happen)
- Could happen in relation to a close relationship with a psychotic individual
What is Schizoaffective Disorder?
Active Phase occurs at the same time as a major mood episode but:
- Have to have a period of pure psychosis with no mood (at least 2 weeks)
- Mood symptoms have to be present for the majority of the total illness
What is the onset of Schizophrenia?
- 1% of population
- Typical onset is late teens in college years,
- less sever later, more sever earlier, less sever course with women
What are the associated factors?
Low socioeconomic status and nicotine addiction
Age of onset: Rapidity of onset: Type of symptoms: Structural CNS changes: ***Mood Symptoms: Gender:
Better when older, worse when younger
Better when rapid, worse when slow
Better when positive, worse when negative
Better when absent, worse if exist
***Better when present, worse when absent
Better for females, worse for males
What is the problem with Kleptomania and Pyromania?
Self control of specific actions
Kleptomania
Pyromania
What do you need to assess?
The only thing driving them is the urge to do the actual stealing, but nothing else and are hoarded, given away, or returned
Object is not the goal
Same thing, but with fire
*Motivation
Biochemical Correlates?
low serotonin high dopamine (Ventral tegmental area to nucleus accumbens
Treatment
- Behavioral Therapy
2. Medication-SSRI’s
