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psycopathology > Schizophrenia Spectrum Snd Other Psychotic Disorders > Flashcards

Schizophrenia Spectrum Snd Other Psychotic Disorders Flashcards

1
Q

What are the 5 psychotic symptom disorders?

A
  1. Delusions
  2. Hallucinations
  3. Disorganized speech

Above 3 are “core” domains

  1. Disorganized or catatonic behavior
  2. Negative symptoms
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2
Q

Explain the psychotic DELUSION symptom domain

A

Delusion(core)- A fixed belief that is not amenable to change, even with conflicting evidence

  • delusion of grandeur(grandiose)
  • delusion of persecution (paranoid)
  • Delusion of control(external force controlling behavior)
  • Delusion of reference (belief that outside action refers directly to the person or has special personal meaning’
  • Thought broadcasting delusion (thoughts being transmitted to others)
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3
Q

Explain the psychotic HALLUCINATION symptom domain

A

A sensory perception without an external stimulus (auditory are the most common)

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4
Q

Describe the psychotic symptom domain : disorganized speech (core)

A

Speech (thinking) lacks the normal, logical connections between thoughts. Patients who exhibit this symptom are described as having m

A formal thought disirder

Loose associations in thinking

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5
Q

Describe symptoms of the psychotic domain: disorganized or catatonic behavior

A

Disorganized: non-goal oriented behavior (e.g., wandering aimlessly)

Catatonic: multiple motor/behavioral abnormalities thatreflect diminished reactivity to the environment:

  • posturing
  • waxy flexibility
  • stereotypes
  • Non-responsiveness
  • mutism
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6
Q

Describe symptoms os the psychotic domain: negative symptoms

A

Diminished emotional expression

Avolition(decrease in motivated self-initiated purposeful activities

Alogia(diminished speech output)

Anhedonia(inability to feel pleasure)

Asociality (lack of self interactions)

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7
Q

What are the diagnostic criteria of schizophrenia?

A

At least 2 psychotic domain symptoms :

  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Grossly disorganized behavior
  5. Negative symptoms

Atleast 1 core symptom domain (1, 2 or 3)

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8
Q

Give the schizophrenia diagnosis timeline

A

Signs of the disturbance for 6+ months (including any prodromal and/or residual phases)

6+ months of prodromal phase, active phase (must be 1+ month). And residual phase

Prodromal and residual phases often manifest as only negative symptoms and/or do,Ian symptoms in subthreshold forms

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9
Q

What are the subtypes of schizophrenia?

A

DSMno longer subtypes schizophrenia except to specify “with catatonia”

Presentation of schizophrenia varies depending on which psychotic domain symptoms are most important

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10
Q

Give the differential of schizophrenia

A

Substance-induced psychosis, (e.g., consider psychomotomimetic drugs such as stimulants and dissociative anesthetics)

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11
Q

What are the associated features of schizophrenia?

A
  • nicotine dependence(self medication)
  • increased suicide risk

Aggression

  • patient may be aggressive to protect himself/herself
  • If command hallucinations(or uses drugs), patient is at greater risk 9f being violent
  • Despite publicity, schizophrenics are not at higher risk of homocide
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12
Q

Give the epidemiology of schizophrenia

A

1% of general population with no gender bias(though males have greater illness severity)

There is a higher prevelance of schizophrenics with low socioeconomic status (SES): “downward drift” phenomenon

High number of schizophrenics amongst the homeless, largely as a result of de institutionalization

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13
Q

Describe schizophrenic onset

A
  • typical onset: late teens, slightly later onset in women
  • A negative symptom prodrome often precedes the onset of positive symptoms by a few weeks to months
  • Late-onset(40+ years): More in women and characterized by positive symptoms and less severe course
  • childhood onset (+13 years): severe form of disorder associated with more pronounced deficits in neurodevelopment
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14
Q

Give the course and outcome of schizophrenia

A

Slow gradual decline in function, or one characterized by fluctuating symptoms

The disorder is chronic

Majority of patients have a moderate to severe disability with need for periodic hospitalization

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15
Q

Give the etiology of schizophrenia

A

Dopamine(DA) pathway and 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 frontalbareas = negative symptoms and cognitive impairment
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16
Q

What are dopamine pathways?

A

Mesolimbic pathway(positive symptoms)

Mesocortical pathway(negative symptoms)

Nigrostriatal pathway(extrapyramidal syndrome)

Tuberoinfundibular pathway (increased prolactin release)

17
Q

Explain the dopamine pathway: mesolimbic pathway

A

Positive symptoms

  • projections from ventral tegmental area (VTA) to nucleus acumbens(NA)
  • reward, reinforcement, motivation, motor function
18
Q

Explain the dopamine pathway: mesocortical pathway

A

Negative symptoms

  • projections from VTA to DLPFC
  • Executive functions
  • projections from VTA to VMPFC
  • emotions and affect
19
Q

Explain the dopamine pathway: nigrostrital pathway

A

Extrapyramidal syndrome

  • Projectiond from substantia nigra to striatum (caudate and putamen)
  • stimulation of purposeful movement
20
Q

Explain the dopamine pathway: tuberoinfundibular pathway(increased prolactin pathway )

A

Increased prolactin release

  • projections from the hypothalamus to the infundibulum region
  • normally inhibits prolactin release
21
Q

Give the schizophrenia etiology with dopamine not being the whole story

A

Dopamine not the entire story
-33% of patients do not respond to “typical” antipsychotics

  • more than just dopamine this excess
  • Non-dopaminergic sub-type of schizophrenia
  • reduced glutamate in frontal lobes and glutamine increase= cognitive impairment
  • viral infection in uterus increases risk
22
Q

How can neuroanatomical chang3s lead to schizophrenia?

A

Enlarged cerebral ventricles(ventriculomehaly)

Cortical atrophy

Smaller size and cellular disorganization of temporal lobe

Cellular disorganization suggests that schizophrenia is a neurodevelopmental disorder

23
Q

What are the neuropsychological effects of schizophrenia?

A

-Impairments are seen in a variety of cognitive functions such as attention, memory, verbal fluency and “executive “ functions (I.e., initiating, planning, shifting, following though)

List as many words as you can think of that start with the letter “D”. Schizophrenics would have a difficult time searching their “lexicon” to generate words

24
Q

How can schizophrenia be treated?

A

First generation (typical) antipsychotics

  • thorazine(chlorpromazine)
  • Haldol(haloperidol)

Dopamine (DA) receptor blockers(antagonists)

Alleviates positive symptoms (hallucinations, delusions)

Side effects: extrapyramidal syndrome (ES) due to blockage of nigrostriatal (motor system) dopamine

25
Q

What is extrapyramidal syndrome?

A
  1. Dystonia- sustained muscle contractions of the head and neck, often develops first week
  2. Parkinsonism- tremor and shuffling , often develops in first few months
  3. Akathisia -excessive movements dye to “inner restlessness”, often develops in the first few months

4 tar dive Dyskinesia- repetitive, involuntary, purposelessness movements of the face and extremities - comes due to long term side eff3cts of meds

26
Q

What is neuroleptic malignant syndrome?

A
  • Tachycardia, hypertension, rapid respiration, fever, extreme rigidity, delirium, and death
  • Within 2 weeks of starting medication or increasing dosage
  • Results from a previous drop in dopamine that impacts hypothalamic function (autonomous nervous. System )
27
Q

How can schizophrenia be treated( 2nd generation)?

A 
2nd generation(atypical treatments) antipsychotics
Clozaril (clozapine)
Risperdal(risperidone)

-dopamine (DA) receptor blockers (antagonists ) and serotonin antagonist

Alleviates positive(hallucinations) and negative (anhedonia) symptoms

Side effects: Agranulocytosis is seen in 1-2% of patients taking clozapine

28
Q

How can schizophrenia be treated without antipsychotics?

A

Psychotherapy- for secondary effects, not primary effects

  • behavioral therapy to increase activities of daily living
  • supportive psychotherapy (if indicated)
  • family education with the goal of diminishing household/environmental stress

Electroconvulsive therapy

Not usually as effective as medications but may be more useful for catatonic subtype

29
Q

What are the diagnostic criteria of schizophreniform ?

A
  • identical symptoms to schizophrenia, distinguished by duration
  • 1+ month but less than 6. Months of active phase symptoms

Sometimes provisional fir schizophrenia until 6-month symptom duration is reached

  • delusions
  • hallucinations
  • Disorganized speech
  • Disorganized or catatonic behavior
  • diminished range of emotional expression
30
Q

What are the diagnostic criteria of Brief psychotic disorder symptoms?

A
  • Atleast 1 core psychotic domain symptom (I.e., delusions, hallucinations, disorganized speech)
  • episode lasts less than 1 month
  • Person returns to full premorbjd functioning
  • specify trigger of episode:
  • with marked stressor
  • without marked stressor
31
Q

Give diagnostic criteria if delusi9n dusirder

A

The presence of a delusion
Symptoms must last 1+ month

No other psychotic domains

No functional impairment aside from the direct impact of the delusion

Specify: Non-bizarre delusion: a belief that involves something that could occur in real life, is physically possible

Bizzare delusion: A belief that is clearly implausible and not derived from ordinary life experiences

32
Q

How may delusional disorder occur?

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”)
33
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

Erotomatic type: belief that someone else is in love with the individual

Jealous type : belief of infedility of partner

Somatic type: belief involving bodily functions/sensations, such as parasitosis, maldorous, organ dysfunction

Unspecified type- theme of none above

34
Q

What are the differentials of delusional disorder?

A
  • bidy Dysmorphic disorder (BDD) with absent insught(delusional belief): in BDD, delusion is appearance-related
  • illness anxiety disorder (IAD): IAD patients worry about health but they are not delusional

Unspecified(theme is none of the above)

35
Q

Briefly describe schizoaffective

A

Active phase of schizophrenia occurs concurrently with a Major mood episode (MDE or manic episode)

Active phase lasts 2+ weeks without mood

Mood symptoms are present for “the majority of the total durstion” of symptomatic periods of illness

36
Q

How can schizoaffective disorder be diagnosed?

A
  • concurrent psychosis and 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)
37
Q

Give the etiologies of delusional disorder and schizoaffective disorder

A 
Delusion disorder (DD)
-Genetic-DD is more common in people who have family members with DD or schizophrenia
  • dopamine and serotonin imbalance
  • environmental/psychologica- triggered by stress, isolation, alcohol and drug abuse might contribute

Schizoaffective disorder
-unknown but thought to overlap with schizophrenia

38
Q

How can schizoaffective and delusional disorders be affected?

A
  • antipsychotic medications
  • individuals psychotherapy to identify underlying distorted thoughts
  • CBT to recognize and change thought patterns and behaviors
  • psychosocial therapy to assist with employment, living arrangements
  • family therapy to help families deal more effectively with a loved one

psycopathology (23 decks)

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