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NEUROPSYCH & CLINICAL NEURO > Week 11: Psychotic disorders > Flashcards

Week 11: Psychotic disorders Flashcards

1
Q

What do people with psychotic disorders struggle with?

A

Thinking clearly, making good judgements, responding emotionally, communicating, understanding reality and behaving appropriately

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2
Q

What are the different types of psychotic disorders?

A 
Schizophrenia
Schizoaffective disorder
Schizophreniform disorder
Brief psychotic disorder 
Delusional disorder
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3
Q

Schizophrenia is characterized by….

A

Major disturbances in thought (disordered thinking with illogical ideas), emotion (lack of expression, inappropriate emotions) and behaviour (disturbances in movement and behaviour)

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4
Q

Schizophrenia and suicide?

A

Those with schizophrenia have increased risk of suicide and death

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5
Q

What is the prevalence of schizophrenia?

A

1%

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6
Q

Gender differences in schizophrenia?

A

Men slightly more than women

- men are also diagnosed at an earlier age than women

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7
Q

When is the typical onset of schizophrenia?

A

Late adolescence or early adulthood

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8
Q

What are the symptoms of schizophrenia? and how many need to be present for diagnosis?

A

Delusions
Hallucinations
Disorganised speech
Disorganised motor behaviour (catatonia)
Negative symptoms (diminished motivation or emotional expression)

Two or more, with at least one of the first 3

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9
Q

How long do the symptoms have to persist to be diagnosed as schizophrenia?

A

At least 6 months

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10
Q

What does it mean to have a positive symptom?

A

To have gained things you didnt have before

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11
Q

What does it mean to have negative symptoms?

A

To have lost things you had in the past

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12
Q

What are the positive emotions in schizophrenia?

A

Delusions and hallucinations

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13
Q

What are the negative symptoms of schizophrenia?

A

Avolition (lack of interest)
Alogia (lack of speech)
Anhedonia (no more pleasure in pleasurable activities)
Blunted affect (lowered emotional expression)
Asociality (little or no desire to socialize with others- inability to form close personal realtionships)

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14
Q

What are the disorganized symptoms of schizophrenia

A

disorganised speech and behaviour

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15
Q

What are delusions?

A

They are firmly held beliefs that are contrary to reality

Often resistant to disconfirming evidence

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16
Q

What are persecutory delusions?

A

the affected persons believe they are being persecuted, despite a lack of evidence. Specifically, they have been defined as containing two central elements: The individual thinks that harm is occurring, or is going to occur.

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17
Q

What are thought insertion delusions?

A

experiencing one’s own thoughts as someone else’s

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18
Q

What are thought broadcasting delusions?

A

Delusion that one’s thought is projected and perceived by others.

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19
Q

What are outside control delusions?

A

delusion that one’s thoughts, feelings, and actions are not one’s own but are being imposed by someone else or some other external force.

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20
Q

What are gradiose delusions?

A

A delusion of grandeur is a false or unusual belief about one’s greatness

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21
Q

What are ideas of reference delusions?

A

Thoughts that things that have happened in the real world are somehow weirdly connected to the individual

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22
Q

What are hallucinations?

A

Sensory experiences in the absence of sensory stimulation

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23
Q

What are the different types of halluncinations?

A

Auditory
Visual
Hearing voices

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24
Q

What is the most common types of hallucination?

A

Auditory

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25
Q

Why do people hear voices?

A

Increased levels of activity in brocas area during hallucinations

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26
Q

What are the two categories of negative schizophrenia symptoms?

A

Experience - motivation, emotional experience, sociality

Expression - expression of emotion, vocalizations

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27
Q

Disorganised speech in schizophrenia?

A 
Incoherence: inability to organise ideas 
Loose associations (derailment): rambles, difficulty staying on track
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28
Q

Disorganised behaviour in schizophrenia?

A

Odd or peculiar behaviour
(silliness, agitation, unusual dress)
E.g. wearing several heavy coats in summer

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29
Q

What are some of the movement symptoms of schizophrenia?

A

Catatonia
Catatonic immobility
Waxy flexibility

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30
Q

What is catatonia?

A

Motor abnormalities
Repetitive complex gestures
Excitable, wild flailing of the limbs

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31
Q

What is catatonic immobility?

A

Maintaining unusual posture for long periods of time

Eg. standing on one leg

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32
Q

What is waxy flexibility?

A

Limbs can be manipulated and posed by another person

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33
Q

What causes the positive symptoms of schizophrenia?

A

Thought to be caused by excess dopamine in the mesolimbic pathway

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34
Q

How do we improve positive symptoms?

A

Theoretically, decreasing dopamine in the mesolimbic pathway would be therapeutic
- Antipsychotics are dopamine blockers

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35
Q

What causes the negative symptoms of schizophrenia?

A

Shortage of dopamine in the mesocortical pathway - can increase to improve

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36
Q

What is the role of the mesolimbic system?

A

Regulation of emotional behaviour and motivation

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37
Q

What is the role of the mesocortical pathway?

A

Cognition and executive function

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38
Q

What are the dopamine levels like in a normal brain?

A

They are at normal levels and in balance - therefore there are no schizophrenic symptoms experienced

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39
Q

Summarise dopamine levels in a schizophrenic brain?

A

Mesolimbic - increased dopamine = +symptoms

Mesocortical - decreased dopamine = - symptoms

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40
Q

Explain the conundrum of treating schizophrenia?

A

Treating with a dopamine agonist can successfully treat their positive symptoms by reducing dopamine in the mesolimbic system
BUT
also reduces more in the mesocortical pathway meaning the negative and cognitive symptoms are not treated and in some cases can be made worse

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41
Q

Why were dopamine agonists historically considered to be a good treatment for schizophrenia?

A

They managed the obvious treatments - looked like they worked

42
Q

What treatment is better than a dopamine agonist for schizophrenia? why?

A

Atypical D2 partial agonist antipsychotics (eg. aripiprazole)- they bind to the receptors but only activates it partially slightly depressing and slightly increasing dopamine system
- normalizing the activity of both systems

43
Q

The glutamate hypothesis of schizophrenia?

A

‘Go’ neurotransmitter

Much research implicating glutamate NMDA receptors in schizophrenia

NMDA receptors can cause psychotic symptoms in humans

Some glutamatergic drugs have shown promise in treating schizophrenia

44
Q

What is the most prominent structural change in schizophrenia

A

Ventricular enlargement

45
Q

What does ventricular enlargement cause?

A

Poorer performance on cognitive tests, poor premorbid adjustment, poor response to treatment

46
Q

What does TRS stand for?

A

Treatment-resistant schizophrenia

47
Q

What is Treatment-resistant schizophrenia? how does it differ from normal schizophrenia?

A

A form of schizophrenia that does not respond to any antipsychotic treatment - may represent a distinct pathophysiological entity (maybe a different disorder)

more grey matter volume and reduction in lobes of the brain - reduced connectivity in certain key brain regions and decreased dopaminergic synapses

48
Q

What does normal cortical development involve? when does it occur?

A

Proliferation, migration of cells, dendritic circuit absorption and myelination

First 2 occur mostly during prenatal life and the latter two during first 2 post natal decades

49
Q

How does pruning and myelin deposition potentially contribute to schizophrenia?

A

Psychosis nearly always emerges while the prefrontal cortex is still developing - may involve excessive pruning of excitatory pathways - leading to an excitatory-inhibitory imbalance in the prefrontal cortex

50
Q

Amphetamines and schizophrenia?

A

Can increase levels of dopamine in the brain and increases psychotic symptoms (stimulant induced psychosis)

51
Q

GABA and schizophrenia?

A

Reduced synthesis and reuptake of GABA has been demonstrated in the prefrontal cortex in patients with schizophrenia

52
Q

Acetylcholine and schizophrenia?

A

Decreased levels of cholinergic receptors are observed in the hippocampus, thalamus, and striatum

53
Q

Serotonin and schizophrenia?

A

Prefrontal 5HT receptors have been linked to the pathogenesis of schizophrenia
Activation of 5HT receptors induced a schizophrenia-like state in humans

54
Q

Disruption of one neurotransmitter system in schizophrenia leads to….

A

Compensatory mechanisms by other systems

55
Q

What immune system activation is present in schizophrenia?

A
  • Elevated cytokines and microglial activation

- Neuroinflammation is linked to the risk of psychosis and related disorders

56
Q

The gut microbiome is what and what is it increasingly being linked to…

A

Normal flora of the gut is made up of several species of viruses and fungi

Schizophrenia, depression and bipolar

57
Q

The guts microbiome and schizophrenia?

A
  • Increased number of microbiome species
  • Greater lactic acid bacteria
  • Differences in metabolic pathways controlling glutamate and B12 transport (increased)
  • Decreased carbs and lips metabolism
58
Q

The gut and the brain are connected via the…

A

Vagas nerve

59
Q

What other factors are linked to the development of schizophrenia?

A

Prenatal exposure to viral infections
Poor prenatal nutrition
Adverse obstetric events - difficulties during birth
Cannabis smoking during adolescence - increases chance of psychosis by 3x

60
Q

Is there a genetic risk of schizophrenia?

A

Yes there is

  • risk greater if you have affected relatives
  • twin studies support
61
Q

What genes have a role to play in schizophrenia?

A

Dopamine receptor D2 gene

Genes encoding proteins involved in glutamatergic neurotransmission and several calcium voltage channel proteins

Genes expressed in tissues with immunity roles

62
Q

What is the concordance rate in monozygotic twins?

A

33%

63
Q

What is the concordance rate in non-identical twins?

A

7%

64
Q

What is interesting about twins and their risk of schizophrenia?

A

Early age onset of schizophrenia in one twin was a risk for the other developing it later on

Suggesting that early-onset schizophrenia may have a stronger genetic component of risk than other subtypes

65
Q

What is schizoaffective disorder?

A

People have symptoms of both schizophrenia and a mood disorder (depression or bipolar)

66
Q

What is the prevalence of schizoaffective disorder? why might this not be a true reflection of those with it?

A

0.03%
Because it is a combination of the 2, it may be misdiagnosed as one or the other.
This makes it hard to know how many people actually have it

67
Q

Any gender differences in schizoaffective disorder?

A

Equal in men and women - no

68
Q

Are treatments effective in schizoaffective disorder?

A

They can help to manage it but relapses are common

69
Q

People with schizoaffective disorder typically have…

A

substance abuse disorders as well

70
Q

What are the two different types of schizoaffective disorder?

A

Bipolar type: Includes episodes of mania and sometimes major depression
Depressive type: includes only major depressive episodes

71
Q

Symptoms of schizoaffective disorder?

A 
Delusions 
Depression 
Hallucinations 
lack of personal care 
Mania or sudden jumps in energy or happiness 
Risky behaviour 
Problems with speech and communication
72
Q

Causes of schizoaffective disorder?

A

Genetics

Brain chemistry and structure: problems in circuits that moderate mood and thinking

Environment: viral infections or highly stressful situations could play a part

Drug use: mind altering drugs

73
Q

Diagnosis of schizoaffective disorder involves…

A

Periods of uninterrupted illness
An episode of depression or mania
Symptoms of schizophrenia
At least 2 psychotic periods, each lasting 2 weeks - at least one needs to happen without depressive or mani symptoms

74
Q

Treatment of schizoaffective disorder?

A

Medication - antipsychotics (atypical) or antidepressants

Psychotherapy - help learn about their illness, set goals and manage everyday life

Skills training

Hospitalisation

Electroconvulsive therapy (for those that dont respond to medications or psychotherapy)

75
Q

What is schizophreniform disorder?

A

Type of psychotic illness with symptoms similar to schizophrenia - lasting less than 6 months

76
Q

What if schizophreniform disorder lasts longer than 6 months?

A

Would be considered schizophrenia instead

77
Q

Symptoms of schizophreniform disorder?

A 
Similar to schizophrenia 
- delusions 
- halluncinations 
- disorganised speech 
- odd or strange behaviour 
- lack of enegry 
- poor hygiene and grooming habits 
withdrawal from friends, family and social life
78
Q

Causes of schizophreniform disorder?

A

Unknown

Genetics

Brain structure and function: disturbances in brain circuits that mediate thinking and perception

Environment: poor relationships or very stressful events

79
Q

How common is schizophreniform disorder?

A

1 in 1000 develop it during their lifetime (18-24 yrs in men, 24-35 yrs in women)

80
Q

Treatment for schizophreniform disorder?

A

Medication (antipsychotic drugs) and psychotherapy (recognize and learn more about the illness)

Family therapy

May need to be hospitalised if a risk

Early diagnosis and treatment are important

81
Q

How many people with schizophreniform disorder don’t recover and go on to develop schizophrenia?

A

2/3

82
Q

What is brief psychotic disorder?

A

A sudden, short period of psychotic behaviour often in response to a very stressful event

Recovery is quick - often under a month

83
Q

What are the three types of brief psychotic disorder?

A

Brief psychotic disorder with obvious stressor: shortly after trauma (eg. death of loved one) - reaction to a very disturbing event

Brief psychotic disorder without obvious stressor: there is no apparent stressor that causes it

Brief psychotic disorder with postpartum onset: Only in women, within 4 weeks of having a baby

84
Q

Causes of brief psychotic disorder?

A

Could have a genetic link

Another theory suggests that poor coping skills could trigger the disorder as a defence against or an escape from a frightening or stressful situation

People with antisocial personality disorder or paranoid personality disorder are more likely to get it

85
Q

Any gender differences in brief psychotic disorder?

A

Typically happens more in women than in men

86
Q

At what age does a brief psychotic disorder normally occur?

A

when people are in their 20s or 30s

87
Q

Medication for brief psychotic disorder?

A

Antipsychotics, just like schizophrenia

88
Q

What is delusional disorder?

A

Key symptom is having a disorder involving a real-life situation that could be true but isn’t

89
Q

How long does the delusion last in delusional disorder?

A

For at least one month

90
Q

Delusions come in many forms but they all have one thing in common. What is it?

A

The people affected by them can’t be convinced that something they believe isn’t true

91
Q

What are the diagnoses criteria for delusional disorder?

A

Non-bizarre delusions
Absence of obviously odd behaviour
Absence of hallucinations
No memory loss, medical issues or drug use is responsible for the delusions
ANy mood disorders do not last as long as the delusion

92
Q

What affects what kind of delusion people have?

A

Their personality, culture and family background

93
Q

What are the common types of delusions in delusional disorder?

A

Persecution (someone trying to hurt you)

Infidelity (unusual jealousy or possessiveness towards another person)

Love (obsessive love that takes over thoughts or an idea someone famous is in love with you)

Religion

Guilt or worthlessness (common with people in depression)

Grandiose

Negation or nihilistic (feelings of emptiness)

Somatic (thinking they have a medical issue)

Mixed (delusions with two or more themes)

94
Q

What is paraphrenia?

A

Symptoms similar to schizophrenia
Starts in late life

Organized system of paranoid delusions with or without hallucinations
Without deterioration of intellect or personality

95
Q

What is shared psychotic disorder?

A

Occurs when one person is in a relationship has a delusion and the other person in the relationship adopts it too

Rare

Apart from this, thoughts and behaviour are normal

96
Q

What is substance-induced psychotic disorder?

A

Caused by the use of or withdrawal from drugs

Drugs that depress the nervous system and stimulants affect your brain activity so what seems real to you doesn’t match the world

Usually goes away when you stop taking the drug

97
Q

Medical conditions leading to psychotic behaviour?

A

Different medical conditions can give rise to psychotic symptoms

98
Q

Post-ictal psychosis?

A

Happens in some people with epilepsy who have had a number of seizures in a row

Antipsychotic drugs can stop symptoms and may help prevent future episodes

99
Q

Myxedematous psychosis?

A

May occur when the thyroid gland doesnt work

May have delusions, hallucinations and changes your sense of smell and taste

Taking thyroid hormones can help to balance your glands activity and end the psychosis

100
Q

Female hormone shifts and psychosis?

A

May induce psychosis symptoms.

‘menstrual psychosis’ - may be confused about what is real, hallucinate and believe things that arent true

Out of balance hormones during the cycle can affect thinking and moods

Can use CBT and antipsychotic drugs

NEUROPSYCH & CLINICAL NEURO (12 decks)

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