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Neuroscience > 12.1 Psychosis > Flashcards

12.1 Psychosis Flashcards

1
Q

Definition of Psychosis

A

Presence of hallucinations or delusions. (describes symptoms, not a diagnosis in itself)

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2
Q

Definition of Hallucinations

A

Perception without a stimulus. (can be in any sensory modality, visual hallucinations are usually organic - caused by a problem with brain or eyes)

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3
Q

Give 2 different types of hallucinations and when they occur.

A 
Hypnogogic = Going to sleep
Hypnopomopic = Waking up
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4
Q

Definition of Delusions

A

Abnormal belief, outside of cultural norms, unshakable

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5
Q

Causes of organic psychosis

A 
Delirium caused by infection
Delirium tremens (alcohol withdrawal)
Acute drug/alcohol intoxication
Post-ictal psychosis (after a seizure)
Hyperthyroidism
Encephalitis (including NMDA receptor)
Hypercalcaemia (moans part of moans, groans, bones, stones)
Cerebral lupus
Iatrogenic causes (steroids, L-DOPA)
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6
Q

List the 5 first rank symptoms of Schizophrenia

A
  1. Auditory hallucinations
  2. Passivity experiences
  3. Thought withdrawal, broadcast or insertion
  4. Delusional perceptions
  5. Somatic hallucinations
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7
Q

Give the 2 types of Auditory Hallucinations

A
  1. Thought echo (hearing thoughts aloud)

2. Running commentary (describe what they are doing - e.g. “he is sitting down, he is brushing his teeth”)

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8
Q

What are Passivity Experiences?

A

Patient believes an action or feeling is caused by an external force
“MI5 have been moving my leg”

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9
Q

What are thought withdrawal, thought broadcast and thought 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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10
Q

What is Delusional Perception?

A

Attribution of new meaning, usually in the sense of self-reference to a normally perceived object

e.g. “the traffic light went red and I knew this was a sign that aliens were going to land soon”

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11
Q

What are Somatic Hallucinations?

A

Mimics feeling from inside the body (e.g. convinced a snake is living inside their stomach) - usually a lack of insight (patients don’t believe that they are unwell)

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12
Q

What are Positive Symptoms?

A 
Positive symptoms are added symptoms
They include:
Delusions,
Hallucinations,
Thought disorder,
Lack of insight
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13
Q

What are Negative Symptoms?

A 
Negative symptoms are symptoms that take away from the patient (often they will neglect themselves)
They include:
Under-activity,
Low motivation,
Social withdrawal,
Emotional flattening
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14
Q

ICD10 diagnosis

A

One of the following:

  1. Thought echo, insertion, withdrawal, broadcast
  2. Delusions of control, influence or passivity
  3. Hallucinatory voices giving a running commentary or other types of hallucinatory voices
  4. Persistent delusions of other kinds

Or at least 2 of the following:

  1. Persistent hallucinations in any modality (occur everyday for at least one month)
  2. Neologisms, breaks or interpolations in the train of thought; resulting in incoherent or irrelevant speech
  3. Catatonic behaviour
  4. Negative symptoms
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15
Q

Give some of the different types of Schizophrenia

A
  1. Paranoid Schizophrenia (delusions or hallucinations prominent)
  2. Simple Schizophrenia (similar to depression - loss of drive and interest, aimlessness, idleness etc…)
  3. Hebephrenic Schizophrenia (similar to mania - giggly, inappropriate behaviour etc…)
  4. Undifferentiated Schizophrenia (insufficient symptoms to meet criteria of any subtypes or so many symptoms fit more than one criteria)
  5. Catatonic Schizophrenia
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16
Q

Outline the structures involved in the Pathophysiology of Schizophrenia

A
  1. Dopamine pathways activity changing
  2. Brain changes
  3. Limbic system involvement
17
Q

What Dopamine pathways are involved Schizophrenia?

A

Mesolimbic pathway - overactive in schizophrenia (from the ventral tegmental area to limbic structures and nucleus accumbens)

Mesocortical pathway - underactive in schizophrenia (from the ventral tegmental area to frontal cortex and cingulate cortex)

18
Q

What are the 4 Dopaminergic pathways?

A
  1. Mesolimbic pathway
  2. Mesocortical pathway
  3. Nigrostriatal pathway
  4. Tuberohypophyseal pathway
19
Q

What are the brain changes seen in Schizophrenia?

A
  1. Enlarged ventricles

2. Reduced hippocampal formation, amygdala, parahippocampal gyrus and prefrontal cortex

20
Q

What is the role of the Limbic structures and Basal ganglia in Schizophrenia

A

Limbic structures - have a role in regulating emotional behaviour
Basal gangla - even untreated patients can present with motor symptoms

21
Q

Outline the Autoimmune hypothesis of Schizophrenia.

A

Believed to be due to the involvement of anti-NMDA antibodies leading to anti-NMDA encephalitis. Antibodies bind to the NMDA receptor.

80% of patients are female - around 50% have an underlying tumour (mostly ovarian teratoma)

Treatment = Corticosteroids

22
Q

Outline the Treatments for Schizophrenia

A

Typical antipsychotics (e.g. Haloperidol) - block D2 receptors in all CNS dopaminergic pathways (Mesolimbic, Mesocortical, Nigrostriatal, Tuberhypophyseal) - lots of side effects

Atypical antipsychotics - low affinity for D2 receptors, milder side effects as dissociate rapidly from D2 receptor

23
Q

What are the different types of dopamine receptors and their families?

A

D1 receptor family = D1, D5 receptors - secondary messenger increases cAMP (via Gs)

D2 receptor family = D2, D3, D4 receptors - secondary messenger decreases cAMP (via Gi)

D2 receptors (not the family) found in striatum, substantia nigra and pituitary gland

24
Q

What are the problems in treatment of Schizophrenia?

A

Antipsychotic medications cause side effects:

Typically Parkinsonian side effects (e.g. bradykinesia, tremor, muscle rigidity, pill rolling tremor, shuffling/propulsive gait etc…)

Can also get Acute Dystonia (development of Torticollis - another drug given to treat this)

25
Q

What is Avatar Therapy?

A

Avatar therapy is when the patient introduces an avatar to where they think the voices are coming from - this allows the patient to confront their hallucinations. Almost like a type of CBT

26
Q

Give a basic outline into the Basal Ganglia (and consider how this can cause OCD)

A
  1. Input - from Cortical and Subcortical areas
  2. Processing - from Striatum - allows integration of information Basal ganglia encode for the decision to move, the directin and amplitude of movement and motor expression of emotions
  3. Output - Inhibitory projections from Globus Pallidus and Substantia Nigra to Thalamus

In OCD the output inhibition is believed to be lacking and instead the patients have a re-entry circuit

27
Q

Where does the Nigrostriatal pathway run?

A

from - Substantia Nigra Pars Compacta

to - Striatum (caudate nucleus and putamen)

28
Q

Real name of the condition known as ‘sleepy sickness’

A

Acute encephalitis lethargica

29
Q

What are the features of Catatonia

A

More than two weeks with one or more of:

  • Stupor/Mutism (cannot talk)
  • Excitement
  • Posturing
  • Negativism
  • Rigidity
  • Waxy flexibility - put patient into positions and they stay
  • Command automatism (abnormal mechanical responses to commands)
30
Q

Why do patients on dopamine get Catatonia?

A

Believed to be due to less GABA binding so loss of inhibitory effect.

31
Q

What is the prognosis of Psychosis?

A

Moderately good long term global outcome in about 50%.
Mortality twice as high in general population.
Shorter life expectancy.
Higher incidence of CVS disease, respiratory disease and cancer.
Suicide risk 9x higher.
Death from violent incident 2x higher.
Approximately 50% have a substance misuse problem.
Higher rate of cigarette smoking (reduces auditory hallucinations)

32
Q

What are the good prognostic factors in Psychosis?

A

Good prognostic factors:

  • Absence of family history
  • Good premorbid function
  • Acute onset
  • Mood disturbance
  • Prompt treatment (early intervention)
  • Maintenance of initiative and motivation
33
Q

What is Drug Induced Psychosis?

A

Psychosis induced by a psychoactive substance (cannabis, cocaine, LSD, ecstacy, ketamine…)

34
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 psychotic symptoms for more than 48 hours
Duration of the disorder not exceeding six months

35
Q

What is Affective Psychosis?

A

Psychosis

36
Q

What is Post-Partum Psychosis

A

Affecting 1 in 1000 women. Very severe and needs to be recognised quickly to avoid harm to mother or baby.
More common in those with previous bipolar disorder or psychotic illness or those with a family history of psychotic illnesses. However can be present in those with no previous psychiatric history
Onset is within days to weeks of delivery. Can develop over hours to days.

Neuroscience (13 decks)

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