Kirkpatrick: Psychosis Flashcards by Megan Foggia

a perception of something (as a visual image or a sound) with no external cause

hallucination

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a fixed, false belief that is not shared by other members of the person’s subculture

delusion

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irrelevance and incoherence of verbal productions ranging from simple blocking and mild circumstantiality to total loosening of associations

disorganized speech

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Disorganized speech is in some instances similar to (blank)

fluent aphasia

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What is catatonia?

physical immobility

little or no speech

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What is catatonic excitement?

aimless overactivity

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What can happen if catatonia persists?

autonomic overactivity

**fever, tachycardia

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How to treat catatonia?

lorazepam
antipsychotics
ECT

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This form of catatonia can include delirium and can be fatal

malignant catatonia

**these patients become completely immobile and comatose - these pts can die from this

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What are negative symptoms?

decrease or absence of a normal behavior or experience

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What negative symptoms are seen in schizophrenia?

**not all symptoms seen in everyone with schizophrenia

Blunted affect (decrease in facial expression, expressive gestures/body language, modulation of speech/pitch/volume of voice)
Poverty of speech (alogia: few words spoken, little information conveyed)
Anhedonia (decreased experience of pleasure)
Asociality
Amotivation
Lack of normal distress

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Psychosis can be found in several disorders. What makes the psychosis different in schizophrenia?

it is idiopathic - not due to another disorder;

not an affective disorder w psychosis

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What symptoms are included in the criteria for schizophrenia?

delusions
hallucinations
disorganized speech
grossly disorganized or catatonic behavior
negative symptoms

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How long must schizophrenic symptoms last to meet criteria? What must be excluded?

continuous symptoms for at least 6 months; exclude affective disorder, abuse, meds, other meds, and autism spectrum disorder

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What is one theory for the development of schizophrenia?

prenatal famine exposure through epigenetic mechanisms

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What are some risk factors for schizophrenia?

Low birth weight
Obstetrical complications
Winter birth for schizophrenia as a whole 
Summer birth for one subgroup 
Gestational diabetes
Prenatal famine
**Prenatal stress, including infections
Advanced paternal age
Cannabis use by patient
Physical and sexual abuse in childhood/early adolescence
Immigration

**most of these risk factors are associated with early life

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What genes, if mutated, can contribute to development of schizophrenia?

DISC1
neuregulin 1

**if you have too many copies of the gene, that is a risk factor

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For many patients, schizophrenia starts in utero. What is some evidence for this?

children of mother’s with schizo have abnormal motor and cognitive impairment
adults w schizophreni have abnormal motor and social function in childhood

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T/F: prenatal & perinatal events can increase the risk of several diseases that are first apparent in adult life

true

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So why are there so many different clinical pictures and pathophysiologies involved in schizophrenia?

there are multiple causal pathways, multiple risk factors, so each patient develops it via a different combination of factors, which leads to a different presentation of disease

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Much like cardiovascular disease, schizophrenia has many (blank)

causal pathways

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When are psychotic symptoms usu present in schizophrenia? Negative symptoms? Cognitive impairment?

At what point do patients usu present to clinic?

late adolescence/early adulthood;
childhood;
preschool age in high risk individuals

**patients usu present to clinic following the onset of psychosis

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People can present for admission for schizophrenia at any age. When is the peak age, the most common age?

~20 yo

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Schizophrenia can be very episodic. What does this mean?

flare-ups of psychotic symptoms followed by periods of doing “well”

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When are patients at greater risk of having a psychotic episode?

non taking meds abusing substances hearing critical comments from caregivers poorer premorbid adjustment

What is the usual model for schizophrenia?

Schizophrenia is synonymous with the presence of psychotic symptoms (hallucinations, delusions, disorganized thought and behavior) Pathophysiology is synonymous with abnormal regulation of dopamine

What are problems with the usual model for schizophrenia?

other neurotransmitters besides dopamine are involved, and moreover, the response to antipsychotics is variable - not everyone responds to dopamine also, other disorders have psychosis, and schizophrenia pts have neuropsychiatric problems other than psychosis

Schizophrenia is more than the presence of psychosis. What else is impaired??

neuropsychiatric syndromes anatomical abnormalities metabolic problems

So why is there such a focus of psychosis if schizophrenic patients have other symptoms?

psychosis is what we can treat | our concept of the illness is distorted

This is the strongest predictor of level of function in pts with schizophrenia

cognitive impairment

T/F: People with schizophrenia on average die 15-20 earlier than the general population

True

Describe the cognitive impairments in pts with schizophrenia

some degree of cognitive impairment may be present in every schizophrenia pt; cognitive impairment is present prior to psychosis; family members of these pts also have cognitive impairments

(blank) is a better predictor of a patient’s level of function than is the severity of psychotic symptoms

cognitive function

List some cognitive domains that take a hit with schizophrenia

``` processing speed episodic memory working memory executive function attention fluency motor speed ```

People with schizophrenia have an increased 2-3x increased risk of (blank)

depression

Why might depression be common in schizophrenia pts?

these two illnesses share risk factors, like low birth weight, prenatal famine and winter birth

Lots of patients with schizoohrenia are also more likely to engage in substance abuse. What drug may increase the risk of schizophrenia?

marijuana

There is an increased prevalence of the following anxiety disorders in schizophrenia pts

OCD panic attacks PTSD GAD **OCD syndrome is a risk factor for subsequent schizophrenia

Other neuropsychiatric syndromes with increased prevalence in pts with schizophrenia?

neurological signs dyskinetic movements (jerking movements) oculomotor dysfunction polydipsia

Are these syndromes, like substance abuse, depression, anxiety, considered "comorbidities?"

hm...some may be part of the inherited schizophrenia spectrum some may share environmental risk factors or some common biology with schizophrenia **basically, these might just be components of the disease itself, not necessarily "comorbid"

In what ways can schizophrenia be considered a general medical condition?

earlier avg age of death (precedes normal population by like 20-25yrs) deaths most often caused by cardiovascular disease bc meds and treatment lead to diabetes and weight gain in addition, more smoking and sedentary lifestyle, etc

T/F: Pts with schizophrenia die at a younger age from just about every medical conditions

True **with the exceptions of stroke and cancer

Pts with schizophrenia have mild (blank) abnormalities from head to foot.

anatomical

How does the BMI of pts with schizophrenia compare to the general population?

these pts are slightly shorter and thinner than general population, slightly lower BMI

What happens to pts with psychosis when they are administered the glucose tolerance test? What does this suggest about these pts?

similar glucose levels when fasting, but higher (pre-diabetic) glucose after 2hrs * *impaired glucose tolerance, pre-diabetes * *this is familial, seen in siblings, too

How does pulse pressure differ in pts with psychosis vs controls?

pts with psychosis have an increased pulse pressure **early signs of heart disease compared to matched controls

How does the level of unbound testosterone differ in pts with psychosis vs controls?

men with psychosis have lower testosterone

Pts with psychosis have significantly shortened (blank) compared to matched controls

telomeres

What are some cytokines that change during psychotic exacerbations?

IL-1beta IL-6 TGF-beta

What are some cytokines that are elevated at first clinical contact, and remain elevated in pts with schizophrenia?

IL-12 IFN-gamma TNF-alpha sIL-2R

People with schizophrenia can be considered to have accelerated (blank)

aging

What is wrong with the stem cells in pts with psychosis? What chemokine is abnormal/deficient?

people w schizophrenia often have diabetes, and so they have abnormal/decreased SDF1alpha which brings new stem cells out of the bone marrow

What are some abnormalities of the brain in schizophrenia pts?

``` decreased volume neurons have decreased dendrites and axons (increased density of neurons, decreased number of neurons in some regions) increased dopamine in some regions abnormal NMDA receptors decreased white matter volume ```

Administration of the following three compounds can mildly increase psychotic symptoms in pts with schizophrenia

cannabis 5HT agonist NMDA antagonist

How do you treat schizophrenia?

meds: antipsychotics treat other syndromes, like depression and anxiety psychosocial treatments

During family interventions, this can increase risk of relapse

expressed emotion (critical/intrusive comments)

What happens in family interventions?

you educate the patient and the family about the illness

What is cognitive remediation useful for?

improves social cognition | small improvements in verbal memory, working memory, attention, speed processing

Schizophrenia isn’t a psychotic disorder; it’s a disorder of essentially (blank)

every brain function

Schizophrenia isn’t a brain disorder; it is a disorder of (blank) in which psychosis is present

the entire body

T/F: It is misleading to consider neuropsychiatric syndromes such as abnormal movements "comorbid" with schizophrenia; they are part of the disorder

true

Is schizophrenia = dopamine dysregulation?

Kirkpatrick: Psychosis Flashcards

(62 cards)