L4 - SCZ AND OTHER PSYCHOTIC DISORDERS Flashcards
(38 cards)
Name some psychotic symptoms?
DDHGN
Delusions - inability to question thought content
Hallucinations
Disorganised thinking (speech)
Grossly Disorganised or Abnormal Motor behaviour (catatonia)
Negative symptoms
What are delusions?
They are fixed beliefs that are not amenable to change in light of conflicting evidence.
Name some types of delusions.
6 - PREGNS
Persecutory delusions - belief that one is going to be harmed or harassed, by an individual, organization or other group (most common)
Referential delusions - belief that certain gestures comments, environmental cues are directed at themselves (hidden messages)
Grandiose delusions - that an individual has exceptional abilities, wealth or fame.
Erotomanic Delusions - false beliefs that someone is in love with him/her. Doesn’t believe it even when person says no.
Nihillistic Delusions - belief that a major catastrophe will occur
Somatic Delusions - Preoccupations regarding health and organ function.
What are two features that a delusion can be?
Bizarre or non-bizarre
- bizarre if its clearly implausible
- non-bizarre = may have happened but extremely unlikely
and
Primary or Secondary
- primary = formed without prior change in mood or perception
- secondary = thoughts developed as a consequence of some abnormality of mood/memory/perception
What is a Hallucination?
A perception-like experience that occurs without an external stimulus.
Most commonly auditory, but can happen with any sensory modality
What are some features of disorganised thinking/speech?
derailment or loose associations
tangentiality - not answering question properly/providing irrelevent info
incoherence (“Word salad”)
Describe what grossly disorganised or abnormal motor behaviour is.
Can manifest in numerous ways.
childlike “silliness” or unpredictable agitation
CATATONIA - marked decrease in reactivity to the environment. (not common)
What are negative symptoms?
Thoughts, feelings, or behaviours normally present that are absent or diminished in a person with a mental disorder.
- Diminished emotional expression - intonation of speech, movements of hand head and face
- Avolition - decrease in motivated self-initated purposeful activites
- Alogia - diminished speech output
- Anhedonia - decreased ability to feel pleasure
- Asociality - lack of interest in social interactions
These symptoms are harder to combat that positive symptoms.
What is Brief Psychotic Disorder?
A. presence of at least 1: delusions, hallucinations, disoganised speech, grossly disorganised or catatonic behaviour
B. episode lasts at least 1 day and less than 1 month
C. disturbance not better explained by MDD or Bipolar, or due to another med condition of subs use
What is delusional disorder?
A. presence of at least 1 delusion with duration of 1 month or more.
B. Never had 2 or more sz symptoms for a month
C. Functioning is not markedly impaired, and behaviour is not bizarre.
D. only brief manic or depressive episodes
E. disturbance not attributed to anything else..
Describe Shizophreniform Disorder.
A. 2 or more psychotic symptoms for 1 month, or less if treated.
B. Episode of the disorder lasts at least 1 month but less than 6 months.
Describe Schizophrenia.
A. 2 or more psychotic symptoms for 1 month or less if treated.
B. level of functioning in one or more major areas is markedly below level achieved prior to onset/expected level.
C. continuous disturbance for at least 6 months
D. not attributable to anything else.
Describe schizoaffective disorder.
A. uninterrupted period of illness during which there is a major mood episode (Major depressive or manic)
B. delusions or hallucinations for 2 or more weeks in absence of mood episode.
C. symptoms that meet criteria for major mood episode are present for majority of total active and residual portions of illness.
D. not attributable to anything else.
- no overlap of mood and schizo episodes, they happen seperately
Age of onset for schizophrenia?
average:
male - 18
female - 25
same prevalence rates across genders
Associated features with SZ?
Depression suicide anxiety PTSD - trauma from experience of psychosis or its treatment Substance use problems poor quality of life stigma
Are people with psychotic disorders violent?
No, they tend to withdraw from others.
Factors that predict violence are the same as in the general population - male, past history of violence, certain personality trains, substance abuse, etc.
They are more likely to be victimised.
What is the link between psychosis and genetics?
- heritability seen
- Epigenetics - COMT gene and interaction with cannabis.
involved in the breakdown of dopamine. Some enzymes promote a slower breakdown of dopamine than others - risk of developing psychosis is increased with specific form of COMT gene.
Are psychotic disorders caused by a character flaw?
No personality traits are linked to schizo or psychotic disorders.
What is the dopamine hypothesis?
This suggests that excessive dopamine functioning in the CNS is associated with psychotic symptoms.
To support this, it’s been found that:
- Drugs that reduce dopamine activity have some efficacy in treating sx of sz.
- Amphetamine, which causes the release of dopamine, produces symptoms of sz.
However, no evidence of high levels of dopamine has been found in brains of people with sz
so. .. OVERLY SENSITIVE DOPAMINE RECEPTORS?
or. . ASSOCIATED WITH POSITIVE SX ONLY?
NA and 5-HT also said to have a role
Effects of sz on brain structure?
Englarged ventricles
reduced grey and white matter in prefrontal cortex
-found progressive change (UHR, FEP, Chronic) in hippocampus, pituitary volume and more.
-sz due to prenatal damage? result of genetic factors/enviro influence (maternal viral infection while pregnant, inadequate nutrition).
- Neurodevelopmental model - silent damage emerges in prefrontal cortex as the latter develops in adolescence.
- ‘TWO HIT’ model - one early hit, and another one in adolescence –> 1st hit exposed during early neurodevelopmental stages. creates vulnerability. second hit in later life, exposes symptoms.
- Olfaction - olfactory deficts are seen in pre-psychotic, FEB and chronic patients. olfactory brain reigons linked with regions believed to be associated with sz.
deficits might be risk factor
Role of Family in SZ?
Psychological factor.
- Schizophrenogenic Mother - cold, aloof, overprotective, domineering, strips child of self esteem and independence.
Has been discredited. - COMMUNICATION DEVIANCE MODEL - Families of sz tend to have deviant communication patterns.
Social Factors in SZ?
Psychological factor.
Risk factors are - living in urban enviro, migraine and being socially excluded.
Maybe a link to minority status in high density living, especially with use of cannabis.
Childhood Trauma and SZ?
Psychological Factor.
sig portion of people w/ psychotic disorder report traumatic experiences in childhood. May play a causal role in psychosis.
Stress and SZ?
high risk patients who developed psychosis had increased pituitary volumes, indicating higher levels of stress hormones.
