Lecture 20 - Psychosis

Question 1

What is the definition of Psychosis?

Answer 1

The presence of hallucinations or delusions

Its not a diagnosis it describes symptoms

Question 2

What are hallucinations?

Answer 2

Perception without stimuli

Can be in any sensory modality (visual or auditory etc..)

Question 3

What are the 2 types of hallucinations healthy individuals can experience?

Answer 3

Hypnogogic

Hypnopompic

Question 4

What are hypnogogic hallucinations?

Answer 4

Hallucinations where you get them while going to sleep

Question 5

What are hypnopompic hallucinations?

Answer 5

Hallucinations when waking up

Question 6

What are delusions?

Answer 6

A fixed false belief which is unshakeable and outside of cultural norms

Question 7

Do patients with schizophrenia have a split mind or personality?

Answer 7

No

Question 8

Are schizophrenic patients more dangerous than other patients?

Answer 8

No not generally

Question 9

What are Schneiders First Rank Symptoms of Schizophrenia?
(Pathognomic of schizophrenia)

Answer 9

Auditory hallucinations
Passivity experiences
Though withdrawal, broadcast or insertion
Delusional perceptions
Somatic hallucinations

Question 10

What are auditory hallucinations in schizophrenia?

Answer 10

Thoughts echo
Running commentaries of action
Third person voice talking about patient

Question 11

What are passivity experiences in schizophrenia?

Answer 11

Belief that action or feelings are caused by external forces (someone else is moving their limbs)

Question 12

What are thought withdrawals, broadcast or insertion in schizophrenia?

Answer 12

Withdrawal (something taking their thoughts away)
Broadcast (people know what patients thinking)
Insertion (thoughts being implanted)

Question 13

What are delusional perceptions?

Answer 13

New meanings to a normally perceived object

(Red traffic light = alien invasion)

Question 14

What are somatic hallucinations?

Answer 14

Sense of being touched when not actually being touched

Question 15

What are positive symptoms and negative symptoms in schizophrenia?

Answer 15

Added symptoms = Positive

Symtoms that take away from patient = Negative

Question 16

What are some positive symptoms of Schizophrenia?

Answer 16

Delusions
Hallucinations
Thought disorders (cant organise thoughts)
Lack of insight

Question 17

What are some negative symptoms of schizophrenia?

Answer 17

Under activity
Low motivations
Social withdrawal
Emotional flattening
Self neglect

Question 18

What is the main theory of why Schizophrenia occurs?

Answer 18

Dopamine theory

Question 19

What is the Dopamine Theory of Schizophrenia?

Answer 19

Drugs that release dopamine (excess) causes Psychotic symptoms

Medications antagonising Dopamine receptors treat psychosis and those who have highest affinty to D2 receptors work most effectively

Question 20

What types of drug cause the releaese of lots of dopamine leading to schizophrenia psychosis?

Answer 20

Amphetamines

Question 21

What are the 4 Dopamine pathways in the brain?

Answer 21

Mesolimbic
Mesocortical
Nigrostriatal
Tuberoinfundibular pathway

Question 22

What 2 dopamine pathways are thought to have different activities in schizophrenia?

Answer 22

Mesolimbic pathway
Mesocortical pathway

Question 23

How is the activity of the Mesolimbic pathway affected in schizophrenia?

Answer 23

Overactive

Question 24

How is the activity of the Mesocortical pathway affected in schizophrenia?

Answer 24

Under active

Question 25

What symptoms of schizophrenia does the overactive mesolimbic pathway produce in schizophrenia?

Answer 25

Positive symptoms

Question 26

What symptoms of schizophrenia does the underactive Mesocortical pathway produce in schizophrenia?

Answer 26

Negative symptoms

Question 27

What are some structures in the mesolimbic pathway?

Answer 27

Starts from ventral tegmental area to: -amygdala -hippocampus -nucleus accumbens

Question 28

What symptoms of schizophrenia does the under active mesocortical pathway produce in schizophrenia?

Answer 28

Negative symptoms

Question 29

What are some structures in the mesolimbic pathway?

Answer 29

Ventral tegmental area to: -amygdala -hippocampus -nucleus accumbens

Question 30

What are some structures in the mesocortical pathway?

Answer 30

From ventral tegmental area to: -frontal cortex -cingulate cortex

Question 31

What are some brain changes in schizophrenia?

Answer 31

Enlarged ventricles Reduced grey matter Decreased temporal lobe volume Reduced hippocampal formation, amygdala, parahippocampal gurus (all lambic structures) Reduced prefrontal cortex formation

Question 32

What are the neuorpathological changes seen in schizophrenia?

Answer 32

Decreased synaptic markers Decreased Oligodendrocytes Less thalamic neurones

Question 33

Why can some patients with schizophrenia present with motor symtoms?

Answer 33

Sometimes basal ganglia can be affected

Question 34

What is the treatment for Schizophrenia?

Answer 34

Antipsychotics that block D2 receptors in dopaminergic pathways in CNS (Typical and Atypical antipsychotics)

Question 35

Where is the main site of action of typical antipsychotics?

Answer 35

D2 receptors in all CNS dopaminergic pathways but mainly on Mesolimbic and Mesocortical pathways

Question 36

What causes the side effects of typical antipsychotics?

Answer 36

Antagonism of D2 receptors in other pathways that aren’t the mesolimbic and Mesocortical pathways in the CNS

Question 37

Why do atypical antipsychotics have milder side effects than typical antipsychotics?

Answer 37

They dissociates rapidly from D2 receptors since have lower affinty

Question 38

What other receptors except for D2 receptors to atypical antipsychotics block?

Answer 38

5HT2 so have some action on serotonin systems

Question 39

What are some side effects of atypical antipsychotics?

Answer 39

Obesity Hyperlipidaemia Glucose intolerance

Question 40

Why can giving antipsychotics lead to drug induced Parkinson’s?

Answer 40

Dopamine blocked in the nigrostriatal pathway Less dopamine = less movement harder to initiate movement So direct pathway of basal ganglia not stimulated so the thalamus doesn’t receive as much inhibition so get tremor

Question 41

What structures are part of the nigrostriatal pathway?

Answer 41

Substantial nigra pars compacta Striatum (caudate and putamen)

Question 42

What are the 4 key signs in Parkinson’s disease?

Answer 42

Brady Kinesin Lead pipe rigidity Pil rolling tremor Hypertonia

Question 43

What is Catatonia? What causes it?

Answer 43

Excess of dopamine for some reason leads to slow movement Seen in extreme schizophrenia

Question 44

What is thought to cause catatonia? How’s it treated?

Answer 44

Excess dopamine in schizophrenia leads to less GABA being able to bind so lose inhibitory effects of neurones GIVE LORAZEPAM

Question 45

What is the tuberoinfundibular pathway?

Answer 45

From arcuate and periventricular nuclei of hypothalamus To infundibular region of hypothalamus

Question 46

Why can you get Hyperprolactinaemia when giving antipsychotics?

Answer 46

Antipsychotics antagonise dopamine Dopamine normally inhibits prolactin So giving antipsychotics mean less dopamine to inhibit prolactin

Question 47

What are the side effects of antipsychotics causing Hyperprolactinaemia?

Answer 47

Decreased fertility Reduced libido Amenorrhoea Galactorrhoea Long term, osteopenia/osteoporosis

Question 48

Why is it difficult to treat people with schizophrenia?

Answer 48

They lack insight (don’t believe they’re unwell) Medication adherence is therefore often poor

Question 49

How can antipsychotic medications be administered with schizophrenics?

Answer 49

PO Short acting IM Depot

Question 50

What are some good prognostic factors for schizophrenia?

Answer 50

Absence of FHx Good premorbid function Acute onset Mood disturbance Prompt treatment Maintenance of initiative and motivation

Question 51

What are some long term complications of schizophrenia?

Answer 51

Mortality is twice as high as in general population Shorter life expectancy (-ve symptoms so unlikely to make healthy choices and drugs given increase CVS risk) Higher CVS disease, resp and cancer incidence Inc suicide risk Substance misuse problems MORE SMOKERS