Psychosis Flashcards
(38 cards)
Neuropsychopathology of Psychosis
neuro-psychopathology syndrome affecting the function of the frontal/temporal lobes and the associated dopaminergic projections to these areas resulting in poor filtering of external/internal stimuli—thinking, mood, behavior, reality perception
Glutamate excitatory neurotranmitter (NMDA-glutamate receptors)
Restores and promotes neuroplasticity/synapse maintenance/interconnections
Hypofunction of NMDA receptors can result in negative, positive and cognitive symptoms
Gama-Aminobutyric Acid (GABA)
inhibitory neurotransmitter
Decreased levels can produce psychotic-like symptoms
Mesolimbic dopamine hyperactivity
Mesocortical dopamine hypoactivity
Mesolimbic dopamine hyperactivity
Positive symptoms
Mesocortical dopamine hypoactivity
Negative symptoms
Domains in schizophrenia/psychosis spectrum
Hallucinations Delusions Disorganized thinking/speech/writing Negative symptoms Abnormal behavior including catatonia Depression Impaired Cognition
What is the definition of psychosis?
Impaired reality perception, manifested by hallucinations, delusions, thought disorganization, affective instability, psychomotor changes and cognitive impairment.
What is schizophrenia?
is a disorder that lasts for at least 6 months and includes at least 1 month of active-phase symptoms (i.e., two or more of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms)
5 subtypes of schizophrenia
Paranoid Disorganized Catatonic Undifferentiated Residual
Schizophreniform Disorder
characterized by a symptomatic presentation that is equivalent to Schizophrenia except for its duration: 1 to 6 months with or without decline in functionin
Schizoaffective Disorder
periodic manifestations of Major Depression and or Mania overlap with symptoms of Schizophrenia. Schizophrenia is the underlying psychopathology. Overlapping mood d/o
Delusional Disorder
is characterized by at least 1 month of non-bizarre or bizarre delusions without other active-phase symptoms of Schizophrenia. functional and does not have to be hallucinations
brief psychotic disorder
lasts more than 1 day and remits by 1 month
Psychotic Disorder, NOS
included for classifying psychotic presentations that do not meet the criteria for any of the specific Psychotic Disorders defined in this section or psychotic symptomatology about which there is inadequate or contradictory information.
Types of delusional disorders
Erotomanic think someone is in love with you Jealous Presecutory Grandiose speak to the dead Somatic intestines removed
Treatment for delusional disorders
No other psychotic symptoms
Remains fairly functional at work, family, socially
Antipsychotics are indicated, but have modest effect
Best to begin with psychotherapy
Some will progress to schizophrenia
different types of Schizoaffective d/o
Uninterrupted Schizophrenia with periodic overlapping mood disorder
1. Bipolar Type
Better response to meds
2. Depressive type
Substandard response to meds
3. Functional impairment
Greater variability compared with Schizophrenia
Treatment for schizoaffective d/o
Atypical antipsychotics Addresses; psychosis, mood stabilizer, mania Mood stabilizers Lithium, valproate, carbazepine Anti-depressants
Treatments and risk factors for brief psychotic d/o
pre-existing psych dx: personality disorders (schizoid, schizotypal, borderline, paranoid)
Treatment
Excellent response to antipsychotics (atypical are 1st line)
Benzodiazepine for acute agitation
Hospitalize until stable
Drug/disease induced psychosis
Intoxication Cocaine Phencyclidine Ecstasy Bath Salts LSD Marijuana Amphetamines
Withdrawal
Alcohol (most common cause of drug related hallucinations)
Medical Conditions that can induce psychosis
Alcoholic encephalopathy Herpes encephalopathy Systemic Lupus Erythematosus Complex partial seizures Alzheimer’s Dementia Huntington’s Disease CNS infection CNS tumor CVA Hepatic/renal failure Hyperthyroidism
epidemiology of schizophrenia
Incidence
10-40 new cases/100,000 in the US
1.5 new cases/10,000 world-wide
men more than women
Life Time Prevalence
1% world-wide will develop schizophrenia in their life time
>2,000,000 people are affected in the US
Less than ½ have received some treatment
25,000,000 affected world-wide
Etiology for schizophrenia
genetics Advanced paternal age at conception 1st-2nd trimester viral infection Toxoplasmosis exposure in utero Infant Starvation/maternal deprivation Prenatal: toxic exposure, anoxia, birth trauma DOB : late winter-early spring Anatomical: Smaller brains w/ cortical thinning, ventricular enlargement Psychoactive drugs influence of family and society
What are the 4 A’s for schizophrenia
Autism
Ambivalence
Affectivity
Association
Clinical presentation of Schizophrenia?
Hallucinations, including all sensory systems
Delusions: fixed beliefs, mostly paranoid/grandiose/control/guilt/somatic/thought insertion/withdrawal/broadcasting
Disorganized thoughts/behaviors
Cognitive impairment
Negative symptoms
Personality changes
