Pyschotic Disorders Flashcards

1
Q

Define psychosis

A

The presence of hallucinations or delusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are hallucinations?

A

Perception without a stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are visual hallucinations usually caused by?

A

Problems with brain or eye
(Not psychotic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are hypnogogic hallucinations?

A

as you’re going to sleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are hypnopompic hallucinations?

A

As you’re waking up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a delusion

A

A fixed false belief which is unshakeable
Outside of cultural norms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 5 first rank symptoms of schizophrenia?

A
  • auditory hallucinations
  • passivity experiences
  • thought withdrawal, broadcast or insertion
  • delusional perceptions
  • somatic hallucinations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Types of auditory hallucinations

A
  • running commentary
  • thought echo: hearing thoughts aloud
  • third person: voices referring patient to 3rd person
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are passivity experiences?

A

Patient believes an action or feeling is caused by an external force
e.g. MI5 have been moving my leg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is thought withdrawl?

A

Feeling like their thoughts are being taken out of their mind

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is thought broadcast?

A

Feeling like everyone knows what the person is thinking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is thought insertion?

A

Feeling that thoughts are implanted by others
Experiencing one’s own thoughts as someone else’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is delusional perception?

A

Attribution of new meaning, usually in sense of self reference to normally perceived object + cannot be understood as arising from patient’s affective state
seeing something that has actually happened by interpreting in a delusional way

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are somatic hallucinations?

A

Mimics feeling from inside the body
e.g. feeling snake inside body, feeling heart twisting inside of them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Positive symptoms of schizophrenia

A

something added
- delusions
- hallucinations
- thought disorder
- lack of insight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Negative symptoms of schizophrenia

A

something taken away
- underactivity
- low motivation
- social withdrawal
- emotional flattening
- self neglect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is thought disorder

A

Problem with organisation of thoughts in logical way

18
Q

What is lack of insight?

A

Patient doesn’t realise that they are unwell

19
Q

Positive vs negative symptoms of schizophrenia

A
  • positive: something added
  • negative: something taken away
20
Q

Evidence for involvement of dopamine in schizophrenia

A
  • drugs than increase dopamine levels induced by psychosis
  • drugs that antagonise dopamine (especially at D2 receptor) treat psychosis
21
Q

Where is the mesolimbic pathway between?

A

From Ventral temgental area
To Limbic structures + nucleus accumbens

22
Q

What is the mesocortical pathway between?

A

From ventral tegmental area
To frontal + cingulate cortex

23
Q

Mesolimbic pathway involvement in schizophrenia

A

Overactive in schizophrenia
Causes positive symptoms

24
Q

Mesocortical pathway involvement in schizophrenia

A

Underactive in schizophrenia
Causes negative symptoms

25
Q

Brain changes in schizophrenia

A
  • enlarged ventricles
  • reduced grey matter (brain weight)
  • decreased temporal lobe volume
  • reduced hippcampal formation, amygdala, parahippocampal gyrus + prefrontal cortex
26
Q

Neuropathology of schizophrenia

A
  • decreased pre synaptic markers
  • decreased olgiodendroglia
  • fewer thalamic neurones
  • these three changes have lead to aberrant connectivity theory
27
Q

Treatment of schizophrenia

A
  • typical antipsychotics: block D2 receptor in all 4 CNS dopaminergic pathways
  • atypical antipsychotics: lower affinity for D2 receptors + block 5HT2 receptors
28
Q

Why do atypical antipsychotics have milder side effects than typical?

A

Atypical dissociate rapidly from D2 receptors

29
Q

Side effects of atypical antipsychotics

A
  • hyperprolactinaemia
  • movement affected
  • amenorrhoea
  • galactorrhoea
  • decreased fertility + libido
  • osteoporosis
  • erectile dysfunction
30
Q

What are the 4 CNS dopaminergic pathways

A

Mesolimbic pathways
Mesocortical pathways
Nigrostriatal pathway
Tuberoinfundibular pathway

31
Q

What are side effects of antipsychotics due to?

A

Blockage of dopamine receptors in other pathways

32
Q

What is the nigrostriatal pathway between?

A

From substantia nigra pars compacta
To striatum

33
Q

What does use of antipsychotics on the nigrostriatal pathway cause?

A

Less dopamine = less movement

34
Q

What makes up the striatum?

A

Caudate nucleus
Putamen

35
Q

What is the tuberoinfundibular pathway between?

A

From arcuate + periventricular nuceli of hypothalamus
To infundibular region of hypothalamus

36
Q

Why is hyperprolactinaemia a side effect of antipsychotics?

A
  • dopamine inhibits prolactin release from anterior pituitary
  • DA antagonists lower DA > loss of inhibition of prolactin
  • prolactin levels increase
37
Q

What can hyperprolactinaemia cause?

A
  • amenorrhoea
  • galactorrheoa
  • decreased fertility
  • reduced libido
  • erectile dysfunction
  • osteopenia/osteoporosis
38
Q

Difficulty in treating people with schizophrenia

A
  • patients can have a lack of insight
  • they don’t believe that they are unwell
  • medications are often not taken
39
Q

Good prognositic factors of schizophrenia

A
  • absence of family history
  • good premorbid function
  • acute onset
  • mood disturbance
  • prompt treatment
  • maintenance of initiative + motivation
40
Q

Long term complications of schizophrenia

A
  • shorter life expectancy
  • higher incidence of cardiovascular, respiratory disease + cancer
  • greater suicide risk
  • risk of violent death
  • smoking
  • substance misuse
41
Q

How can difficulties of treating schizophrenia be overcome?

A

Medications can be given via depot injection