Session 12 Psychosis

Question 1

Define Psychosis

Answer 1

the presence of HALLUCINATIONS or DELUSIONS

it describes the symptoms i.e. not a diagnosis in itself

Question 2

What are hallucinations?

Answer 2

Perception of something without a stimulus which can be in any sensory modality

visual hallucinations are usually organic i.e. caused by problem with brain or eyes

Question 3

What are the two types of hallucinations that are experienced in ‘normal’ population and when do these occur?

Answer 3

HypnoGOgic - GOing to sleep

HypnoPompic - waking uP (how to remeber: pompei by bastille was my alarm)

Question 4

Define a delusion

Answer 4

a fixed false belief which is unshakeable - outside of cultural norms

Question 5

What are the 5 First Rank Symptoms?

Answer 5

1. Auditory hallucinations
2. Passivity experiences
3. Thought withdrawal, broadcast or insertion
4. Delusional perceptions
5. Somatic hallucinations

Question 6

What are the 3 forms of auditory hallucinations?

Answer 6

Thought echo = hearing thoughts out loud
Running commentary
Third Person = voices referring to patient in third person and conversing with each other about the patient

Question 7

What are passivity experiences?

Answer 7

patient believes an action or feeling is caused by an external force

e.g. MI5 have been moving my leg

Question 8

What does the patient believe with:

Thought withdrawal

Thought broadcast

Thought Insertion

Answer 8

Thought withdrawal = thoughts are being taken out of my mind

Thought broadcast = everyone knows what the person is thinking

Thought Insertion = thoughts implanted by others

Question 9

What are delusional perceptions?

Answer 9

attribution of new meaning, usually in the sense of self-reference, to a normally perceived object

new meaning cannot be understood as arising from patient’s affective state or previous attitudes

e.g. “the traffic lights went red and I knew this was a sign that aliens were going to land soon’

Question 10

What are somatic hallucinations?

Answer 10

mimics feeling from inside the body

Question 11

What are the differences between positive and negative symptoms?

Answer 11

positive = added symptoms
* delusions, hallucinations, thought disorder, lack of insight

negative = symptoms that take away from the patient
* underactivity, low motivation, social withdrawal, emotional flattening, self neglect

Question 12

Outline the theories for the pathophysiology of schizophrenia

Answer 12

1. Dopamine theory
   * medications that antagonise DA receptors, help to treat psychosis - those with the strongest affinity are most clinically effective
   * amphetamines (cause the release of dopamine) induce psychotic symptoms
2. Mesolimbic pathway
   = From ventral tegmental area to limbic structures and nucleus accumbens
   * thought to be OVERactive in schizophrenia
3. Mesocortical pathway
   = from ventral tegmental area to frontal cortex and cingulate cortex
   * thought to be UNDERactive in schizophrenia

Question 13

Brain changes that occur in Schizophrenia?

Answer 13

enlarged ventricles

reduced grey matter (with reduced brain weight)

decreased temporal lobe volume

reduced hippocampal formation, amygdala, parahippocampal gyrus and prefrontal cortex

Question 14

What 3 changes have led to a theory of “aberrant connectivity” causing schizophrenia?

Answer 14

1. decrease pre-synaptic markers
2. Decreased oligodendroglia
3. fewer thalamic neurons

Question 15

What do typical antipsychotics do?

Answer 15

block D2 receptors in all CNS dopaminergic pathways

main action as antipsychotics is on mesolimbic and mesocortical pathways

NB: side effects from antagonising D2 receptors in other pathways

Question 16

What do atypical antipsychotics do?

Answer 16

have a lower affinity for D2 receptors
therefore –> milder side effects as dissociate rapidly from D2 receptor

also block 5HT2 receptors

Question 17

Where are D2 receptors typically distributed in the CNS?

Answer 17

Striatum
Substantia Nigra
Pituitary Gland

Question 18

Nigrostriatal pathway

from?

to?

Answer 18

from - substantia nigra pars compacta

to - striatum (caudate nucleus + putamen)

Question 19

Tuberoinfundibular pathway

from?

to?

Answer 19

from - arcuate and periventricular nuclei of hypothalamus

to - infundibular region of hypothalamus

Question 20

How do dopamine antagonists cause side effects such as amenorrhoea, galactorrhoea, decreased fertility and reduced libido?

Answer 20

dopamine normally INHIBITS prolactin release from the pituitary

DA antagonist –> lowers dopamine –> loss of dopamine’s inhibitory function –> increased prolactin levels

NB: can also lead osteopenia or osteoporosis if DA antagonist given long term

Question 21

Outline some of the difficulties when treating people with schizophrenia

Answer 21

• lack insight
• medications therefore often not taken
• medications can be given in different ways: PO, short acting IM, depot

Question 22

What are some good prognostic factors for SCZ?

Answer 22

• absence of family history
• good premorbid function
• acute onset
• mood disturbance
• prompt treatment
• maintenance of initiative and motivation

Question 23

Symptoms:
patient doesnt talk any spends the day sitting in various positions for several hours at a time

What is this patient presenting with?
What is the neurotransmitter involved?

Answer 23

presenting with: catatonia / catatonic schizophrenia

neurotransmitter implicated = GABA
less GABA binding so loss of inhibitory effect

Question 24

What are some causes of death that has an increased incidence in SCZ?

Answer 24

suicide
cardiovascular disease
respiratory disease
cancer 
violent incidents