Week 11 - Psychoses and Epilepsy Flashcards
(36 cards)
What is psychosis
Not a disorder but a symptoms in disorders disorders like schizophrenia, bipolar disorder, substance use, dementia.
- Features: Delusions, hallucinations, disorganised speech.
- Loss of Reality: Mind can’t distinguish fact from fiction.
What is schizophrenia
severe mental disorder
- Meaning: “Split mind” – not the same as multiple personality disorder.
- Features: Disturbed thoughts, moods, behaviors.
- Impact: Disrupts functioning in society; can be chronic or relapsing.
- Causes changes in mood, thoughts and behaviours may seem like sufferers have lost touch with reality barrier to productivity and participation in society – may be left unable to cope
how do you diagnose schizophrenia
- Requires 6+ months of symptoms.
- Must include at least one of: delusions, hallucinations, disorganised speech.
- Interferes with major life activities like self-care or work
What is the prodromal (early) phase of psychosis
- Subtle early signs: Social withdrawal, flat emotions, odd beliefs.
- Often goes unnoticed.
- Early intervention may reduce severity.
Symptoms include - Mood swings or lack of emotion
- Social withdrawal
- Lack of hygiene and personal care
- Difficulty thinking or concentrating
What are acute phase positive symptoms of psychoses
positive symptoms” refer to the presence of behaviors or experiences that are added to a person’s normal functioning
- Delusions (e.g. paranoia)
- Hallucinations (mainly auditory)
- Disorganised thinking/speech
- Catatonia, abnormal movements
what are acute phase negative symptoms of psychoses
“Negative symptoms,” on the other hand, reflect a decrease or loss of normal functions
- Social withdrawal
- Flat affect
- Anhedonia (lack of pleasure)
- Apathy and low motivation
what is a characteristic feature of schizophrenia
selective attention problems
other symptoms
* Cognitive deficits (attention, memory).
* Emotional symptoms: anxiety, guilt, depression.
* High risk of suicide (up to 50%).
Positive symptoms often dominate in young but negative symptoms are more dominant in older people
what are causes of schizophrenia
- Multifactorial: genetics, environment, brain chemistry. – stressful life events. Drug and alcohol use, genetic inheritance, differences in brain chemistry
- 10% risk if a first-degree relative has it.
- Related to genes for neuronal development and glutamate transmission.
what are the 2 neural disfunctions which may cause schizophrenia
- dopamine dysfunction
- glutamate/NMDAR dysfunction
Explain how dopamine dysfunction can cause schizophrenia
Excessive dopamine synthesis and release (excessive D2 receptor stimulation))→ linked to positive symptoms.
* Antipsychotics aim to reduce D2 signaling.
* Balance between D1 and D2 receptor pathway shifted to excessive D2 signalling
Explain how gultamate/NMDAR dysfunction can cause schizophrenia
- Involves the hypofunction of NMDAR receptors (type of glutamate receptor)
- This occurs mainly on interneurons which normally inhibits excessive brain activity
- Hernce there’s increased glutamate activity which disrupts brain circuit
- leads to negative symptoms and cognitive dysfunction
- NMDAR dysfunction → leads to negative and cognitive symptoms.
- Hypofunction of NMDARs inhibitory in interneurons leading to excessive glutamate release especially in prefrontal cortex and hippocampus –> leading to excessing activation of neurons
What is used to treat schizophrenia
- Antipsychotics reduce positive symptoms, not cognitive ones.
- Often take 2–3 weeks to show benefit.
- May normalise excessive D2 saignaling to restore balance between D1 and D2 receptor pathways
What are first generation (typical) antipsychotics - effects
- Examples: Haloperidol, Chlorpromazine.
- D2 receptor agonist
- effective against positive symptoms (hallucinations, delusions)
- D2 antagonists in both striatal and cortical areas→ effective but with strong side effects.
- Also noradrenergic, cholinergic and histaminergic blocking action
What are the side effects of first generation (typical) antipsychotics
- high risk of extrapyramidal symptoms (EPS) (movement disorder since dopamine is blocked) -
- resulting in secondary parkinsonism - dystonia, bradykinesia, rigidity, tremor and tardive dyskinesia
Risks: Extrapyramidal symptoms (e.g. Parkinsonism, tardive dyskinesia), sedation, dry mouth.
What are second generation (atypical) antipsychotics
- Examples: Clozapine, Risperidone.
- D2 receptor antagonist
- 5-HT (serotonin) receptor antagonist
- affective against positive and some improvement in negative symptoms
- Block D2 + 5-HT (serotonin) receptors.
- Also acts on adrenergic, cholinergic (muscarinic) and histamine receptor
- Antagonism of 5HT receptors stimulates dopamine in a range of pathways, thus reducing some side effects of a typical dopamine blocker
- Fewer motor side effects but higher risk of metabolic issues (e.g. type 2 diabetes, weight gain).
- Lower risk of extrapyramidal effects
What are the side effects of second generation (atypical) antipsychotics
- lower risk of extrapyramidal symptoms (movement disorder)
- higher risk of metabolic symptoms (weight gain, diabetes)
- sedation
what is KarXT
new medication
- target muscarinic signalling - activates muscarinic receptor dampens dopamine release and modulates other brain circuits involved in cognition
- alleviates core symptoms of schizophrenia
- expensive and requires twice daily dosing
what are the side effects of KarXT
has fewer side effects
- side effects mostly involve gut disturbance
what is a seizure
One-time electrical brain disturbance causing muscle twitches and spasms changes in sensation, mood behaviour or thought or altered consciousness
what is epilepsy
Chronic disorder with 2+ unprovoked seizures with no immediately connectable cause (e.g. low blood sugar)
What are seizure triggers (non epileptic)
- Fever (especially in children).
- Drug or alcohol use/withdrawal.
- Electrolyte disturbances.
- Brain infections, trauma.
- Caffeine or medications like theophylline.
what are the consequences of epilepsy
- Most seizures not harmful to the brain – no permanent brain damage or cognitive decline
- Mental abnormalities usually caused by brain disorder that causes epilepsy except for status epilepticus
- Major impact: social stigma, driving restrictions, job limitations.
- Mental health comorbidities: anxiety, depression.
What is the information required to classify a seizure
- Where in the brain the seizure starts: Focal vs Generalised.
- Awareness during the seizure: Aware vs Impaired.
- Movement during seizure : Motor vs Non-motor.
what are the different types of seizures
- focal (partial) seizure
- generalised onset seizures
- tonic-clonic seizures
