Week Eleven - Psychotic Disorders

Question 1

What do people with psychotic disorders struggle to do? (6)

Answer 1

think clearly
communicate properly
make good judgements
behave appropriately
respond emotionally
understand reality

Question 2

Schizophrenia is characterised by?

Answer 2

Major disturbances in thought, emotion and behaviour

• disordered thinking
• lack of emotional expression
• disturbances in movement/behaviour (untidy appearances)

Question 3

DSM5 diagnostic criteria for schizophrenia?

Answer 3

Two or more symptoms and one symptom should be either 1, 2 or 3 for at least 6 months:

• delusions
• hallucinations
• disorganised speech
• disorganised motor behaviour
• negative symptoms

Question 4

Positive symptoms of schizophrenia? (2)

Answer 4

Delusions: Firmly held beliefs that are contrary to reality (persecuratory most common)

Hallucinations: Sensory experiences in the absence of sensory stimulation (auditory most common)

Question 5

Negative symptoms of schizophrenia?

Answer 5

Experience domain
Expression domain
- avolition: lack of interest
- asociality: inability to form close relations
- anhedonia: inability to experience pleasure
blunted: no affect in face/voice
alogia: reduction in speech/intelligence

Question 6

Other symptoms of schizophrenia?

Answer 6

Disorganised symptoms

• speech
• behaviour

Movement symptoms

• catatonia
• immobility

Question 7

What are positive symptoms of schizophrenia caused by?

Answer 7

Excess of dopamine in the mesolimbic pathway

- decreasing dopamine in this pathway via an agonist should be effective

Question 8

What are negative/cognitive symptoms of schizophrenia caused by?

Answer 8

Caused by a shortage of dopamine in the mesocortical pathway

- increasing dopamine in this pathway should be effective

Question 9

Problems with treating schizophrenia with D2 agonists in the mesolimbic pathway?

Answer 9

Reduces signalling in the mesocortical pathways meaning negative/cognitive symptoms may become worse (at the least they won’t be addressed)

Question 10

Explain the role of an atypical D2 partial agonist?

Answer 10

Works to reduce dopamine in the mesolimbic, treating pos symptoms - will also act to enhance dopamine signalling, meaning the neg/cog symptoms could be improved as well

• Aripiprazole

Question 11

The glutamate hypothesis

Answer 11

The predominant ‘go’ NT in the brain is glutamate.

Evidence to suggest implications of glutamate NMDA receptors in Schizophrenia

• post mortem studies
• NMDA receptor agonists can cause psychotic symptoms

Question 12

Prominent brain area change in schizophrenic patients?

Answer 12

Ventricular enlargement

Results in:

• poor cognition
• poor response to treatment

Question 13

The pathophysiology of treatment- resistant schizophrenia? (TRS)

Answer 13

Differences between patients with TRS and other schizophrenia (wide spread grey matter)

TRS patients also show reduced connectivity in certain key brain regions

TRS have reduced density of dopaminergic synapses

Question 14

Neurodevelopment of schizophrenia?

Answer 14

Reduced elaboration of inhibitory pathways and excessive pruning of excitatory pathways leading to altered excitatory-inhibitory balance in the prefrontal cortex

Question 15

Patients with schizophrenia show what?

Answer 15

Abnormal synaptic communication between neurons in the brain. These occur in several NT systems where disruption in one causes compensatory mechanisms by others

Question 16

GABA and schizophrenia?

Answer 16

Reduced synthesis and reuptake of GABA has been demonstrated in the prefrontal cortex of patients with schizophrenia

Question 17

Acetycholine and schizophrenia?

Answer 17

Decreased levels of cholinergic receptors are observed in the HC, thalamus and striatum in patients with schizophrenia

Question 18

Serotonin and schizophrenia

Answer 18

Prefrontal 5-HT2A receptors have been linked to the pathogenesis of schizophrenia
- activation of these induces psychosis in humans

Question 19

Inflammation and schizophrenia?

Answer 19

Neuroinflammation is linked to the risk of psychosis and expression of sub-clinical symptoms

Question 20

Microbiome and schizophrenia?

Answer 20

The gut microbiota is being linked to pathology of schizophrenia

• S patients were dominated by greater number of microbiome species
• had greater abundance of lactic acid bacteria

Question 21

Environmental factors that are linked to development of schizophrenia?

Answer 21

Prenatal exposure to viral infections
Poor prenatal nutrition
Adverse obstetric events
Cannabis smoking during adolescence (increases up to 3x)

Question 22

Genetic factors and schizophrenia?

Answer 22

Greater risk of development if relatives are diagnosed.

There are susceptibility genes

• D2 receptor genes
• calcium channel proteins
• immunity genes

Question 23

Twin study and schizophrenia?

Answer 23

Early onset schizophrenia may have stronger genetic component of risk that other subtypes of schizophrenia

Question 24

What is schizoaffective disorder? (what are the 2 types)

Answer 24

Symptoms of both schizophrenia and mood disorder (eg bipolar) - hard to diagnose and often misdiagnosed (no tests)

Bipolar type: episodes of mania and major depression
Depressive type: only depressive episodes

Question 25

Symptoms of schizoaffective disorder?

Answer 25

``` delusions depression hallucinations no personal care mania speech problems trouble at school/work ```

Question 26

Causes of schizoaffective disorder? (4)

Answer 26

Genetics: May inherit a tendency to get features linked to schizoaffective disorder from parents. Brain chemistry/structure: Problems with brain circuits that mediate mood and thinking. Environment: Viral infections or highly stressful situations could play a part in getting schizoaffective disorder if you’re at risk for it. Drug use: Taking mind-altering drugs.

Question 27

Treatments of schizoaffective disorder?

Answer 27

Medication (antipsychotics or SSRI's - for mood issues) Psychotherapy Skills training ECT

Question 28

What is schizophreniform disorder?

Answer 28

type of psychotic illness with symptoms similar to those of schizophrenia, but lasting for less than 6 months. - same symptoms as others but lasts less than 6 months type of "psychosis" in which a person cannot tell what is real from what is imagined. It also affects how people think, act, express emotions, and relate to others.

Question 29

Causes of schizophreniform disorder?

Answer 29

Genetic, brain structures (same as schizoaffective) Environment: poor relationships/stressful events

Question 30

Treatment for schizophreniform disorder?

Answer 30

Medication: antipsychotics Psychotherapy If symptoms don't improve - most likely to have schizophrenia

Question 31

What is brief psychotic disorder?

Answer 31

sudden, short period of psychotic behaviour, often in response to a very stressful event, such as a death in the family. Recovery is often quick – usually less than a month. 1. Brief psychotic disorder with obvious stressor 2. Brief psychotic disorder without obvious stressor 3. Brief psychotic disorder with postpartum onset: women only

Question 32

Symptoms of brief psychotic disorder?

Answer 32

Same as other forms of schizophrenia

Question 33

Causes of brief psychotic disorder?

Answer 33

Genetic Poor coping skills Is a rare disease - people with antisocial personality are more likely to experience

Question 34

Treatment for brief psychotic disorder?

Answer 34

Medication: antipsychotics | Psychotherapy

Question 35

What is delusional disorder?

Answer 35

having a delusion (a false, fixed belief) involving a real-life situation that could be true but isn't, such as being followed, being plotted against, or having a disease. - lasts for at least 1 month - cant be convinced its not true

Question 36

When do we diagnose delusional disorder?

Answer 36

When it is the only mental health issue a person has.

Question 37

Symptoms of delusional disorder?

Answer 37

Non-bizarre delusions are the key feature | - no other similar features like that seen in the other forms of schizophrenia

Question 38

What is paraphrenia?

Answer 38

It starts late in life, when people are elderly. Paraphrenia is characterised by an organised system of paranoid delusions with or without hallucinations (the positive symptoms of schizophrenia) and without deterioration of intellect or personality (its negative symptom).

Question 39

What is shared psychotic disorder?

Answer 39

his disorder occurs when one person in a relationship has a delusion and the other person in the relationship adopts it, too.

Question 40

What is substance-induced psychotic disorder?

Answer 40

Caused by the use of or withdrawal from drugs, such as hallucinogens and crack cocaine, that cause hallucinations, delusions, or confused speech. - usually goes when stop taking drug

Question 41

Medical conditions that give rise to psychotic behaviour?

Answer 41

Post-ictal psychosis (PIP) happens in some people with epilepsy who've had a number of seizures in a row. Myxedematous psychosis may happen when your thyroid gland doesn't work well, known as hypothyroidism (may have hallucinations, delusions) Female Hormone Shifts may induce psychotic symptom (menstruation induced psychosis).