Behavioral Science (Block 6): Thought Disorders

Front 1

prototypic thought disorder

Back 1

schizophrenia

Front 2

hallmark features of thought disorder aka. "psychotic disorder" (4)

Back 2

-disorganized thoughts
-hallucinations/delusions
-Loss of the self, physical and mental boundaries, i.e. not sure where I stop and you begin
-Gross impairment of reality testing

Front 3

men develop schizophrenia MORE/LESS/AS OFTEN AS than women.

Back 3

as often as

Front 4

psychotic symptoms (5)

Back 4

need to have at least 2 for at least 1 month:
- hallucinations
- bizarre delusions
- disorganized speech
- grossly disorganized/catatonic behavior
- negative symptoms (flat affect, alogia, avolition)

note: alogia = poverty of speech
avolition = lack of drive to pursue meaning, direction, and purpose

Front 5

name the 3 exclusion criteria for thought disorders, like schizophrenia

Back 5

- no mood symptoms that predominated
- no medical causes
- not induced by a substance!

Front 6

positive vs. negative symptoms of schizophrenia

Back 6

positive = symptoms that are acquired. pt didn't have it before...ie. hallucinations, delusions (including somatic delusions where pt feels vague pain from "them"), disorganized behavior ("the demons are attacking me...they've been doing it for sometime now.")

negative=Reflect a diminution or loss of normal functions in individuals with psychosis (aka. thought disorder). Symptoms may include flattening of affect, isolation, poor hygiene, lack of interest/energy, and withdrawal.

Front 7

__________ is one of the most important things to find out about a schizophrenic patient b/c _________. what is the importance of insight?

Back 7

thought insertion; schizo pts with command halllucinations (voice telling them to kill/hurt others, themselves) are likely to do/try it.

half of schizo pts will attempt suicide, 10% will succeed!

insight is knowing that that the voices probably aren't real and that she doesn't need to listen to it.

Front 8

what is the incidence of schizophrenia? what is the ratio of men to women affected? what's the prevalence of schizo around the world?

Back 8

one in one hundred people will develop the disorder in their late teens/early twenties (think about Mr. Ayers who went to Juliard and developed schizophrenia).

men = women in developing this disorder

prevalence is same all over the world.

Front 9

what are features observed in pre-morbid history of schizophrenia?

Back 9

Quiet
Passive
Withdrawn child
Few friends
Introvert
Loner
Daydreamer

Front 10

what is the time difference (duration of illness) in brief psychotic disorder, schizophreniform disorder, and schizophrenia?

Back 10

brief psychotic disorder: 1 day<x<1 month
schizophreniform: 1 month<x<6 months
schizophrenia: >6 months

Front 11

1) To diagnose a patient with schizophrenia, he/she must have at least __ month of ___ of the following: (name em!)

2)But only ONE of the Sx's is necessary if (3):

3) Does pt have to show decreased level of fxning in areas such as work, social interaction and self care?

Back 11

1) at least 1 month of 2 of the following: - positive symptoms: hallucinations, bizarre delusions, disorganized speech, disorganized/catatonic behavior (think Mr. Ayers!)
- negative symptoms: flat affect, alogia, avolition

2)But only ONE of these Sx's if there are: bizarre delusions, hallucinations of a voice keeping running commentary on person's thoughts, or if there's 2 or more voices conversing with each other.

3) yes (must have sypmtoms, prodomal or residual, for at least 6 months)

Front 12

what other Sx's must a pt have to have for at least 6 months?

Back 12

negative symptoms:
- Isolation
-Withdrawal
-Poor hygiene
-Flat Affect
-Lack of Initiative
-Loss of Interest or Energy

Front 13

what are the 3 exclusion criteria for dx'ing schizophrenia?

Back 13

- mood symptoms dont' predominate
- no medical reasons for Sx's
- no substance related causes for symptoms

Front 14

what are the subtypes of schizophrenia and what are the major features of each (5)?

Back 14

1. Paranoid = preoccupation with one or more delusions or frequent auditory hallucinations; but NO PROMINENT disorganized speech, catatonic behavior, flat affect (this has best prognosis, able to resp to meds)
2. Catatonic = immobility, excessive but purposeless motor activity, pt can't eat, can't take care of themselves, echolalia and echopraxia
3. Disorganized type=PROMINENT disorganized speech/behavior, flat behavior w/o hallucinations/delusions
4.Undifferentiated type = associated with significant cognitive decline; not much else known
5. Residual type= absence of positive symptoms, but residual negative symptoms (ie. poor hygiene)

"Playing Cello Does U Right" (again, think Mr. Ayers)

Front 15

what are some medical conditions that could cause thought disorder?

Back 15

parkinsons dz
wilson's dz (younger pts)
huntington's dz
hepatic encephalopathy
hypo/hyperthyroidism
B12 deficiency

Front 16

in what 2 ways does schizophreniform disorder differ from schizophrenia?

Back 16

- duration of illness (schizophreniform is shorter, 1-6 months)
- impaired social/occupational functioning during illness is NOT REQUIRED for schizophreniform

Front 17

describe brief psychotic disorder

Back 17

-sudden onset of positive symptoms (delusions, hallucinations, disorganized speech/behavior) often preceeded by a stressor
- lasts 1 day to 1 month
- avg onset 20-30 y/o

Front 18

how are delusions in delusional disorder different from other thought disorders?

Back 18

delusional disorder is characterized by one or more NON-BIZARRE delusions persisting for at least 1 month (could occur in real life like being followed, loved at a distance, deceived by a spouse/lover)
- functioning isn't markedly impaired

Front 19

what are the 2 things you have to know about schizoaffective disorder?

Back 19

1. its a disorder that meets criteria for mood and thought disorders
2. there's 2 weeks where person doens't have any mood symptoms, just psychotic Sx's like delusions or hallucinations.

Front 20

T or F. Psychotic disorders develop on their own, never as a result of other disorders. Explain.

Back 20

F. some personality disorders (ie. borderline, narcissistic, etc) can develop some psychotic symptoms

Front 21

what are the 4 dopamine pathways in the brain? explain how hypo or hyper activity of DA in the first 2 affect symptoms of schizophrenia.

Back 21

1. mesolimbic - DA overactivity leads to positive Sx's like hallucinations/delusions
2. mesocortical- DA hypoactivity leads to negative Sx's
3. nigrostriatal
4. tuberoinfundibular

Front 22

what are evidence for/against DA in thought disorders?

Back 22

For DA: amphetamines (DA agonists) produce psychosis (boosting DA activity in mesolimbic system); all antipsychotics block DA receptors

Against DA: LSD/PCP produce psychosis but act at glutamate receptors

Front 23

what is evidence for glutamate in thought disorders?

Back 23

for: PCP causes abnormal excitation at glut receptos resulting in psychosis; glutamate excitotoxicity leads to death in areas such as dorsolateral prefrontal cortex (which seems to be an underactive part of brain in psychotic patients)

Front 24

significant features of neurodevelopmental hypothesis of thought disorders

Back 24

There’s probably some early insult to the brain that doesn’t manifest itself early on. Somehow as brain develops, it gets worse over time and develops into schizophrenia.
- there's inc number of cells in deep cortical layers, dec in outer layers with cortical atrophy and ventricular enlargement
- Revision of synapses through childhood and adulthood finally reaches a critical point where symptoms are unmasked

Front 25

what do post-mortem abnormalities in schizo pts show about its development?

Back 25

Since there’s no gliosis (scarring of the brain) , there’s probably not a post-natal event. So its just a pre-natal event that doesn’t manifest itself until later in life. Prefrontal part of brain comes online last so until that part matures in early 20s, you start getting manifestations of schizo symptoms