Behavioral Science - Thought Disorders And Antipsychotics

Front 1

Hallmark features of a Thought Disorder

Back 1

Disorganized thoughts
hallucinations or delusions
loss of the self, physical and mental boundaries,
gross impairment of reality testing

Front 2

What are some potential causes of thought disorders?

Back 2

schizophrenogenic mother, DE pathways, glutamate pathways, pre/perinatal injury, neural migration abnormalities

Front 3

Diagnostic Criteria for Schizophrenia

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2+ psychotic sx for 1+ month: hallucination, disorganized speech, grossly disorganized/catatonic behavior, negative sx (flat/inappropriate affect, alogia, avolition) OR if 2+ voices having a convo about you OR bizzare delusions OR voice is running commentary
Other Sx for at least 6mo (isolation, withdrawl, poor hygene, flat affect, lack of initiative/interest/energy), decreased level of functioning

Front 4

Exclusion criteria for schizophrenia

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No mood sx that predominate, no med causes, not substance induced

Front 5

What are the Positive Sx of Schizophrenia?

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Hallucinations, delusions, disorganized behavior
Hallucinations are the last thing to respond to treatment (whisper)

Front 6

Command Insertion Voices

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thoughts being put into your head, being told to do something. Very dangerous!
More voices = worse prognosis

Front 7

What is the risk of suicide for Schizophrenics?

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50% attempt suicide. 10% succeed.

Front 8

What are the Negative sx of Schizophrenia?

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isolation, withdrawl, poor hygiene, flat affect, lack of initiative/interest/energy

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What are some common hx for schizophrenics?

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quiet, passive, withdrawn, few friends, introvert, loner, daydreamer
positive family hx of mental illness

Front 10

What are the components of the MENTAL STATUS EXAM?

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Orientation, Motor Activity, Affect, Mood, Thought Process, Thought Content, Perception, Insight, Judgement, Memory and Abstraction

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Paranoid Schizophrenia

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preoccupation with 1+ delusion OR frequent auditory hallucinations
NO: disorganized speech, disorg/catatonic behavior, flat/inappropriate affect
BEST PROGNOSIS! Later onset

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Catatonic Schizophrenia

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Motoric immobility (catalepsy/stupor), Excessive motor activity (purposeless), extreme negativism/mutism, peculiarities of voluntary mvmt, echolalia/-praxia

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Disorganized Type Schizophrenia

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ALL prominent: disorganized speech and behavior, flat/inappropriate behavior
Usually no delusions/hallucinations

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Undifferentiated Type Schizophrenia

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Sx are met, but criteria not met for Paranoid, Disorganized or Catatonic types

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Residual Type Schizophrenia

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Absent prominent delusions, hallucinations, disorganized speech and behavior
Continuing disturbance with negative sx OR 2 of criteria in attenuated form

Front 16

What medical conditions cause thought disorders?

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Parkinson's, Wilson's, Huntington's, Hepatic Encephalopathy, Hypo/Hyperthyrodism, B12 Deficiency, many others...

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Substances that cause psychotic disorders during withdrawl

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Alcohol, Sedatives, Hypnotics, Anxiolytics

Front 18

Schizophreniform Disorder

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Like schizophrenia, but total duration is greater than 1mo but less than 6mo, impaired function not required

Front 19

What is the prognosis for schizophreniform disorder?

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good if onset sx within 4wks of changed behavior, confused/perplexed at height of episode, good premorbid function, no flat affect
1/3 will recover within 6mo -> the rest become some kind of schizo

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Brief Psychotic Disorder

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Sudden onset delusions, hallucinations, disorg speech, disorg/catatonic behavior
Lasts 1+days, less than 1 month
avg onset 20s-30s, preceeded by stressor

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Delusional Disorder

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1+ non-bizarre (could happen in real life) delusion, lasts 1+ month,
no impaired function, poor response to treatment
Age of onset = middle, late adulthood
(Erotomanic, grandiose, jealous, persecutory, somatic, mixed)

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Schizoaffective Disorder

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major mood sx (dep/manic) + concurrent psychotic sx
must have 2+wks with NO mood sx and ONLY psychotic sx
onset early adulthood, better prognosis: mood > schizoaff > schizo

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Shared Psychotic Disorder

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aka Folie a Deux
Delusion develops in person in context of close relationship with someone who already has delusion -> 2nd person comes to share delusional belief (rare, cults?)

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Culture Bound Syndromes

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AMOK, Ataque de Nervios, Koro, Mal de Ojo, Piblokto, Windigo

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Mood Disorders with Psychotic Features

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psychotic features develop as mood disorder worsens (can be mood congruent or incongruent)

Front 26

Which personality disorders are prone to develop psychotic sx?

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Borderline, Narcissistic, Paranoid, Schizotypal

(personality disorder = ongoing, chronic disturbance, poor adaptability)

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Treatment of Psychotic Disorders

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Hospitalize (evaluate, safety, antipsychotic meds, can't take care of self), Education, Psychotherapy
Goal: improve reality testing, maximize compliance, id stressors that exacerbate illness

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Stress-Diathesis Model of Thought Disorders

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neurophysical and psychosocial factors are important -> genetic vulnerability/predisposition + stressors

Front 29

What is the mesolimbic pathway's role in Thought disorders?

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DE pathway from ventral tegmentum to limbic areas
Imp in auditory hallucinations, delusions
overactivity = POSITIVE SX of psychosis

Front 30

What is the mesocortical pathway's role in thought disorders?

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DE from ventral tegmental area to cx (dorsolateral prefrontal cx)
deficiency here = NEGATIVE SX and cog changes

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What is the nigrostriatal pathway's role in thought disorders?

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DE pathway altered by antipsychotic drugs -> movement side effects

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What is the tuberoinfundibular pathway's role in thought disorders?

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De pathway, affected by antipsychotic drugs -> prolactin related side effects (especially young women)

Front 33

Evidence for and against DE pathways

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FOR: amphetamines (DE agonists) produce psychosis, all antipsychotics block DE receptors
AGAINST: LSD/PCP cause psychosis but on glutamate receptor, 2-10wks for antipsychotic to work, no DE receptor abnormalities, no clear neg sx link to DE

Front 34

What is the glutamate hypothesis for thought disorders?

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Glutamate excites cells to DEATH in areas such as dorsolateral prefrontal cx (underactive in psychotic pts)
evidence: PCP excites glu and causes psychosis

Front 35

What is the neurodevelopmental hypothesis of thought disorders?

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Schizophrenia arises from ABNORMAL BRAIN DEVELOPMENT (even intrauterine) -> clinical manifestations in late adolescence/early adult due to post-natal brain maturation

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What is evidence supporting neurodevelopmental hypothesis of thought disorders?

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Increased risk of schizo with OB complications, viral in-utero exposure, in utero famine
Association between schizo and subtle developmental abnormalities, "soft" neuro signs

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What are some pathophysiologies associated with the neurodevelopmental hypothesis of thought disorders?

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brain grows outwards -> more cells in deep layers than outer layers, cortical atrophy, ventricular enlargement, appearance of sx in adulthood (b/c revision of synapses through childhood, overaggressive pruning), abnormal neural migration in frontal/temporal lobes