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37 Cards in this Set

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Hallmark features of a Thought Disorder
Disorganized thoughts
hallucinations or delusions
loss of the self, physical and mental boundaries,
gross impairment of reality testing
What are some potential causes of thought disorders?
schizophrenogenic mother, DE pathways, glutamate pathways, pre/perinatal injury, neural migration abnormalities
Diagnostic Criteria for Schizophrenia
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
Exclusion criteria for schizophrenia
No mood sx that predominate, no med causes, not substance induced
What are the Positive Sx of Schizophrenia?
Hallucinations, delusions, disorganized behavior
Hallucinations are the last thing to respond to treatment (whisper)
Command Insertion Voices
thoughts being put into your head, being told to do something. Very dangerous!
More voices = worse prognosis
What is the risk of suicide for Schizophrenics?
50% attempt suicide. 10% succeed.
What are the Negative sx of Schizophrenia?
isolation, withdrawl, poor hygiene, flat affect, lack of initiative/interest/energy
What are some common hx for schizophrenics?
quiet, passive, withdrawn, few friends, introvert, loner, daydreamer
positive family hx of mental illness
What are the components of the MENTAL STATUS EXAM?
Orientation, Motor Activity, Affect, Mood, Thought Process, Thought Content, Perception, Insight, Judgement, Memory and Abstraction
Paranoid Schizophrenia
preoccupation with 1+ delusion OR frequent auditory hallucinations
NO: disorganized speech, disorg/catatonic behavior, flat/inappropriate affect
BEST PROGNOSIS! Later onset
Catatonic Schizophrenia
Motoric immobility (catalepsy/stupor), Excessive motor activity (purposeless), extreme negativism/mutism, peculiarities of voluntary mvmt, echolalia/-praxia
Disorganized Type Schizophrenia
ALL prominent: disorganized speech and behavior, flat/inappropriate behavior
Usually no delusions/hallucinations
Undifferentiated Type Schizophrenia
Sx are met, but criteria not met for Paranoid, Disorganized or Catatonic types
Residual Type Schizophrenia
Absent prominent delusions, hallucinations, disorganized speech and behavior
Continuing disturbance with negative sx OR 2 of criteria in attenuated form
What medical conditions cause thought disorders?
Parkinson's, Wilson's, Huntington's, Hepatic Encephalopathy, Hypo/Hyperthyrodism, B12 Deficiency, many others...
Substances that cause psychotic disorders during withdrawl
Alcohol, Sedatives, Hypnotics, Anxiolytics
Schizophreniform Disorder
Like schizophrenia, but total duration is greater than 1mo but less than 6mo, impaired function not required
What is the prognosis for schizophreniform disorder?
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
Brief Psychotic Disorder
Sudden onset delusions, hallucinations, disorg speech, disorg/catatonic behavior
Lasts 1+days, less than 1 month
avg onset 20s-30s, preceeded by stressor
Delusional Disorder
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)
Schizoaffective Disorder
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
Shared Psychotic Disorder
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?)
Culture Bound Syndromes
AMOK, Ataque de Nervios, Koro, Mal de Ojo, Piblokto, Windigo
Mood Disorders with Psychotic Features
psychotic features develop as mood disorder worsens (can be mood congruent or incongruent)
Which personality disorders are prone to develop psychotic sx?
Borderline, Narcissistic, Paranoid, Schizotypal

(personality disorder = ongoing, chronic disturbance, poor adaptability)
Treatment of Psychotic Disorders
Hospitalize (evaluate, safety, antipsychotic meds, can't take care of self), Education, Psychotherapy
Goal: improve reality testing, maximize compliance, id stressors that exacerbate illness
Stress-Diathesis Model of Thought Disorders
neurophysical and psychosocial factors are important -> genetic vulnerability/predisposition + stressors
What is the mesolimbic pathway's role in Thought disorders?
DE pathway from ventral tegmentum to limbic areas
Imp in auditory hallucinations, delusions
overactivity = POSITIVE SX of psychosis
What is the mesocortical pathway's role in thought disorders?
DE from ventral tegmental area to cx (dorsolateral prefrontal cx)
deficiency here = NEGATIVE SX and cog changes
What is the nigrostriatal pathway's role in thought disorders?
DE pathway altered by antipsychotic drugs -> movement side effects
What is the tuberoinfundibular pathway's role in thought disorders?
De pathway, affected by antipsychotic drugs -> prolactin related side effects (especially young women)
Evidence for and against DE pathways
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
What is the glutamate hypothesis for thought disorders?
Glutamate excites cells to DEATH in areas such as dorsolateral prefrontal cx (underactive in psychotic pts)
evidence: PCP excites glu and causes psychosis
What is the neurodevelopmental hypothesis of thought disorders?
Schizophrenia arises from ABNORMAL BRAIN DEVELOPMENT (even intrauterine) -> clinical manifestations in late adolescence/early adult due to post-natal brain maturation
What is evidence supporting neurodevelopmental hypothesis of thought disorders?
Increased risk of schizo with OB complications, viral in-utero exposure, in utero famine
Association between schizo and subtle developmental abnormalities, "soft" neuro signs
What are some pathophysiologies associated with the neurodevelopmental hypothesis of thought disorders?
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