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71 Cards in this Set
- Front
- Back
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What is a general description of psychotic disorders?
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Loss of contact with reality (inability to evaluate properly what is real and what is not)
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What are words that a pt makes up; often a condensation of several words? what type of disorder is this?
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Neologisms
Disorders of thought |
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what are the two types of thought disorders?
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disorder of thought process (formulation) ... "disorganized speech"
disorder of thought content |
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What are perceptions without external stimuli? what type of thought disorder is this?
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Hallucinations
disorder of thought content |
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what are fixed, false beliefs, not amendable by logic or experience?
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Delusions
disorder of thought content |
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What do delusions of thought content include?
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Hallucinations and Delusions
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What are the two categories of symptoms in schizophrenia?
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Positive (Type 1) - production of abnormal behaviors
Negative (Type 2) - deficiency of normal behavior |
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What are some appearance types of schizophrenia?
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Motor disturbances
-catatonia (stupor or excitement) Behavioral problems -hygeine or social function |
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What type of mood and affect are seen in schizophrenia?
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Affective Flattening
Anhedonia Inappropriate Affect |
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What are the type of irregular thought in schizophrenia?
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Associative disorders
- Circumstantial thinking - Tangential thinking others: perserveration distractability clanging neologisms |
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can your culture influence hallucinations?
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yes
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What are the most common types of delusions?
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Delusions are most commonly persecutory, but may be somatic, grandiose, religious or nihilistic. They are influenced by culture, and none is specific to any one disorder (such as schizophrenia).
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What can often distinguish psychotic disorders (like Schizophrenia) from "normal" hallucinations and delusions.
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lack of insight (breakdown in this ability to rationally critique their own thoughts)
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What are common Positive Symptoms of schizophrenia?
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Hallucinations and delusions
marked positive thought formation bizzare or disorganized behavior |
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What are common Negative Symptoms of schizophrenia?
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alogia (poverty of speech or speech content)
affective flattening anhedonia avolition/apathy |
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What is the prevalence, gender distribution and socioeconomic distribution of schizophrenia?
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1% of pop.
equal gender: males younger onset, both usually in late adolescence/early adult lower socioeconomic (also "downward drift") same prevalence worldwide |
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** What are the requirements for Schizophrenia diagnosis?
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1. "A" criteria: psychotic episode for 1 month, unless treated (2 or more)
2. 6 month overall duration: disturbance or residual symptoms 3. Global Criteria: impaired normal function |
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* What are the "A" criteria of schizophrenia?
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delusions, hallucinations, disorganized speech, disorganized behavior/catatonia, and negative symptoms
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* What are the five sub-types of schizophrenia?
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Catatonic
Disorganized (disorganized speech and behavior, and flat or inappropriate affect) Paranoid Undifferentiated Residual |
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what are secondary psychotic disorders?
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those caused by drugs or medical disorders
probably most common, harder to and less studied |
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* What is schizophreniform? Brief Psychotic?
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like schizophrenia, but between 1 to 6 months
brief = less than 1 month Global Criteria not necessary |
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*What is schizoaffective disorder?
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symptoms of both schizophrenia and mood disorder
"A" criteria must be at least 2 weeks independent of mood |
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* what is delusional disorder?
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disorder in which patients present with persistent delusions. Delusions are nonbizarre, thus differentiating this from schizophrenia.
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What is Shared Psychotic Disorder? Tx?
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The inducer or primary case is a person already has some delusional disorder. Also, a second person, in close relationship with the inducer, comes to share the delusion.
separation |
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What is the most common cause of psychotic symptoms that is not a psychotic disorder? what are some others?
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Delirium: Delirium is an acute confusional state, with multiple possible etiologies that can cause delusions and hallucinations.
Dementia Neurologic General medical Other Psychiatric Disorder -major depression with psychotic symptoms -panic disorder -OCD |
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* What are the common comorbidities of schizophrenia?
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depression (mood disorders)
substance abuse |
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* What are the three stages of schizophrenia?
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Prodromal
Acute/active Residual |
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What are the four possible prognoses of schizophrenia?
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1. complete resolution
2. repeated recurrence with full recovery each time 3. repeated recurrence with partial recovery each time 4. progressive deterioration |
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How do most schizophrenic do long temr?
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1/4 good outcome
1/4 bad outcome 1/2 intermediate |
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is acute onset a positive prognostic factor for schizophrenia?
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yes
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what are repeated but non-goal-oriented movements such as rocking?
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stereotypy
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What two dopamine pathways are implicated in schizophrenia? what is the common pharm treatment?
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mesolimbic system: positive symptoms
mesocortical system: negative symptoms dopamine blockers |
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what are some of the neurologic soft signs of schizophrenia?
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abnormal: stereognosis, graphesthesia (writing on hand), proprioception, smooth eye movements
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T or F: Schizophrenia likely results from a complex interaction between multiple genes and numerous environmental risk factors
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true
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What was found regarding the Val/Val COMT genotype and pot use?
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worse at clearing dopamine --> increased risk of schizophrenia
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What two contributing factors in neurodevelopment play a role in risk of psychotic disorder?
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genes + environment
--> ongoing changes in brain structure and function schizophrenia seen more as a neurodevelopmental disorder |
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What are the structural brain abnormalities seen in schizo?
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Enlarged lateral and third ventricles
Reduced cortical gray matter volume Cortex Cortical sub regions -Prefrontal Cortex -Temporal areas |
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When there is gray matter loss, which area is associated with pos. or neg. symptoms? [prefrontal or temporal]
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frontal associated with neg. symptoms
temporal associated with pos. symptoms |
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what is hypofrontatlity? how is this observed in schizo?
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lack of prefrontal cortex activation
seen in schizo pts compared to controls during cognitive tasks |
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* how is the thalamus implicated in schizo?
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patients with schizophrenia have problems “filtering” information
can lack the ability to sort out what information is or is not relevant reduced thalamic size in most studies |
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* What are the brain structures associated with schizo?
what are the neurotransmission? |
whole brain
prefrontal cortex medial temporal lobe Dopamine Glutamate GABA |
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* what is the mechanism of all antipsychotics?
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block D2 receptors
(dopamine agonists can cause psychosis) |
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* What are the four dopamine pathways?
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1. Nigrostriatal (movement)
2. Mesolimbic (emotional --> pos. symptoms) 3. Mesocortical (cognition/behavior --> neg. symptoms) 4. Tuberinfundibular |
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* What does the mesolimbic DA pathway cause in schizo?
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Emotional behavior --> Positive Symptoms
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* What does the mesocortical DA pathway cause in schizo?
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Cognition/Behavior --> Negative Symptoms and Cognitive Symptoms
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What characteristic do scz pts that show the greatest response to neuroleptic meds have?
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higher D2 occupancy at baseline
(not all scz pts respond equally well to meds) |
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what is the nucleus accumbens? where is it located?
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Nucleus accumbens - the key structure of the brain responsible for reward, motivation and addiction
It is located where the head of the caudate and the anterior portion of the putamen meet just lateral to the septum pellucidum |
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what is the role of DA in hypofrontality? what about in the basal ganglia?
(all for scz) |
lower DA in the prefrontal cortex (executive function: planning, initiating, apathy, behavior)
higher DA in the basal ganglia |
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What antipsychotic blocks the DA receptors?
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Thorazine
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* What is the role of glutamate and GABA in the release of DA? what types of neurons release DA?
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glutamate increases
GABA decreases explains increase in mesolimbic and decrease in mesocortical monoaminergic neurons ** takeaway: glutamate/GABA dysfunction involved in the DA irregularities in scz |
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* What is the difference between Typical antipsychotics and Atypicals?
major side effects of both? |
1st gen - block DA receptors
2nd gen - block DA and 5HT 1 - movement problems 2 - metabolic (wt. gain --> DM*) |
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* What is the most know Typical antipsychotic? Atypical?
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Haloperidol & Thorazine (first)
Clozapine |
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In addition to D2 receptors, what else do Typicals block?
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muscarinic (M1), histaminc (H1) and alpha-1 receptors
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** What are the major side effects in Typicals for each of the DA pathways?
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nigrostriatal --> drug induced Parkinsons (extrapyramidal symptoms)
mesolimbic --> decreased positive symptoms (hallucinations and delusions) mesocortical --> increased negative symptoms tuberinfundibular --> hyperprolacinemia (Dopamine inhibits prolactin release; prolactin leads to too much inhibition) * basically all blunt positive effects of dopamine |
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* What is the biggest side effect to Typicals?
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Tardive Dyskinesia (late onset... not reversible)
early onset EPS are reversible with removing the drug |
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What is dystonia?
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sudden contraction
uncontrolled spasms side effect of typical antipsychotics |
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what is akathesia
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restlessness in lower extremities
side effect of typical antipsychotics |
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what is a high potency typical that has a high risk of tardive dyskensia?
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haldol
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what are some drawbacks of atypicals?
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sedation
hypotension drueling blood monitoring |
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What two types of receptors to Atypicals block?
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D2 and 5HT
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* What is the effect of serotonin agonism?
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decreased DA release
* serotonin modulates DA release --> more serotonin decreases amount of DA released |
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**KEY** what is the benefit of 5HT/DA blockage in the Atypicals for each DA pathway?
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mesolimbic - D2 blockage sufficient for antipsychotic
in mesocortical, nigrostriatal and tuberoinfundibular --> LESS D2 blockage so less EPS, negative symptoms and hyper prolactin *in general terms: 5HT is a D2 blocker, so blocking a blocker allows for more D2 release in places where it is needed (e.g. PFC) |
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SCZ do best when psychosocial therapy is also with pharm. what are the important areas?
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Family education/therapy
Cognitive Behavioral Therapy Supported employment* Assertive community treatment Social skills training |
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How is psychiatric diagnosis different in kids?
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Bio-psycho-social formation
developmental context reliability of historian |
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What is severe and pervasive impairment in the development of reciprocal social interaction in children?
what are the "types"? |
PDD: Pervasive Developmental Disorders
-Autism -Asperger's -PDD NOS |
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What is the "pyramid" of disruptive behavior disorders in children?
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ADHD --> ODD --> CD
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What is disorder has impulsiveness, hyperactivity, and inattention?
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ADHD
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What is a pattern of negativistic, hostile and defiant behavior lasting at least 6 months with 4 additional (argumentative/defiant) criteria met?
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ODD: oppositional defiant disorder
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What is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated in agression, destruction, deceitfulness?
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CD: conduct disorder
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What are the two forms of Reactive Attachment Disorder?
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Inhibited type
Disinhibited type |
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How many symptoms of hyperactivity or inattention must a child have for ADHD diagnosis?
what are they? |
6
see list: common sense |
