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32 Cards in this Set
- Front
- Back
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Psychoses
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Disorder of though: Impaired behavior with the inability to think coherently or comprehend reality. May include hallucinations and delusions. The most telling symptom of psychosis is called lack of insight |
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Psychosis Lack of insight
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People suffering from symptoms of psychosis are not aware that they are behaving in an unusual manner. No matter how outrageous the hallucinations or delusions are, the person does not see them as unrealistic in any way. Not everyone with psychosis has the lack of insight. The level and length of the lack of insight can vary in each individual
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Pathologic states that can exhibit psychosis
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Brain Damage Alzheimer's Disease Bipolar disease Mania Schizophrenia Parkinson's disease patients on high-dose L-DOPA Amphetamine/cocaine psychosis |
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Psychosis treatment
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Antipsychotic drugs are the treatment of choice Anticonvulsant, antidepressant, or other drugs may also be needed in some cases |
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Drug induced psychosis
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Produced by overstimulation of the brain by stimulants or from CNS excitation produced by withdrawals from a strong sedative (ethanol, barbituates). Usually best treated with benzodiazepines. Antipsychotics are also effective
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Schizophrenia History
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Documented in writings dating back to 3000BC -evil possession, exorcisms and drilling holes into skull Shows of Bethlehem Bedlam hospitals -people could pay to see the "lunatics" In 1887 Dr Emile Kraepelin identified schizophrenia as a discrete mental illness believed to be a disease of the brain called "dementia praecox" Dr. Eugen Bleuler coined schizophrenia in 1911 |
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Schizophrenia Epidemiology
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Global prevalence is About 1% effects men and women equally men usually in teens or early twenties women usually in twenties or thirteies Higher incidence in comorbid conditions -HT, diabetes, STDs, substance abuse, smoking 10% incidence of suicide |
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Schizophrenia natural causes of death
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Diabetes, cardiovascular disease, respiratory disease, infectious diseases Cardiovascular disease risk factors: Obesity: 45-55%, 1.5-2 times Smoking: 50-80%, 2-3 times Diabetes: 10-14%, 2 times Hypertension: >18% Dyslipidemia: up to 5 times |
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Schizophrenia case
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25 year old man believes roommates are listening to his thoughts through the television, poor personal hygiene and is preoccupied by people giving him instructions in his head
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Schizophrenia diagnosis
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Schizophrenia is characterized by delusions, hallucinations, disorganized speech and behavior, and other symptoms that cause social or occupational dysfuntion APA: Diagnostic and Statistical Manual of Mental Disorders V -Disorder that lasts for at least 6 months -includes at least one month active-phase symptoms Should contain 2 or more of the following: delusions, hallucinations, disorganized speech, grossly disorganized, negative symptoms |
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Delusions
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Misinterpretation of perceptions or experiences |
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Hallucinations
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Auditory is the most common Voices distinct from the person's own thoughts Hearing, seeing, feeling or smelling something that is not there |
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Disorganized Speech
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Conversations or thinking that slips of the tract Loose associations, unrelated, disorganized |
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Grossly Disorganized
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inability to f'n in society. Restless, angry, agitated disheveled, difficulties in everyday activities, repeating the same activity, public vs private
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Negative symptoms of Schizophrenia
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Account for a substantial degree of morbidity 1) Affective flattening: unresponsive face, diminished emotions 2) Alogia: Poverty of speech, brief empty replies 3) Avolition: Inability to initiate/persist in work or social activities 4) Anhedonia: (without pleasure) inability to experience pleasurable emotions from normally pleasurable life events 5) Social withdrawal |
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Positive symptoms of schizophrenia
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Delusions Hallucinations Disorganized speech Bizarre behavior Aggression |
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Cognitive deficits and mood symptoms of schizophrenia
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Cognitive Deficits: Attention, memory, executive, functioning, decision-making Mood symptoms: Depression, anxiety, hopelessness, demoralization, stigmatization, suicide |
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Etiology
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Remains unknown, many theories -Neurodevelopmental -Neurodegeneration -Genetic Susceptibility: Multiple alleles ~48% in twin pairs if identical sibling has illness |
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Neurodevelopmental hypothesis: Normal brain development |
Newborn to adult> neurons normally decrease by~50% In the average person~35% of dendrites at 2 years of age are pruned by mid-adolescence |
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Neurodevelopmental hypothesis: Possible developmental probles |
Fetal disturbance leads to abnormal neuron migration in developing brain There may be excessive pruning, or excessive loss of neurons from the start which may explain the development of schizophrenia |
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Neurodegenerative hypothesis
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Progressive nature of the disease -Indicated that the underlying cause is not a static & previously completed pathological process Glutamate mediated excitotoxicity -Normal glutamate f'n>excitatory nt -Excitotoxicity: the neurons literally excited to death -Starts as a normal process>too much of a good thing -Overstimulation of the brain |
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Neurodegenerative hypothesis: Influx of Ca
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Excessive glutamate stimulation Cellular Ca channels remain open Influx of Ca: -Activates intracellular enzymes>form free-radicals -Excessive free-radicals have toxic actions on cellular mbs and organelles -Leads to cell death |
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Schizophrenia is a brain disease |
Where are the lesions? Cortical areas of the brain, may exhibit decreased cortical thickening resulting in enlarged ventricles What is the nature of the lesions? Disorganized neural networks, fewer neurons, excess loss of cortical gray matter What is the end result of the lesions? May lead to overstimulation of the brain Difficulty in filtering out extraneous stimuli leading to delusions and hallucinations |
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Overstimulation
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Patients have diminished capacity to filter out unimportant features of their environment Their attention is drawn impulsively and unpredictably to many details that other persons would ignore. This can lead to misperception of their environment and lead to hallucinations and delusions |
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Dopamine agonism
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Increasede pyramidal-neuron response to glutamate excitation Stimulant: Cocaine, amphetamine |
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Dopamine D2 antagonism
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Blockage of dopamine facilitation of pyramidal-neuron response First Generation (haloperidol) |
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D2 and 5HT antagonism
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Blackade of dopamine facilitation of pyramidal-neuron response and serotonin facilitation of glutamate release Second Generation: olanzapine, risperidone, quetiapine |
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Dopamine regulation and antagonists
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1) Mesolimbic pathway: hyperactivity of DA neurons= positive symptoms. Therapeutic D2 blockade 2) Mesocortical pathway: negative symptoms, cognition effects> ^DA 3) Nigrostriatal pathway: regulates motor movement side effects (pseudoparkinson) 4) Tuberoinfundibular pathway: Regulates prolactin release |
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First Generation Antipsychotics
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Phenothiazines: Chlorptromazine (Thorazine) Non-Phenothiazine: Haloperidol (Haldol) D2 antagonism reduces positive symptoms of schizophrenia Extrapyradimal symptoms: blockade of striatal D2 receptors -acute dystonias (involuntary movements) -pseudoparkinsons -tardive dykenesia (longterm involuntary move) Prolactin increase: lactation, breast-swelling Other: antihistamine, sedation, weight gain |
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Second Generation Antipsychotics
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Atypical Antipsychotics: Clozapine, olanzapine, quetiapine, risperidone, aripiprazole, ziprasidone D2 antagonism reduces positive symptoms 5HT antagonism may help decrease negative and cognitive symptoms by increasing DA release in cortex Beneficial therapeutic effects -Treats positive and negative symptoms -Decrease in extrapyramidal side effects and greatly reduced risk of tardive dyskinesia -Less prolactin elevation |
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Major side effects of Atypical antipsychotics |
Weight gain: Longer treatments>Greater weight gain Diabetes mellitus: increased reports with long term treatment. May be related to weight gain and development of insulin resistance Cholesterol levels increase approximately 10% after 14 weeks of treatment with olanzapine Olanzapine: high side effects Quetipine: Hight side effects Aripiprazole: Low to no side effects Ziprasidone: Low to no side effects |
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Best Choice? First generation vs second generation
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Efficacy for positive symptoms: Both Possible enhanced efficacy for negative and cognitive symptoms: 2nd generation Movement disorders: Higher for 1st generation Hyperprolactinemia: higher for 1st generation Weight gain and diabetes: mainly 2nd generation |
