What are the characteristics of a thought disorder?
- Disorganized Thoughts
- Hallucinations or Delusions
- Loss of the self, physical and mental boundaries, i.e. not sure where I stop and you begin
- Gross impairment of reality testing
What three mental status exam findings will be most often abnormal in people with a thought disorder?
- thought process (disorganization, loose associations)
- throught content (delusion)
- perceptions (hallucinations)
What is the prototypic thought disorder?
Schizophrenia
What are the NT’s involved in thought disorders?
- Dopamine
- glutamate
What qualify as psychotic symptoms (for schizophrenia) in the DSM?
- Hallucinations
- delusions
- disorganized speech
- grossly disorganized/catatonic behavior
- Negative symptoms (flat/inppt affect, alogia, avolition)
- need at least 2, one of which is one of the top 3.
What are the exclusion criteria for schizophrenia?
- No mood symptoms that predominate
- No medical causes
- Not induced by a substance
What are positive symptoms?
-Hallucinations, delusions, and disorganized behavior are often called the positive symptoms of schizophrenia.
(not a DSM term)
What is one of the most important questions to ask a schizophrenic patient?
Whether or not there are thoughts being put in their head.
=Thought insertion
What are negative symptoms?
- Isolation
- Withdrawal
- Poor hygiene
- Flat Affect
- Lack of Initiative
- Lack of Interest
- Lack of Energy
How long must you have active symptoms to be diagnosed with schizophrenia?
-one month
**(at least six months for other negative/prodromal symptoms)
What does paranoid schizophrenia entail?
-Preoccupation with one or more delusions or frequent auditory hallucinations
What does catatonic schizophrenia entail?
- Not really specific to schizophrenia anymore –now a specifier for any psychiatric illness where catatonia is present
- motoric immobility
What does residual type schizophrenia entail?
- Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior (after initial diagnosis of schizo)
- event with treatment, schizophrenic patients never return to baseline function
What is important about a thought disorder due to a general medical condition?
THOUGHT DISORDER MUST BE CAUSED BY THE MEDICAL CONDITION ITSELF
What medications can result in thought disorder symptoms or psychotic symptoms?
- Steroids
- Interferons
- Anticholinergics
How does schizophreniform disorder differ from schizophrenia?
- Total duration of illness (including prodromal, active, and residual) lasts at least one month but less than 6 months (1/3 return to baseline functioning, 2/3 progress to schizophrenia)
- Impaired social and occupational functioning during some part of the illness is NOT required
What is brief psychotic disorder?
- Sudden onset of schizophrenia symptoms
- lasts at least one day but less than one month of sx’s
- return back to premorbid functioning
What is delusional disorder?
- one more more bizarre or non-bizarre delusions that persists for at least one month
- functioning not markedly impaired
What does schizoaffective disorder entail?
- Disorder with major mood symptoms (depressed or manic) with concurrent psychotic symptoms
- equal presence/severity of both
Which pathway is probably most important in auditory hallucinations and delusions?
- OVERACTIVITY in Mesolimbic pathway
- Dopamine!
Which pathway is probably most important in the negative symptoms and cognitive changes in schizophrenia?
- UNDERACTIVITY in mesocortical pathway
- Dopamine!
What is the evidence that glutamate plays a role in thought disorders?
-LSD and PCP produce psychosis
What brain abnormalities are seen in schizophrenia?
- Ventriculomegaly and temporal lobe volume decrease
- No gliosis (post natal brain injury)
- abnormal neural migration
