06: Schizophrenia & Other Psychotic Disorders Flashcards
1
Q
What is psychosis?
A
- 3 ways to qualify:
- Delusions
-
Hallucinations (perceiving stimulus in absence of actual external sensory stimulus that seems indistinguishable from such an experience in reality)
- Most often auditory
-
Formal thought disorder
- Loosening of associations
- Word salad
- Blocking
- Neologism
- Exclusion criteria:
- Other medical condition (e.g., brain tumor, hyperthyroidism)
2
Q
What is the differential diagnosis of psychosis?
A
- Brief psychotic disorder
- Delusional disorder
- Schizophrenia
- Schizophreniform disorder
- Schizoaffective disorder
- Manic episode with psychotic features
- Major depressive episode with psychotic features
3
Q
What is a brief psychotic disorder?
A
- Delusions/hallucinations/FTD present for > 1 day and < 1 month
- Pt returns to full premorbid functioning after the episode
- Typically associated with emotional turmoil and lability, confusion, and severe impairment
- May occur with or without marked stressor (if marked stressor present, disorder also called brief reactive psychosis)
4
Q
What is a delusional disorder?
A
- Presence of one or more delusions for at least one month
- Hallucinations may be present, but are not prominent and are related to the delusional theme
- FTD, disorganized & catatonic behavior, negative sx not present
- Functioning not markedly impaired, apart from direct impact of delusions
- If mood episodes occur, they are brief relative to overall duration of the delusional periods
5
Q
What is catatonia, and what are its qualifiers?
A
Catatonia: marked decrease in reactivity to the environment
- Catalepsy (passive induction of a posture against gravity)
- Agitation ((not influenced by external stimuli)
- Mutism (lack of verbal response)
- Posturing (maintenance of a posture against gravity)
- Grimacing
- Echolalia (mimicking another’s speech)
- Mannerism (odd, circumstantial caricature of normal actions)
- Stupor (not actively relating to environment)
- Negativism (opposition to instructions)
- Echopraxia (mimicking another’s movements)
- Waxy flexibility (slight resistance to positioning)
- Stereotypy (repetitive, abnormally frequent, non-goal directed movements)
Mnemonic: CAMP GEMS NEWS
6
Q
What are negative symptoms?
A
- Diminished emotional expression
- Flat Affect
- Reduced movements of head, hands or body
- Lack of variations in speech pitch, volume, rhythm, and intonation
- Avolition (decrease in motivated self-initiated purposeful activities)
- Alogia (diminished speech output)
- Asociality (lack of interest in social interactions)
- Anhedonia
Mnemonic: 5 A’s
7
Q
What are various delusional disorder classifications?
A
Classified according to the delusion’s central theme:
- Erotomanic: conviction that another person is in love with the individual
- Grandiose: conviction of having great talent or insight, having made an important discovery or having special relationship with a prominent person
- Jealous: convictionof having an unfaithful partner
- Persecutory: conviction of being conspired against, cheated, spied on, followed, poisoned, maliciously maligned, harassed or obstructed in pursuit of goals
- Somatic: conviction of abnormalities of bodily functions or sensations
- Mixed
8
Q
What are the diagnostic criteria for Schizophrenia regarding the Active Phase (Criterion A)?
A
- At least 2 of the following are present for a significant portion of a 1-month period (can be less, if successfully treated):
- Delusions
- Hallucinations
- Formal thought disorder
- Grossly disorganized or catatonic behavior
- Negative symptoms
- At least one symptom must be 1/2/3
- Delusions and hallucinations are also referred to as positive symptoms; formal thought disorder is a disorganized symptom
9
Q
What are the diagnostic criteria for Schizophrenia regarding Functional Impairment?
A
Pertains to pt’s level of functioning:
- Impaired in at least one major area (work, interpersonal relations, self-care)
- Markedly below the level achieved prior to the onset of illness
- Impaired for a significant portion of time since the onset of illness
10
Q
What are the diagnostic criteria for Schizophrenia regarding duration?
A
- Continuous signs of illness must be present for at least 6 months
- Must include at least one month of active-phase symptoms
- May include periods of prodromal or residual symptoms
11
Q
What are the characteristics of prodromal and residual symptoms?
A
- Negative symptoms
- Attenuated “quasi-psychotic” experiences and thoughts:
- Overvalued ideas (e.g., paranoid ideation, ideas of reference)
- Unusual perceptual experiences (e.g., illusions)
- Odd thinking/speech (e.g., vague, circumstantial, overly-abstract)
- Odd behavior that is not grossly disorganized (e.g., mumbling in public)
12
Q
What is the time-course of prodromal and residual symptoms of schizophrenia?
A
- Prodromal symptoms occur prior to the onset of the disorder (i.e., determination is made in retrospect)
- Can persist for several years
- Residual symptoms occur after the resolution of the active phase
- Tend to last as long as the disorder is present
13
Q
What are the diagnostic criteria for schizophreniform disorder, and what is its prognosis?
A
- Duration > 1 mo and < 6 mos, including prodromal, active and residual phases
- Impaired social or occupational functioning not required
- Prognosis:
- 1/3 completely recover
- 2/3 ultimately diagnosed with schizophrenia or schizoaffective disorder
14
Q
Describe mood disorders with psychotic features.
A
- Delusions and hallucinations
- Mood congruent for mania (grandiose, paranoid)
- Mood congruent for depression (personal inadequacy, guilt, disease, death, nihilism, deserved punishment)
- May be mood incongruent (e.g., paranoid for depression)
- Formal thought disorder only occurs with mania (not MDE)
15
Q
Why is a manic episode with psychotic features difficult to diagnose?
A
- In the moment (i.e., cross-sectionally), can be indistinguishable from brief psychotic disorder as well as the active-phase of schizophreniform disorder and schizophrenia
- Past Hx and future course crucial to distinguish among these disorders
