16. Clincal approach to psychotic disorders Flashcards
What criteria and explanation of a disorder is covered under personality disorders, the disorder is considered part of the schizophrenia spectrum of disorders, known as a pt being eccentric/odd/not many friends/ see harm everywhere?
Schizotypal Personality Disorder
Schizophrenia has a peak onset of late adolescence and early adulthood, with precipitating events including psychosocial stressors, traumatic events, drug and alch abuse, cannabis use, with variables including positive and negative symptoms, which has a better prognosis?
Someone with positive symptoms has a better prognosis than someone with negative symptoms
Schizophrenia has early/prodromal signs and symptoms that may exist before symptoms of the disease, possible schizoid or schizotypal personalities, with few close friends as adolescents and minimal?
social activities
Schizophrenia has many possible etiologies, including… monozygotic twins have a concordance rate of 40-50% while dizygotic twins only have 10-15%, it is also assoc with early life complications (ELC) which inc risk by 1.5-2x, ELC includes adverse events that occur during pregnancy, labor, at deliver, and early in?
neonatal life
Schizophrenia is also associated with genes highly and differentially expressed in the placenta*, which drive interaction between polygenic risk scores and ELC schizo risk, prenatal exposure to influenza vvirus during 1st trimester makes the offspring how many times more likely?
7x more likely is fetus exposed to influenza virus during first trimester
note: dr says and type of inflammation may be a predisposer to psychiatric disorders
Schizophrenia is also associated with maternal URI during any time during the pregnancy increases risk of Schizophrenia 3x by age 47. Neurophysiology surrounding Schizophrenia proposes hyperactive DA transmission in the mesolimbic areas (amygdala/PFC) and hypoactive DA transmission in the?
Prefrontal Cortex
DA system in hippocampus is overactive in schizo pts
Positive symptoms that define psychotic disorders, include delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia). What are fixed beliefs that are not amenable to change in light of conflicting evidence?
Delusions - many types
Hallucinations are perceptions that occur without an external stimulus in any sensory modality, what are the MC kind in Schizophrenia, usually experience as voices (familiar or unfamiliar), and are perceived as distinct from the individuals own thoughts?
Auditory Hallucinations ***MC and most important
Hallucinations that occur while falling asleep are called hypnagogic and while waking up are called hypnopompic—- NOT indicative of psychosis. Disorganized thinking/speech is inferred from the individuals speech, with 3 types including tangentiality, derailment/loose associations and incoherence aka?
World salad where nothing makes sense
Negative symptoms associated with Schizophrenia include diminished emotional expression, avolition, alogia, anhedonia, asociality- these account for most of the morbidity assoc with Schizophrenia, which two are the most important and prominent?
Diminished Emotional Expression: decreased eye contact, speech intonation, movements of hand/head/face
Avolition: decrease in motivated self initiated purposeful activities
Schizophrenia is diagnosed as 2 or more of the following for 1MONTH, with at least 1 of the first 3 symptoms:
1. delusions
2. hallucinations
3. disorganized speech
4. grossly disorganized or catatonic behavior
5. Negative symptoms
Continuous signs of the disturbance must persist for how long???*
persist for at least 6 months* w at least one month of 3 symptoms
What type of Schizophrenia has a clinical picture dominated by two of the following: motoric immobility evidenced by catalepsy/stupor, excessive motor activity, extreme negativism or mutism, along with echolalia or echopraxia?
Schizophrenia - Catatonic Type
When someone presents with Schizophrenia, must also think of seizure disorders, metabolic disorders, thyroid dysfunction, brain tumor, neurosyphillis or a street drug use, work up includes CBC, CMP, TSH, UA, Lipids, HgA1C, Prolactin, urine drug screen, EEG, neuro exam and CT of?
and MRI of brain
Schizophrenia is treated with hospitalization for acute psychosis along with haloperidol, fluphenazine or lorazepam IM injections to stabilize, once stabilized switch to SGAs, such as clozapine (agranulocytosis/weight gain), risperidone (inc prolactin), olanzapine (weight gain/DM), quetiapine (wt gain/sedation/dec risk TD), iloperidone (QTC prolong, inc prolactin), aripiprazole, and what which SE include *QTc prolongation?
Ziprasidone
Other tx for Schizophrenia include community treatment (60%), self help programs (have no insight so probs dont know they have an issue), electroconvulsive therapy ECT, and benzos for catatonic disorder….
MEOW
