3- Psychotic Disorders Flashcards
What is a loss of contact w/ reality evidenced by delusions, hallucinations, disorganized thoughts/speech/behavior?
Psychosis
What are false beliefs, despite disproving evidence?
Delusions
Types: paranoids or persecutory, grandiose, reference, somatic
What are sensory perceptions in the absence of a stimulus?
Hallucinations
What is the most common type of hallucination?
Auditory
Also: visual, tactile, olfactory, gustatory
What NT pathway is implicated in psychosis?
Dopamine
Substances that mimic dopamine (cocaine, L-dopa, meth) will cause sx of what?
Schizophrenia
Substances that mimic glutamate at the NMDA (Ketamine/PCP) receptor will cause sx of what?
Schizophrenia
Substances that mimic serotonin (LSD, Mescaline, Ecstasy) will cause sx of what?
Schizophrenia
The following are examples of what?
- Derailment, tangentiality
- Incoherence, word salad
- Neologism
- Echolalia
- Blocking, paucity
Disorganized speech
Pts w/behavior that is not goal directed, are unable to complete simple tasks, and/or have immobility or waxy flexibility are exhibiting what type of behavior?
Disorganized or catatonic behavior
What sx of psychosis result in decrease or absence of function?
Negative sx
Apathy, anhedonia, asociality, and alogia (lack of speech) are an example of what sx?
Negative sx
What medications will be more effective against negative sx?
Atypical antipsychotics
Pts w/ plausible but false delusions have what form of delusional disorder?
EX: followed by police. NOT alien abductions, chips in brain
Non-bizarre
What is the DSM5 criteria for delusional d/o? (5)
- Non-bizzarre delusions for 1+ month
- Criterion A for schizophrenia has NEVER been met
- Mood episodes are brief relative to delusions
- Functioning NOT markedly impaired, behavior not obviously odd or bizarre
- Not due to substance or GMA
What delusional d/o subtype is characterized by another person (usually of higher status/celebrity) being in love with the pt?
Erotomanic
What delusional d/o subtype is characterized by inflated power, worth, knowledge or special relationship to deity or famous person?
Grandiose
What delusional d/o subtype is characterized by claims that spouse/ SO being unfaithful?
Jealous
What delusional d/o subtype is characterized by being treated malevolently, conspired against, spied on, followed, etc?
Persecutory
What delusional d/o subtype is characterized by physical defect or GMC?
Somatic
What delusional d/o subtype is characterized by features of more than 1 subtype, but none predominate?
Mixed
What d/o is sudden onset of 1+ positive sx that last 1 day-1 month w/ return to normal and has a high suicide risk?
Brief psychotic d/o
What is the DSM 5 criteria for brief psychotic d/o? (3)
- Presence of 1+ of the following: delusions, hallucinations, disorganized speech, disorganized/catatonic behavior
- Duration 1 day to 1 month w/ full return to premorbid level of functioning
- No due to schizophrenia, schizoaffective or mood d/o, substance or GMC
What % of pts w/ schizophreniform d/o recover vs what % progress to schizoaffective d/o?
1/3 recover
2/3 progress
Can a pt with schizophreniform d/o have normal social/occupation functioning?
Yes
What is the DSM5 criteria for schizophreniform d/o? (3)
- Presence of 2+ of the following: delusions, hallucinations, disorganized speech, disorganized/catatonic behavior
- Duration 1 month to 6 months
- No due to schizophrenia, schizoaffective or mood d/o, substance or GMC
The general population has a 1% risk of developing schizophrenia. What is the risk in pt w/ 1st degree relative w/ schizophrenia?
10x general public
What is the avg age of onset for schizophrenia in M and F?
M: 18-25
F: 25-35
Is schizophrenia a life long condition?
Yes
T or F: Pts w/ schizophrenia have a decreased life expectancy?
TRUE
M: 15 yrs earlier
F: 12 yrs earlier
What is the DSM5 criteria for schizophrenia? (4)
- Presence of 2+ of the following: negative sx, delusions, hallucinations, disorganized speech, disorganized/catatonic behavior
- Dysfunction in 1+ area of life
- Duration 6 months (1 month of criteria A + prodrome/residual period)
- Not due to schizoaffective or mood d/o, substance or GMC
* Specify w/ or w/o catatonia
What factors will lead to a better prognosis in pts w/ schizophrenia? (8)
- Female
- Good premorbid functioning
- Later onset
- Acute onset w/ precipitating factor
- Brief duration, early intervention, tx compliance
- High SES, married, good support sx
- Positive sx
- Mood disturbance or Fhx of mood d/o
What d/o is schizophrenia + mood d/o (bipolar or depression)?
Schizoaffective d/o
What is the DSM5 criteria for schizoaffective d/o? (4)
- Presence of 2+ of the following: negative sx, delusions, hallucinations, disorganized speech, disorganized/catatonic behavior && concurrent episode of major depression, mania, or mixed episode
- 2+ wks of delusions/hallucinations W/O mood sx
- Mood sx are present for significant portion of illness
- Not due to substance or GMC
What is first line med tx for schizophrenia?
1st gen antipsychotic: Chlorpromazine > Haloperidol
- low dose and titrate
- DO NOT use 2 antipsychotics @ same time
What is the goal of the first phase of tx (acute stabilization) in pt w/ schizophrenia?
Safety to self/others
What are indications for hospitalization of pts w/ schizophrenia? (3)
- Danger to self/others
- Command auditory hallucinations
- Unable to care for self
What is the goal of the maintenance phase of tx in pt w/ schizophrenia?
Sx control/prevent relapse
What is the biggest issue of the maintenance phase of tx in pt w/ schizophrenia?
Med compliance
What are 2nd gen antipsychotics? (5)
Aripiprazole Clozapine Olanzapine Quietapine Risperidone
What things should you consider when rx meds for schizophrenia?
- Dx/ R/o non-psychiatric causes
- Personal/family hx of response to meds (will have similar responses to meds)
- Atypicals cause increased mortality in elderly
What 2nd gen antipsychotic is a partial D2 agonist and metabolically neutral?
Aripiprazole
What 2nd gent antipsychotic has a risk of agranulocytosis?
Clozapine
What 2nd gen antipsychotic can cause weight gain?
Olanzapine
What 2nd gen antipsychotic can cause hyperprolactinemia, EPS?
Risperidone
What are the general SE of antipsychotic meds?
EPS
- Dystonia
- Parkinsonism
- Akathisia (restlessness)
- Tardive dyskinesia (tongue darting, finger dancing, blinking)
- Neuroleptic malignant syndrome
What are positive sx of schizophrenia?
Delusions
Hallusinations
