4. Psychotic Disorders Flashcards by Rachael Petry

What feature puts schizophrenic patients at HIGH suicide risk?

demoralization

How well did you know this?

Not at all

Perfectly

Definition: mental disorder in which the thoughts, affective response, ability to recognize reality, and the ability to communicate and relate to others are sufficiently impaired to interfere grossly with the capacity to deal with reality

Psychosis

How well did you know this?

Not at all

Perfectly

What are the classical characteristics of psychosis?

Impaired reality testing
Hallucinations (internally generated perceptions)
Delusions (fixed, false beliefs)
Illusions

How well did you know this?

Not at all

Perfectly

Definition: persistent, prominent delusions and/or hallucinations that developed during or soon after substance intoxication or withdrawal or after exposure to a medication that is capable of producing the symptoms

substance/medication induced psychotic disorder

How well did you know this?

Not at all

Perfectly

True or false: substance/medication induced psychotic disorder is another term for delirium

FALSE

How well did you know this?

Not at all

Perfectly

What are common general medical conditions that may lead to a psychotic disorder?

malignant lung CA, MS, brain injury, hypothyroidism

How well did you know this?

Not at all

Perfectly

What must you prove to diagnose a psychotic disorder due to a general medical condition?

-Evidence from history, physical, and labs that psychosis is due to physiological effects of a medical condition and DID NOT PRECEDE the onset of the medical condition and DOES NOT exclusively occur during a delirium

How well did you know this?

Not at all

Perfectly

Definition: severe psychomotor disturbance that may be associated with many different disorders (ex. schizophrenia, depressive stupor, etc.)

catatonia

How well did you know this?

Not at all

Perfectly

What do you have to do when a patient has catatonia?

ALWAYS think of a medical cause first

How well did you know this?

Not at all

Perfectly

What does a patient with catatonia look like?

WAXY FLEXIBILITY, mutism, no response (alert and awake but will not follow demands and has NO movements)

How well did you know this?

Not at all

Perfectly

How do you treat catatonia?

benzodiazepines or ECT

How well did you know this?

Not at all

Perfectly

What must you NEVER give to a catatonic patient?

antipsychotics (may lead to malignant catatonia, VS instability and death)

How well did you know this?

Not at all

Perfectly

What is the idea behind ECT?

used to treat seizures and depression (massive release of catecholamines)

How well did you know this?

Not at all

Perfectly

Definition: disorder characterized by acute alteration of consciousness iwth fluctuating disturbances in cognition, perception, behavior, affect and sleep due to an underlying physical cause (ex. drugs, metabolic or electrolyte abnormalities, endocrine disorders, etc.)

delirium

How well did you know this?

Not at all

Perfectly

True or false: you should always first rule out a mental illness before assessing that a patient is delirious

FALSE: always rule out delirium first!

How well did you know this?

Not at all

Perfectly

What are the key features of delirium?

not oriented to time, place, person or situation

How well did you know this?

Not at all

Perfectly

What are the risk factors for delirium?

Very young or very old (less cognitive reserve)
Preexisting medical conditions or cognitive impairment
Patients in hospitals/nursing homes

How well did you know this?

Not at all

Perfectly

How long does delirium last?

hours to days

How well did you know this?

Not at all

Perfectly

Delirium: acute or prolonged onset?

acute (hours to days)

How well did you know this?

Not at all

Perfectly

Delirium: constant or fluctuating course

fluctuating (varies in quality and intensity with a 24 hour period or between consecutive days)

How well did you know this?

Not at all

Perfectly

Delirium: how is the attention span?

impaired attention (very distractable)

How well did you know this?

Not at all

Perfectly

Delirium: affects short-term or long-term memory

short-term (impaired registration, consolidation, retention and retrieval)

How well did you know this?

Not at all

Perfectly

Delirium: how is the though pattern?

disorganized (illogical flow of ideas)

How well did you know this?

Not at all

Perfectly

Who is more likely to have a bizarre hallucination- a delirious patient or a psychotic patient?

delirium

How well did you know this?

Not at all

Perfectly

How is sleeping in a delirious patient?

daytime drowsiness with frequent napping and nighttime insomnia/sleep fragmentation

How do you diagnose delirium?

EEG shows diffuse slowing of dominant rhythms, generalized delta waves and loss of reactivity of EEG to eye opening and closing

List some secondary syndromes (that can lead to delirium)

- Neurodegenerative conditions - MS - Traumatic brain injury - Epilepsy - AIDS - Systemic inflammatory disease - OSA - Pheochromocytoma or endocrine tumors - Vitamin deficiencies - Chemo - Iatrogenic (ex. drug side effects)

Definition: syndrome of general loss of cognitive functions and significant functional deterioration

dementia

How does DAT (dementia of Alzheimer's type) begin?

short-term memory loss with early perceptual disturbances (ex, apraxia, aphasia, agnosia)

Where do lesions occur in Alzheimer's disease?

Hippocampus and POSTERIOR BRAIN with distruction of Ach neurons in the nucleus basalis

What are the 2 major genetic risk factors for early onset DAT?

APOE4 | Trisomy 21

How do FTDs begin?

personality changes or mood symptoms

Where do lesions occur in FTDs?

prefrontal and temporal cortices, BG and limbic areas

What are some symptoms of FTDs?

marked aphasia | disordered motor function (ex. chorea, gait disturbances, incontinence)

For dementia caused by HIV or AIDs, what symptoms occur?

prominent frontal symptoms (personality change and movement disorder)

What is characteristic of MS-related dementia?

worse during flares

What is a feature that may be seen in autoimmune disorder induced dementia?

rapidly progressive if disease is uncontrolled and can lead to seizures

True or false: alcohol-induced dementia is permanent.

TRUE (but can stop progression if you stop drinking)

What is Wernicke's encephalopathy?

thiamine deficiency (related to alcoholism or malnutrition)

What brain portion is affected in thiamine deficiency?

mammilary bodies

What is Korsakoff's psychosis?

irreversible, severe loss of short term memory that can occur after Wernicke's encephalopathy

What are features of dementia caused by hypothyroidism?

- Sluggishness - Loss of motivation - Slowed through

What features commonly accompany B12/folate deficiency related dementia?

anemia | peripheral neuropathy

What features accompany normal pressure hydrocephalus?

prominent gait disturbances incontinence personality changes

What are the pathological findings of DAT?

- Beta amyloid - Tau proteins - Neurofibrillary tangles - Presenillin 1 and 2

What happens late in DAT?

personality changes, depression, paranoia, etc.

What is the second most prevalent cause of dementia?

vascular dementia

What is the genetic cause of Huntington Disease?

Autosomal Dominant CAG repeats on chromosome 4 (causing increased huntingtin protein)

What parts of the brain are affected in HD?

caudate nucleus

What are the dementia symptoms in HD?

``` paranoia impulsive dyscontrol memory loss psychosis chorea ```

What does neuroimaging of HD show?

characteristic "butterfly" pattern

What part of the brain is affected in Parkinson Disease?

cortical radiations of DA neurons originating in the BG

What are the pathological findings of Parkinson disease?

- Lewy bodies (alpha synuclein) | - Cholinergic deterioration-driven changes

What are the s/s of Parkinson Disease?

``` tremor rigidity cogwheeling memory loss paranoia apathy aggression ```

Does dementia occur in every PD patient?

NO--occurs LATE in 24-31% of PD patients

How does the pahtology of PD dementia differ from Lewy Body dementia?

LBD is similar to PD but SPARES TEMPORAL AREAS

What are the s/s of Lewy body dementia?

- Severe motor symptoms - visual hallucinations - early memory loss - personality changes

True or false: Lewy body dementia is the second most common cause of dementia

FALSE: second most common PRIMARY cause of dementia (rarer than DAT)

What is another name for FTD?

Pick Disease

What are symtpoms of Pick Disease?

- Impulsive/disinhibited or anergic/apathetic - Poor hygeine - Loss of social skills - Aphasia - No insight - Memory may be spared

Timeline for Schizophreniform disorder.

First episode of Schizophrenia-like symptoms that lasts less than 6 months

What are positive symptoms?

Unusual things the patient DOES (psychotic behaviors like delusions, hallucinations, disorganized thinking or speech, disorganized motor behavior (catatonia)

What are delusions of reference?

patient believes random events are directed at them specifically

Definition: false beliefs not changed by evidence or reason

delusion

What are negative symptoms?

disruptions to normal emotions and behaviors (deficits)

Definition: decrease in motivated and self-initiated purposeful activity

avolition

Definition: diminished speech output

alogia

Definition: diminished ability to experience pleasure

anhedonia

Definition: lack of interest in social interactions

asociality

Which is more commonly missed, positive or negative symptoms?

Negative symptoms (mistaken for laziness, depression or unwillingness to help oneself)

What is the most common psychotic disorder?

schizophrenia

What gender is schizophrenia most common in?

male = female (but males more likely to present early)

What is the course of schizophrenia like?

- Chronic | - Periods of remission (person can recover significantly and lead a gratifying and productive life) and exacerbations

When does schizophrenia typically present?

usually in adolescence and young adulthood (rarely after 40 yo)

What are the 3 distinct phases of schizophrenia?

Prodromal Active Residual

When does the prodromal phase of schizophrenia start?

adolescence/early adulthood

What occurs in the prodromal phase of schizophrenia?

Gradual changes in behavior that may appear like personality or mood changes (lasting weeks to months)

When does the active phase of schizophrenia start?

usually leads the patient to seek treatment

What occurs in the active phase of schizophrenia?

delusions, hallucinations, disorganized thinking and behavior

What occurs in the residual phase of schizophrenia?

continuing oddities of thinking and behavior (LACK OF MOTIVAITON) delusions or hallucinations are usually absent

Abnormal thought form: loss of meaning due to random connections/loose associations between ideas

derailment

Abnormal thought form: responses to questions are only partially or remotely connected to the topic

tangential

Abnormal thought form: excessively detailed or circuitous speech, yet still responsive to the question

circumstantial

Abnormal thought form: creation of words with unique meaning understood only by the individual

neologism

Abnormal thought form: losing track of the goal of speech and not being able to return to the topic

blocking

Abnormal thought form: complete disregard for conventions of word usage or grammar (incoherence)

word salad

Abnormal thought form: the sounds of words, instead of the meanings or conventions of speech, determine the flow of speech

clanging

Abnormal thought form: repetition of words or phrases

perseveraiton

What are some connections between environmental factors and schizophrenia?

birth injury intrauterine malnutrition exposure to cytokines infections in the 2nd trimester

How long must prominent psychotic symptoms last in the active phase of schizophrenia to meet diagnosis?

>1 month

For how many months must a patient be sick to be diagnosed with schizophrenia?

6 months or more

If patient has his first schizophrenia like episode and recovers faster than 6 months, what is the diangosis?

schizophreniform disorder

What is the pathology associated with schizophrenia?

- decreased blood flow to frontal lobes - thinning of medial temporal lobe cortex, frontal cortex, and anterior portions of the hippocampus - enlarged lateral and third ventricles

What are common comorbidities of schizophrenia?

smoking | substance use

What is the prognosis for schizophrenia?

reduced life expectance (~10 yrs) | suicide in 10-15% of cases

Definition: major mood disorder (depression or mania) concurrent with schizoprenia-like psychosis

Schizoaffective disorder

What is the timeline for diagnosis of schizoaffective disorder?

psychotic symptoms persist during periods where mood symptoms are absent for >2 weeks

Definition: circumscribed and often bizarre delusions in an otherwise normal-appearing patient

delusional disorder

When does delusional disorder usually develop?

later in life than other schizophrenia spectrum disorders

Definition: transient psychosis precipitated by stress

brief psychotic disorder

How long do brief psychotic disorders last?

usually remit rapidly with minimum intervention (usually do not recur)

What is schizotypal disorder?

personality disorder (cluster A) or SSD characterized by pervasive patterns of interpersonal deficits, eccentrities, odd thinking/speech, suspiciousness, ideas of reference, etc.