Acute and Chronic Illness Flashcards
What are thought disorders
A broad term applying to illnesses involving disordered thinking and disturbances in reality orientation and social involvement
Schizophrenia
A thought disorder that involves bizarre behaviour, thoughts, movement, perceptions, and emotions
Symptoms of schizophrenia
1) Delusions (erroneous, false, fixed beliefs) +
2) Hallucinations (auditory or visual) +
3) Disorganized speech (echolalia, circumstantiality, loose associations, flight of ideas, word salad, neologism, verbigeration, clang associations, stilted language, perseveration) +
4) Disorganized behaviours (aggression, agitation, regression, hypervigilance, waxy flexibility, odd posture, or echopraxia (involuntary imitation of others gestures and movements) +
5) Flat affect -
6) Alogia (decreased production of speech) -
7) Avolition (diminished goal directed activity) -
8) Anhedonia (inability to feel pleasure from life) -
Thought disorders
1) Schizophrenia
- paranoid type
- disorganized type
- catatonic type
- undifferentiated type
- residual type
2) Schizophreniform disorder
3) Schizoaffective disorder
4) Delusional disorder
5) Brief psychotic disoder
6) Shared Psychotic Disorder
Schizophrenia diagnostic criteria
Two of more of either positive or negative symptoms must be present for 6 months or longer. Social, occupational, and self-care decline after onset of symptoms. Symptoms must not be related to a mood disorder or SUD.
S. Paranoid type diagnostic criteria
Preoccupied with one of more delusions or frequent auditory hallucinations. Symptoms include: disorganized speech, disorganized behaviours, and flat or inappropriate affect
S. Disorganized type diagnostic criteria
Disorganized speech, behaviour, flat affect, or inappropriate affect are prominent. The criteria for catatonic type is not met.
S. Catatonic type diagnostic criteria
Motoric immobility as evidenced by catalepsy or stupor. Excessive motor activity not influenced by external stimuli. Extreme negativism consisting of motiveless resistance to all requests, instructions, or mutism. Echolalia or echopraxia.
S. Undifferentiated type diagnostic criteria
A type that does not meet the criteria for paranoid, disorganized, or catatonic
S. Residual type diagnostic criteria
Absence of prominent delusions, hallucinations, disorganized speech, and catatonic/disorganized behaviour. Presence of negative symptoms or positive symptoms that are lessened to odd beliefs or unusual perceptual experiences
Schizophreniform disorder
Same criteria for schizophrenia but only lasts at least one month and less than six months. Specified as confusion or perplexity at height of psychosis, good premorbid functioning, and absence of blunted or flattened affect
Schizoaffective disorder
An uninterrupted period of illness at which time there is either a major depressive disorder, a manic episode, or a mixed episode concurrent with symptoms that meet the characteristic symptoms for schizophrenia. Criteria includes:
1) delusions or hallucinations must last a least 2 weeks in the absence of prominent mood symptoms during the same period of illness
2) Disturbances are not due to substance or a general medical condition
3) Further specified depending on the type of Bipolar
Delusional disorder
Nonbizarre delusions such as jealousy or having a disease for 1 month. Characteristics for schizophrenia have never been met. Function is not impaired. Mood changes may occur during delusions. Not due to substance use.
Types of delusions
1) Erotomanic - someone is in love with you
2) Grandiose - inflated self-worth, power, special relationships with a famous person
3) Jealous - delusions that a sexual partner is unfaithful
4) Persecutory - that a person is being treated badly in some way
5) Somatic - pain or disease
6) Mixed - characteristics of one or more above but no theme predominates
7) Unspecified - none of the above
Brief Psychotic Disorder
Presence of one or more of the following symptoms:
Delusions, hallucinations, disorganized speech, disorganized or bizarre behaviour.
Duration lasts at least one day but less than one month with return back to normal functioning. No result of other condition or substance use. Further specified as; with marker stressors, without marked stressors, or with postpartum onset.
Shared Psychotic Disorder
Development of a delusion in an individual in the context of a close relationship with another person(s) with an established delusion. Not due to another medical condition, psychiatric condition or substance use.
Bipolar
fluctuations in mood occurring for a sustained period of time
Major Depressive Disorder
change from previous functioning with evidence of a depressed mood/decreased interest or pleasure in his/her usual activities. Lasts most of the day for more than 2 weeks
Persistent Depressive Disorder (dysthymia)
depressive symptoms that are chronic. Must be present for 2+ years for adults and 1+ years for children. Considered a mild form depression. Differs from MDD because people suffering can continue normal ADL’s.
Bipolar 1 disorder
occurrence of 1 or more manic episodes with major depression. Pt with mixed episodes may experience psychotic feature, irritability, and agitation. One extreme to another. Cycle starts with shortening of the sleep cycle and then they become doing bizarre things (booking a vaycay at 3 am). Can become hypersexual and engage in reckless behaviour. Mania usually passes after 3-7 days and then the depression sits in and then swing into a major depression due to feelings of regret and can’t function well.
Bipolar 2 disorder
characterized by recurring/chronic depressive episodes and at least one hypomanic (not a full-blown mania) episode. Pt has never experienced symptoms that meet the criteria for a manic/mixed episode. Often misdiagnosed with MDD because hypomanic episodes are misinterpreted as getting better. Often experiences bursts of energy and increased feeling of motivation, eating 2-4 days, then depressive state returns
Cyclothymic Disorder
chronic fluctuations in mood from numerous periods of both depressive symptoms and hypomania. Dx is not made unless pt has been free of MDD, manic, or mixed episodes for at least two years. Pt rarely experiences a state of “normal”. Moods chronicle shift from a little bit up, then a little bit down, over and over again
Neurobiological
neurotransmitters serotonin, dopamine, and norepinephrine
Meds used for severe depression or bipolar disorders
TCA’s - amitriptyline, imipramine, amoxapine, and doxepin
SSRI’s- fluoxetine, paroxetine, sertraline, and escitalopram
SNRI’s- fluoxetine and venlaflaxine
Selective reuptake inhibitors- trazodone
Selective atypical antidepressants- bupropion and mirtazapine
MAOI’s- tranylcypromine, phenelizine, and isocarboxazid
Mood stabilizers- lithium and anticonvulsants (carbamazepine, divalproex sodium, and lamotrigine)
Side effects of TCA’s:
sedation, orthostatic hypotension, and anticholinergic effects such as dry mouth, blurred vision, constipation, and urinary retention
SSRI side effects:
sedation, erectile dysfunction, and interact with numerous meds placing pt. at risk for serotonin intoxication/serotonin syndrome
Serotonin syndrome:
d/t an over activity of serotonin/disruption in the neurotransmitter’s metabolism
MAOI interaction:
hypertensive crisis suggests he/she has ingested food that are high in the dietary amine tyramine or takes meds whose actions mimics the sympathetic nervous system
Lithium toxicity
when drug levels greater than 1.5 mEq/L toxicity increases if the pt reduces their salt intake/experiences lots of sweating or increased urinary output without adequate replacement. Leads to increased reabsorption of lithium by the kidney which increases drug levels.
