Acute and Chronic Illness

Question 1

What are thought disorders

Answer 1

A broad term applying to illnesses involving disordered thinking and disturbances in reality orientation and social involvement

Question 2

Schizophrenia

Answer 2

A thought disorder that involves bizarre behaviour, thoughts, movement, perceptions, and emotions

Question 3

Symptoms of schizophrenia

Answer 3

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) -

Question 4

Thought disorders

Answer 4

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

Question 5

Schizophrenia diagnostic criteria

Answer 5

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.

Question 6

S. Paranoid type diagnostic criteria

Answer 6

Preoccupied with one of more delusions or frequent auditory hallucinations. Symptoms include: disorganized speech, disorganized behaviours, and flat or inappropriate affect

Question 7

S. Disorganized type diagnostic criteria

Answer 7

Disorganized speech, behaviour, flat affect, or inappropriate affect are prominent. The criteria for catatonic type is not met.

Question 8

S. Catatonic type diagnostic criteria

Answer 8

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.

Question 9

S. Undifferentiated type diagnostic criteria

Answer 9

A type that does not meet the criteria for paranoid, disorganized, or catatonic

Question 10

S. Residual type diagnostic criteria

Answer 10

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

Question 11

Schizophreniform disorder

Answer 11

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

Question 12

Schizoaffective disorder

Answer 12

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

Question 13

Delusional disorder

Answer 13

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.

Question 14

Types of delusions

Answer 14

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

Question 15

Brief Psychotic Disorder

Answer 15

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.

Question 16

Shared Psychotic Disorder

Answer 16

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.

Question 17

Bipolar

Answer 17

fluctuations in mood occurring for a sustained period of time

Question 18

Major Depressive Disorder

Answer 18

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

Question 19

Persistent Depressive Disorder (dysthymia)

Answer 19

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.

Question 20

Bipolar 1 disorder

Answer 20

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.

Question 21

Bipolar 2 disorder

Answer 21

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

Question 22

Cyclothymic Disorder

Answer 22

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

Question 23

Neurobiological

Answer 23

neurotransmitters serotonin, dopamine, and norepinephrine

Question 24

Meds used for severe depression or bipolar disorders

Answer 24

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)

Question 25

Side effects of TCA’s:

Answer 25

sedation, orthostatic hypotension, and anticholinergic effects such as dry mouth, blurred vision, constipation, and urinary retention

Question 26

SSRI side effects:

Answer 26

sedation, erectile dysfunction, and interact with numerous meds placing pt. at risk for serotonin intoxication/serotonin syndrome

Question 27

Serotonin syndrome:

Answer 27

d/t an over activity of serotonin/disruption in the neurotransmitter’s metabolism

Question 28

MAOI interaction:

Answer 28

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

Question 29

Lithium toxicity

Answer 29

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.