B7-072 Psychosis/Schizophrenia Flashcards
a severe mental disorder in which the patient has lost contact with external reality
psychosis
positive symptoms of psychosis [4]
delusions
hallucinations
disorganized thinking
abnormal behavior
negative symptoms of psychosis [2]
diminished emotional expression
avolitional (lack of motivation)
all symptoms of psychosis are caused by abnormal […] processes
cognitive
fixed belief that’s not changeable despite conflicting evidence
delusion
(can be bizarre or not bizzare)
perceptual experiences without external stimulus
any sensory modality, but auditory is most common
hallucinations
thought disorder inferred from patients speech
loose associations, tangents, incoherence
disorganized thinking
thought disorder that affects relationships and associations among words used to express thought
thoughts may be unrelated, blocking thoughts
formal thought disorder
thought disorder that involves the development of delusions
disorder of thought content
many manifestations ranging from childlike behaviors to difficulty with goal-directed behaviors or catatonia
disorganized behavior
negativism, bizarre posture, mutism, and excessive motor activity are all examples of
disorganized behavior
schizophrenic diagnostic criteria must include at least 1 of the following [3]
delusions
hallucinations
disorganized speech
active phase of schizophrenia requires […] or more symptoms present for a significant period of time during a […] month period
active phase of schizophrenia requires [2] or more symptoms present for a significant period of time during a [1] month period
schizophrenia diagnosis requires signs of disturbance for […], with at least one month of active phase symptoms
6 months
if the patient is having symptoms of schizophrenia for less than 6 months, do they meet diagnostic criteria?
no
may meet criteria for schizophreniform disorder though
schizophrenia technically meets the same criteria as […]
dementia
“dementia praecox”
what features help distinguish schizophrenia from other dementias
young age of onset
positive symptoms
normal elementary neuro exam
clear sensorium
no obvious pathology
is there a genetic component to schizophrenia?
yes,
higher risk for family members with schizophrenia
but most cases are sporadic
describe the course of schizophrenia
25% full remission
25% mild residual symptoms
50% moderate to severe symptoms
associated with altered dopaminergic activity, increased serotonin activity, and decreased dendrite branching
schizophrenia
cause of schizophrenia
genetic predisposition + triggering environmental event
cluster A personality disorder that also falls on the schizophrenia spectrum
schizotypal personality disorder
may include brief psychotic episodes that are less frequent and severe than schizophrenia
“schizophrenia lite”
schizotypal personality disorder
one or more delusions lasting more than one month
without a mood disorder or other psychotic symptoms
delusional disoder
daily functioning may be impacted by the pathological, fixed belief but is otherwise unaffected
delusional disorder
erotomanic (believes a specific person loves them)
grandiose
persecutory
jealous
somatic
are all types of […] disoder
delusional disorder
one or more positive symptoms lasting between 1 day and 1 month
usually stress related
brief psychotic disorder
two or more symptoms lasting 1-6 months
expectation is they will return to full level of functioning
schizophreniform disorder
shares symptoms with both schizophrenia and MDD or bipolar disorder
schizoaffective disorder
patient must have two or more weeks of psychotic symptoms without a manic or depressive episode
schizoaffective disorder
(differentiates this from MDD with pyschosis)
antagonizing the effects of dopamine in the basal ganglia and limbic system
antipsychotics
[first or second gen antipsychotics]
D2 antagonist
first
[first or second gen antipsychotics]
more worsening negative symptoms
first
[first or second gen antipsychotics]
more parkinsonism
first
[first or second gen antipsychotics]
more hyperkinetic complications
first
[first or second gen antipsychotics]
D2 and 5-HT anatagonist
second
[first or second gen antipsychotics]
less worsening of negative symptoms
second
[first or second gen antipsychotics]
less parkinsonism/hyperkinetic complications
second
[first or second gen antipsychotics]
metabolic syndromes
second
first generation antipsychotics [4]
haloperidol
chlorpromazine
fluphenazine
thioridazine
second generation antipsychotics [4]
risperidone
ziprasidone
quetiapine
olanzapine
[…] formulations of antipsychotics can help improve compliance
depot
fluphenazine
DOC in treatment resistant schizophrenia
clozapine
(more effective than other antipsychotics)
causes agranulocytosis
clozapine
atypical antipsychotic with complex receptor affinity
clozapine
interaction with […] induces P450 to metabolize clozapine
nicotine
( alot of patients with schizophrenia smoke)
partial D2 agonist
5 HT antagonist
aripiprazole
major complication of second generation antipsychotics
metabolic syndrome
postural tremor greater than resting tremor
drug-induced Parkinsonism
[…] antagonists can cause drug-induced Parkinsonism
dopamine
(more likely to be 1st gen)
drug-induced Parkinsonism is reversible in […] months
6
severe onset of akinetic rigid syndrome
malignant neuroleptic syndrome
symptoms of malignant neuroleptic syndrome
Myoglobinuria
Fever
Encephalopathy
Vitals unstable
Enzymes (CK high)
Rigidity
Malignant FEVER
treatment of malignant neuroleptic syndrome
dantrolene
bromocriptine (may worse psychosis)
d/c causative agent
most common EPS with neuroleptic drugs
tardive dyskinesia
involuntary movements of the lip, mouth, tongue, jaw, extremities, trunk
tardive dyskinesia
“bon bon” sign
tardive dyskinesia
(pushing tongue against cheek, looks like candy in cheek)
[…] patients have an increased risk of developing tardive dyskinesia early in treatment
older
oromandibular dystonia
type of tardive dyskinesia
enhance access to treatment, encourage medication adherence, maintain finances and housing, healthy living, etc
supportive psychotherapy
teach the person how to deal with their thoughts and behaviours
individual psychotherapy
help the person change their thinking and behaviour
CBT
loose, unrelated associations among thoughts and speech demonstrates
thought abnormalities
decreased range of expressive affect
affective blunting
fixed, false beliefs that are maintained in the absence of supporting information
delusions
perceptions of stimuli that are not present in the environment
hallcination
typical antipsychotics are also known as
first generation antipsychotics
atypical antipsychotics are also known as
second generation antipsychotics
what substance is most commonly abused in schizophrenic patients?
nicotine
the primary advantage of atypical antipsychotics is
reduction of EPS
[…] antipsychotics modulate serotonin and dopamine to help with psychosis
atypical antipsychotics
[…] antipsychotics modulate dopamine to help with psychosis
typical antipsychotics
long acting injectable antipsychotics
depot
neurotransmitter that is primarily implicated in the pathophysiology of schizophrenia and psychosis
dopamine
neurotransmitter implicated in mood disorders
norepinephrine
stimulant abuse can cause acute
psychosis
(due to dopamine agonist activity)
thought blocking is a […] symptom of schizophrenia
negative
what type of hallucinations are atypical of schizophrenia?
olfactory
(presence may suggest separate process)
increases the risk of seizure
clozapine
which medications are well suited for rapid control of motor overactivity, hostility, and aggressive outbursts?
first and second gen antipsychotics
(haloperidol)
tremor, slurred speech, akathisia, dystonia, anxiety, bradyphrenia, and paranoid are all what type of side effects?
EPS
life threatening syndrome associated with use of dopamine receptor antagonists
neuroleptic malignant syndrome
AMS, fever, muscle rigidity, and autonomic instability are symptoms of […] syndrome
neuroleptic malignant`
infestation delusions can be treated with
typical antipsychotics
(haloperidol, fluphenazine)
psychotic symptoms in DRPLA can be treated with
typical antipsychotics
(haloperidol, fluphenazine)
atrophic brain disease that worsens overtime
smoking induces the activity of
CYP1A
(reduces bioavailability of clozapine)
antipsychotic known to be effective in reducing suicidal feelings in schizophrenia
clozapine
[…] receptors impact sensitivity to leptin, driving hunger
5-HT2
