BMB 3 - Psychotic Disorders; Trauma Flashcards
Psychosis is a descriptive term and can be defined as gross impairment in ____________.
Psychosis is a descriptive term and can be defined as gross impairment in reality testing.
A person experiencing psychosis will have impaired abilities to do what?
- Evaluate the accuracy of their own perceptions
- Infer the details of external reality
True/False.
The longer the duration of untreated psychosis (DUP), the worse the expected outcomes.
True.
What is ‘downward drift’ in terms of psychotic episodes?
As someone has more and more episodes, the recovery process becomes irreversible.
What is the number one question to be answered in working up a patient who seems to be in psychosis?
Is this delirium?
(Consider drug toxicities and interactions; space occupying CNS lesions; head trauma; infections; etc.)
Describe the four categories of the DSM-V diagnostic criteria for schizophrenia.
A. ≥ 2 or more of certain symptoms
B. Functional decline
C. ≥ 6 months duration
D. Other causes ruled out
The first category of the DSM-V diagnostic criteria for schizophrenia is for ≥ 2 of what symptoms to be present?
Delusion, hallucination, disorganized speech, disorganized or catatonic behavior, negative symptoms
(with at least one from the first three)
Early-onset schizophrenia begins before what age?
18 years
Very-early-onset schizophrenia begins before what age?
13 years
(exceedingly rare)
What should you do if a teenage patient presents with some S/Sy that are concerning for potential psychosis?
Refer them to a psychiatrist
(do not ignore these as ‘teenage behaviors’)
The prodromal (beginning) phase of Schizophrenia is classically characterized by which of the following?
- A. Social withdrawal*
- B. Hypervigilance*
- C. Avoidance of eye contact*
- D. Illicit drug use*
- E. Frantic attempts to be “normal” within peer group*
A. Social withdrawal
Name some of the diagnostic steps in working up a case of psychosis.
Head CT or MRI
EEG
Heavy metal screen
Ceruloplasmin
Lumbar puncture (if indicated)
Name some of the major positive symptoms associated with schizophrenia.
Delusions,
hallucinations (can be visual or auditory changes),
disorganized speech (putting words together but they don’t make sense),
disorganized or catatonic behavior (purposeless action, wearing cold weather clothing in an extremely hot day)
What is generally meant by ‘negative symptoms’ in schizophrenia?
A lack or deficit
(e.g. in organization, behaviors, thoughts, speech, enjoyment, etc.)
A defining feature of schizophrenia is a progressive, __________al decline.
A defining feature of schizophrenia is a progressive, functional decline.
Name a structural abnormality associated with schizophrenia and other psychotic disorders.
Enlarged lateral ventricles
Schizophrenia can only be diagnosed once S/Sy have been present for ≥ 6 months.
What are the diagnoses before 6 months?
< 1 month — brief psychotic disorder
1 - 6 months — schizophreniform disorder
> 6 months — schizophrenia
Schizophrenia is associated with _____frontality.
Schizophrenia is associated with hypofrontality (decreased cognitive ability).
A patient presents with delusions, hallucinations, disorganized speech, and disorganized behavior.
What is required for this to be diagnosed as schizophrenia?
A timeframe of ≥ 6 months
(< 1 month is brief psychotic disorder;
1 - 6 months is schizophreniform disorder)
Describe the S/Sy of schizoaffective disorder.
Psychosis
+
a major mood episode (manic or depressed)
A patient presents with systematic, nonbizarre delusions that have no effect on her personality and cognitive capacity. The symptoms have been going on for > 1 month.
What is the diagnosis?
Delusional disorder
What is the technical term for the poverty of speech that is seen as a negative symptom of psychosis?
Alogia
What is the technical term for negative symptom of psychosis that is an inability to start and continue a particular goal?
Avolition
What factors portend a good prognosis in those with psychosis?
Abrupt, later onset
No personality disorder
No family history
Confusion present at height of psychosis
What factors portend a poor prognosis in those with psychosis?
Slow, early onset
Comorbid personality disorder
Family history present
Little confusion present at height of psychosis
What does a schizophrenic patient have to do to receive clozapine?
Fail a 2nd-generation antipsychotic
