Chapter 3: Psychotic disorders

Question 1

delusional themes

Answer 1

persecution/ paranoid
reference (cues in the external environment are uniquely related to individual)
control (includes thought broadcasting, thought insertion)
grandeur
guilt
somatic

Question 2

illusion

Answer 2

misinterpretation of an existing sensory stimulus

Question 3

medical causes of psychosis include

Answer 3

CNS disesase (MS, alzheimers, parkinson's, etc)
endocrinopathies
nutritional/ vitamin deficiency states (B12, folate, niacin)
Other (connective tissue disease, porphyria)

Question 4

positive symptoms of schizophrenia

Answer 4

hallucinations, delusions, bizarre behavior, disorganized speech. Tend to respond more robustly to antipsychotic meds

Question 5

negative symptoms of schizophrenia

Answer 5

flat or blunted affect, anhedonia, apathy, alogia, lack of interest in socialization.

tend to be treatment resistant

Question 6

3 phases of schizophrenia

Answer 6

prodromal (decline in functioning preceding first psychotic episode). Socially withdrawn/ irritable

psychotic (perceptual disturbances, delusions, and disordered thought process/ content

residual (occurs following an episode of active psychosis. Marked by mild hallucinations or delusions, social withdrawal, and negative symptoms.

Question 7

5 As of schizophrenia

Answer 7

anhedonia
affect (flat)
alogia (poverty of speech)
avolition (apathy)
attention (poor)

Question 8

DSM-5 criteria for schizophrenia

Answer 8

2 or more for at least 1 month:
1. Delusions
2. Hallucinations
3. Disorganized speech
4. grossly disorganized or catatonic behavior
5. Negative smptoms
Note: at least one must be 1, 2, or 3

must cause significant social, occupational or self-care functional deterioration

duration of illness for at least 6 months (including prodromal or residual periods)

symptoms not due to substance/ other med condition

Question 9

clozapine and schizophrenia

Answer 9

typically considered when a pt fails both typical and other atypical antipsychotics; due to poetential rare adverse event: agranulocytosis

pts must be monitored (WBC and ANC counts) regularly

Question 10

typical finding in schizophrenic patients include

Answer 10

disheveled appearance
flat affect
disorganize thought process

Question 11

brief psychotic disoder vs schizophreniform vs schizophrenia

Answer 11

brief: less than 1 month
schizophreniform - 1-6 months
schizophrenia: > 6 months

Question 12

Side effects of antipsychotic meds

Answer 12

Extrapyramidal (esp high-potency first gen)
Anticholinergic (esp low-potency first gen, atypicals)
Metabolic syndrome (2nd gen)
Tardive dyskinesia (more likely with first gen)
Neuroleptic malignant syndrome (high potency first gen)
prolonged QT interval and ECG changes, hyperprolactinemia, hematologic, opthalmologic, dermatologic

Question 13

Extrapyramidal symptoms

Answer 13

side effect w/ high-potency first gen antipsychotics

• dystonia (spasms) of face, neck, tongue
• Parkinsonism (resting tremor, rigidity, bradykinesia)
• Akathisia (feeling of restlessness)

Treat with anticholinergics (benztropine, diphenhydramine), benzos/ beta-blockers (specifically for akathisia)

Question 14

Anticholinergic symptoms

Answer 14

esp w/ low-potency first gen antipsychotics, atypical antipsychotics:
Dry mouth, constipation, blurred vision, hyperthermia

Question 15

Metabolic syndrome

Answer 15

side effect of 2nd gen antipsychotics:
constellation of conditions. Increased BP, blood sugar, body fat around waist. Abnormal cholesterol levels. Increased risk for developing cardiovascular disease, stroke, type 2 diabetes.

Consider switching to a 1st gen antipsychotic or a more weight neutral 2nd gen one such as aripiprazole or ziprasidone. Monitor lipids and blood glucose measurements. Refer to PCP for rx of hyperlipidemia, diabetes, etc. Encourage diet, exercise, smoking cessation.

Question 16

Tardive dyskinesia

Answer 16

more likely with 1st gen antipsychotics

choreoathetoid mvmts, usually seen in the face, tongue, and head.

Treatment: discontinue or reduce med. Consider substituting atypical antipsychotic (if appropriate). Benzos, Botox, vitamin E may be used. Movements may persist despite withdrawal of the drug.

atypicals can also cause.

Question 17

Neuroleptic malignant syndrome

Answer 17

side effect in high potency first gen antipsychotics

• change in mental status, autonomic instability (high fever, labile BP, tachycardia, tachypnea, diaphoresis), “lead pipe” rigidity, elevated creatine phosphokinase (CPK) levels, leukocytosis, and metabolic acidosis.
• medical emergency that requires prompt withdrawal of all antipsychotic meds and immediate medial assessment and treatment.

Question 18

cumulative risk of developing tardive dyskinesia from antipsychotics, esp first gen

Answer 18

5% per year

Question 19

schizophreniform disorder

Answer 19

same criteria as schizophrenia, between 1-6 months

Question 20

schizoaffective disorder

Answer 20

• meet criteria for either a major depressive or manic episode during which psychotic symptoms consistent with schizophrenia are also met.
• delusions or hallucinations for 2 weeks in the absence of mood disorder symptoms (necessary to differentiate schizoaffective disorder from mood disorder with psychotic features)
• mood symptoms present for majority of the illness

Question 21

prognosis for schizoaffective disorder

Answer 21

worse with poor premorbid adjustment, slow onset, early onset, predominance of psychotic symptoms, long course, and family history of schizophrenia

Question 22

Treatment for schizoaffective disorder

Answer 22

hospitalization if necessary, supportive psychotherapy
medical therapy: antipsychotics (2nd gen may target both psychotic and mood symptoms), mood stabilizers, antidepressants, or ECT.

Question 23

Brief psychotic disorder

Answer 23

psychotic symptoms as in schizophrenia; however, 1 day to 1 month. Eventual full return to pre-morrbid level of functioning. Not due to effects of a substance or other med condition. rare dx.
may be seen in reaction to extreme stress such as bereavement, sex assault,e tc.

prognosis: high rates of relapse, but almost all completely recover.
treatment: brief hospitalization, supportive therapy, course of antipsychotics for psychosis, and/or benzodiazepines for agitation

Question 24

Delusional disorder

Answer 24

more often in middle aged or older patients. Immigrants, hearing impaired, and with fam history of schizophrenia at increased risk.

• one or more delusions at least 1 month
• not meeting criteria for schizophrenia
• functioning in life not significantly impaired; not obviously bizarre behavior

Question 25

Types of delusions

Answer 25

erotomanic- that another person is in love with the individual
grandiose- having great talent
somatic- physical delusions
Persecutory
Jealous - of unfaithfulness
Mixed- more than one of above
Unspecified- not specified above

Question 26

Prognosis for delusional disorder

Answer 26

better than schizophrenia
50% full recovery
20 % decrease in symptoms
less than 20% no change

Question 27

Koro

Answer 27

intense anxiety that the penis will recede into the body, possibly leading to death (Southeast Asia)

Question 28

Amok

Answer 28

Sudden unprovoked outbursts of violence, often followed by suicide (Malaysia)

Question 29

Brain fag

Answer 29

Headache, fatigue, eye pain, cognitive difficulties, other somatic disturbances in male students (Africa)