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PSYCH CLERKSHIP > Chapter 3_Psychotic Disorders > Flashcards

Chapter 3_Psychotic Disorders Flashcards

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1
Q

Define psychosis in a nutshell

A

DISTORTED PERCEPTION OF REALITY

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2
Q

Two types of delusions of control

A
  1. thought broadcasting - “other people can read my mind”

2. thought insertion - “people are putting thoughts in my head”

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3
Q

delusion vs. illusion vs. hallucination

A

delusion is a fixed false belief that remains despite evidence to the contrary

illusion is a misinterpretation of an existing stimuli (ex: thinking a shadow is a cat)

hallucination is a sensory perception WITHOUT an actual stimulus. Can be visual, auditory, tactile, olfactory

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4
Q

Differential dx of psychosis (hint: there’s a bunch)

A
  1. psychotic d/o due to another medical conditions
  2. substance/medication induced psychotic d/o
  3. delirium/dementia
  4. bipolar diosrder, manic/mixed episode
  5. major depression with psychotic features
  6. brief psychotic disorder
  7. schizophrenia
  8. schizophreniform
  9. schizoaffective
  10. delusional disorder
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5
Q

What CNS diseases can cause psychosis?

A

cerebrovascular disease, multiple sclerosis, neoplasm, Alzheimer’s, Parkinson’s, Huntington’s, tertiary syphilis, epilepsy (often temporal lobe), encephalitis, prion disease, neurosarcoidosis, AIDS

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6
Q

What endocrinopathies can cause psychosis?

A

Addison/Cushing’s disease, hypo/hyperthyroidism, hyper/hypocalcemia, hypopituitarism

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7
Q

What nutritional/vitamin deficiencies can cause psychosis?

A

b12, folate, niacin (pellagra)

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8
Q

SLE, temporal arteritis, and porphyrias can cause…

A

PSYCHOSIS

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9
Q

Broad categories of medical causes ofpsychosis

A

CNS disease, endocrinopathies, vitamin/nutritional states, other

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10
Q

Criteria for psychotic disorder due to medical condition? (Name 3)

A
  1. prominent hallucinations/delusions
  2. symptoms do not occur exclusively in an episode of delirium
  3. clinical evidence (labs, history, physical) to support medical cause (non-psych cause)
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11
Q

Name some classes of medications that can cause psychosis

A

anesthetics, antimicrobials, NSAIDS, anticholinergics, antihistamines, corticosteroids, antihypertensives, methylphenidate, chemotherapeutic agents, , anticonvulsants, antiparkinsonian agents

PRETTY MUCH EVERYTHING

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12
Q

Examples of positive symptoms of schizophrenia

A

hallucinations, delusions, bizarre behavior, disorganized speech. Tend to respond well to medication

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13
Q

Examples of negative symptoms of schizophrenia

A

Anhedonia, flat/blunted affect, apathy, alogia (poverty of speech), lack of interest in socialization. Don’t respond as well to treatment, contribute to social isolation

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14
Q

Examples of cognitive symptoms of schizophrenia

A

impairments in attention, executive function, and working memory (lead to poor work/school function)

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15
Q

Three phases of schizophrenia symptom presentation

A
  1. prodromal - decline in function, social withdrawal, more irritable. New bizarre interests, declining work/school performance
  2. psychotic - active psychosis
  3. residual - follows psychotic episode. socially withdrawn, negative symptoms, psychosis
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16
Q

Physical/movement symptoms of schizophrenia

A

catatonia, stereotyped/repetitive movement, bizarre posturing, muscle rigidity

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17
Q

DSM-5 criteria for schizophrenia

A
  • 2 or more of the following must be present: hallucinations, delusions, disorganized speech, negative symptoms, grossly disorganized/catatonic behavior (at least one must be one out of 1st three)
  • significant social, functional, occupational impairment
  • must be present for at least six months
  • symptoms not due to effect of substance or medical condition
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18
Q

What are the 5 A’s of schizophrenia (negative symptoms)

A 
Apathy
Anhedonia
Alogia
Affect (flat)
Attention (poor)
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19
Q

What is the LAST RESORT antipsychotic?

A

Clozapine. Use if patient fails atypical and typical antipsychotics. Watch out for AGRANULOCYTOSIS (monitor WBC and ANC)

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20
Q

Difference between brief psychotic disorder, schizophreniform, and schizophrenia

A

Brief = 6months

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21
Q

Typical age of presentation of schizophrenia

A

Men: early-mid 20s
Women: late 202

men tend to have more negative symptoms and have poorer outcomes than women

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22
Q

T/F Substance use is comorbid with many schizophrenic patients

A

TRUE! nicotine, alcohol, cannabis, cocaine

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23
Q

downward drift hypothesis

A

postulates that people suffering from schizophrenia are unable to function well in society and therefore end up in lower socioeconomic groups.

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24
Q

What neurotransmitter likely plays a role in pathophysiology of schizophrenia?

A

DOPAMINE! (most antipsychotics are dopamine ANTAGONISTS, and many drugs like cocaine/amphetiamines increase dopamine activity)

25
Q

In theory, which two dopamine pathways are involved in schizophrenia?

A

Prefrontal cortical - not enough dopaminergic activity leads to negative symptoms
Mesolimbic - excessive dopaminergic activity leads to positive symptoms

26
Q

Which two additional pathways do antipsychotics affect and how are they affected?

A

tuberoinfundibular - blocked my antipsychotics, causes hyperprolactinemia leading to gynecomastia, sexual dysfunction, and menstrual irregularities
nigrostriatal - blocked by antipsychotics, causes EPS (ex: parkinsonism, tremor rigidity, slurred speech, akathisia, dystonia, and other abnormal movements)

27
Q

What other NT’s are involved in schizophrenia and how are they affected?

A

elevated serotonin, elevated norepi, decreased GABA, decreased glutamate (less NMDA receptors in schizophrenic patients)

28
Q

What are some good prognostic factors for schizophrenia?

A

later onset, good social support, positive symptoms, mood symptoms, acute onset, FEMALE, good premorbid functioning

29
Q

What are some bad prognostic factors for schizophrenia?

A

earlier onset, MALE gender, negative symptoms, poor premorbid functioning, lack of social support, family history, gradual onset, many relapses, comorbid substance use

30
Q

What can a head CTI/MRI show in schizophrenia?

A

Enlarged ventricles, diffuse cortical atrophy, and reduced brain volume

31
Q

Examples of first generation/typical antipsychotics

A

haloperidol, chlorpromazine (thorazine), fluphenazine, perphrenazine

32
Q

Mechanism of first generation antipsychotics

A

Primarily dopamine (mostly D2) antagonists, treat positive symptoms with little impact on negative

33
Q

Side effects to watch out for on first generation antipsychotics

A

EPS, tardive dyskinesia, neuroleptic malignant syndrome

34
Q

Examples of second generation antipsychotics

A

aripiprazole (abilify), asenapine, clozapine (clozaril), iloperidone, lurasidone (latuda), olanzapine (zyprexa), quetiapine (seroquel), risperdone (risperdal), ziprasidone (geodon)

35
Q

Mechanism of second generation antipsychotics?

A

Antagonize serotonin receptors (5HT2) and dopamine (D4>D2) receptors. No significant difference in efficacy between typical and atypicals.

36
Q

T/F Second generation antipsychotics work immediately

A

False. must take for at least 4 weeks before effect is seen

37
Q

What are some EPS symptoms due to typicals and how are they treated?

A

Dystonias (spasms) of face, neck, and tongue
Parkinsonism (resting tremor, rigidity, bradykinesia)
akathisa (restlessness)

Treat with anticholinergics, benzos/beta blockers (esepcially for akathisia)

38
Q

Dry mouth, constipation, blurred vision, hyperthermia

A

Anti-cholinergic symptoms that can be caused by low potency typicals and atypicals

39
Q

What are some components of metabolic syndrome and how to treat these?

A

hypertension, high blood sugar, excess central body fat, hyperlipidemia ( all increase the risk for CV disease and T2DM).

Treatment: switch to typical antipsychotic, or more “weight neutral” atypical (aripriprazole, ziprasidone). Make sure to monitor lipid and blood glucose. Always encourage good diet/exercise/smoking cessation

40
Q

What is tardive dyskinesia, which class more likely to cause, and how to treat?

A

choreoatheoid movements (tongue, face, head), more likely with typical antipsychotics.

Treatment: D/c or lower dose, consider switching to atypical. Benzos, botox, vitamin E may be used.

41
Q

What is neuroleptic malignant syndrome?

A

Change in mental status, autonomic instability (vital signs all over the place; fever, fast breathing, labile BP), “lead pipe” rigidity, elevated CPK, leukocytosis, metabolic acidosis.
Medical emergency that requires PROMPT withdrawal of all antipsychotics and immediate treatment. More frequently associated with initiation fo treatment and at higher IV/IM dosing of high-potency neuroleptics. Prior history of NMS = higher chance for recurrent NMS.

42
Q

Which typical antipsychotic can cause deposits in lens and cornea?

A

chlorpromazine

43
Q

Treatment for schizophreniform

A

Hospitalization (if necessary), 6 months antipsychotics, supportive psychotherapy if necessary

44
Q

DSM-5 criteria for schizoaffective disorder

A
  1. Meet criteria for either major depressive or major manic episode while criteria in which psychotic symptoms consistent with schizophrenia are also met
  2. Hallucinations/delusions occur for 2 weeks in the absence of mood disorder (distinguishes this from mood disorder with psychotic features)
  3. Mood symptoms are present for majority of psychotic illness
  4. Symptoms must not be due to substance/other medical condition
45
Q

Treatment options for schizoaffective

A

Antipsychotics (atypicals can target both psychosis and mood), mood stabilizers, ECT, antidepressants

46
Q

DSM-5 criteria for brief psychotic disorder (rare)

A
  • Psychotic symptoms consistent with schizophrenia lasting 1day-1month.
  • Must make full recovery from psychosis and return to full premorbid functioning
  • Not due to another substance/ medical condition
47
Q

Main differences between delusional disorder and schizophrenia

A
  • delusion only has to be present for at least 1 month
  • delusions aren’t necessarily bizarre
  • daily functioning NOT SIGNIFICANTLY impaired
  • does not meet criteria for schizophrenia (even though delusions can occur in schizophrenia)
  • Typical presents later in life (middle-late age)
48
Q

Erotomanic delusion

A

delusion that another is in love with the individual

49
Q

Grandiose type delusion

A

delusion of having great talent/special powers

50
Q

Somatic type delusion

A

physical delusion (I’m pregnant)

51
Q

Persecutory type delusion

A

delusion that an individual is being persecuted

52
Q

jealous type

A

delusions of unfaithfulness

53
Q

How to treat delusional disorder

A

difficult to treat given patient’s lack of insight and impairment, antipsychotics recommended (but limited evidence). NO GROUP therapy, but can try supportive therapy

54
Q

Sudden unprovoked outburts of violence, often followed by suicide

A

Amok (malaysia)

55
Q

intense anxiety that penis with recede into body and lead to death

A

Koro (southeast asia)

56
Q

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

A

brain fag

57
Q

Order these disorders in order of worsening prognoses

schizoaffective, schizophrenia, mood disorder with psychotic features, schizophreniform diosrder

A

mood disorder with psychotic features, schizoaffective, schizophreniform, schizophrenia

58
Q

Difference between schizophrenia and schizotypal/schizoid

A

schizotypal/schizoid are personality disorders that don’t have psychosis

PSYCH CLERKSHIP (10 decks)

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