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MAYO > CHAPTER 6 PSYCH > Flashcards

CHAPTER 6 PSYCH Flashcards

1
Q

A prototype psychotic illness characterized by
chronic course,
deterioration in social and occupational functions,
and positive (delusion, hallucination) and negative
(flat affect, alogia, avolition) symptoms

A

Schizophrenia

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2
Q

DSM criteria for Schiz

Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition, Text Revision (DSMIV-
TR) diagnostic criteria

The presence of at least two of five characteristic positive
or negative symptoms for at least 1 month:

A 
delusions,
hallucinations, 
disorganized speech, 
grossly disorganized or catatonic behavior, or
 negative symptoms
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3
Q

In Shiz

only need one of five if the:

A

delusions are bizarre or a voice or voices

are keeping running commentary on the person’s behavior or two or more voices are conversing

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4
Q

Other criteria for Schiz

A

b. Deterioration in social, occupational, and interpersonal
relationships

c. Continuous signs of the disturbance for at least 6 months (can include prodromal or residual symptoms like
amotivation)

d. Schizoaffective disorder and mood disorder with psychotic features have been ruled out

e. Not due to effects of substances or general medical
condition

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5
Q

hallmarks of schizophrenia

A

Psychotic symptoms

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6
Q

In Schiz:

patients experience a confusion of boundaries between
themselves and the world surrounding them, often called
_______

A

“a loss of ego boundaries

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7
Q

Postive Sz of Schiz

A

delusions, hallucinations, bizarre behavior

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8
Q

Negative symptoms of Schiz

A

blunting of affect, autism, ambivalence, social withdrawal, poverty of speech

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9
Q

MC hallucination

A

auditory hallucinations are the

most common

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10
Q

Firmly held false beliefs that can be bizarre or nonbizarre
(beliefs unique to certain cultural or religious
groups are not synonymous with delusions)

A

Delusions

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11
Q

Types of Delusions

A

Somatic, grandiose, paranoid, religious, nihilistic,
sexual, persecutory, delusions of reference, delusions
of thought (insertion, withdrawal, control,
broadcasting)

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12
Q

Belief that a person closely related to him or her has been replaced by a double

A

Capgras syndrome

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13
Q

Identifies a familiar person in various other people he or she encounters; even if no physical resemblance, he or she maintains they are psychologically identical

A

Fregoli synrdrome

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14
Q

Belief that penis is getting smaller and will

disappear

A

Koro

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15
Q

Self-mutilation driven by delusions

A

Van Gogh syndrome

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16
Q

Belief that thoughts can be implanted into the brain

A

Thought insertion

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17
Q

Negative symptoms in Schiz:

_________ speech that is empty or with decreased
spontaneity

A

Alogia:

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18
Q

Negative symptoms in Schiz:

________: sparsity of emotional reactivity

A

blunting

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19
Q

Negative symptoms in Schiz:

______unable to initiate or complete goals

A

Avolition

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20
Q

Other common negative symptoms in Schiz:

A

anhedonia
(unable to experience pleasure), inability to concentrate
or “attend,” inappropriate affect, poor hygiene

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21
Q

Other Sx associated with Schiz

A

1) Poor insight into illness
2) Abnormalities of eye movements (increased frequency
of blinking and abnormal saccades during test of
smooth pursuits)
3) Decreased stage IV sleep
4) Loss of normal gracefulness of body movements

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22
Q

Other Sx associated with Schiz

A

5) Up to 25% may have shown schizoid traits before
schizophrenia developed
6) Tend to be less interested in sexual activity
7) Up to 10% of schizophrenics commit suicide within
first 10 years of their illness
8) Up to 20% of schizophrenics drink excessive amounts
of water, which may lead to chronic hyponatremia
and possible water intoxication
9) Alcohol and drug abuse is common, and schizophrenics
smoke cigarettes three times more than the general
population

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23
Q

Subtypes of Schiz

A 
Paranoid (best prognosis), 
disorganized,
catatonic, 
undifferentiated, 
residual
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24
Q

Subtype of Schiz

a) Presence of delusions (often persecutory)
b) Frequent auditory hallucinations
c) Onset of illness (late 20s or 30s) later than for
other subtypes
d) More likely to marry and have children

A

Paranoid (best outcome)

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25
Q

Subtype of Schiz

a) Display disorganized, nonproductive behaviors
and demonstrate disorganized speech patterns
b) Exhibit flat or inappropriate affect; grimacing is
common
c) Can act silly or childlike and burst out laughing for
no reason
d) Delusions and hallucinations are less organized
and fragmentary
e) Earlier onset

A

Disorganized (formally called hebephrenic)

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26
Q

Subtype of Schiz

i) Motoric immobility (catalepsy, stupor)
ii) Excessive motor activity
iii) Extreme negativism
iv) Stereotypies, mannerisms, grimacing
v) Echolalia, echopraxia

A

Catatonic (less commonly seen now than in previous

years

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27
Q

_________ these patients do not satisfy criteria

for any other schizophrenia subtype

A

Undifferentiated:

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28
Q

these patients
no longer have any major psychotic symptoms but
still exhibit evidence of the illness, with negative
symptoms or at least 2 other odd or eccentric behaviors
or perceptual experiences

A

Residual

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29
Q

Prognosis of Schizophrenia

A

Chronic, usually early onset, poor long-term outcome,

devastating illness

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30
Q

Phases of Schizophrenia

A

Prodromal phase, Active phase, Residual phase

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31
Q

Characterize Prodromal phase of Schizophrenia

A

often prolonged period of social
withdrawal, delayed developmental milestones, awkward
in motor skills, loss of interest in self-care

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32
Q

Good prognostic factors for Schiz

A

a. Acute onset, short duration, no previous psychiatric
history, no family history of schizophrenia
b) Mood symptoms present, sensorium clouded
c) No obsessive-compulsive disorder, no
assaultiveness

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33
Q

Good prognostic factors for Schiz

A 
d) Premorbid functioning good, high socioeconomic
class
e) Married, good psychosexual functioning
f) Normal findings on neuroimaging
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34
Q

Poor prognostic factors for Schiz

A

a) Insidious onset, chronic duration, psychiatric history
present, positive family history of
schizophrenia
b) Mood symptoms absent, sensorium clear
c) Obsessive-compulsive disorder is present,
assaultiveness is present

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35
Q

Poor prognostic factors for Schiz

A 
d. Poor premorbid functioning, low socioeconomic
class
e) Never married, poor psychosexual functioning
f) Structural abnormalities present on neuroimaging
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36
Q

Epidemiology of Schiz

a. Prevalence over lifetime is about 1.0% (no differences
worldwide)
b. Average age at onset: men, _______ years (17-27 years); women, _____ years (17-37 years)
c. Male (M):Female (F) equal frequency

A

21

27

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37
Q

d. M>F in ________
e. F>M in _______
f. Onset before age 10 and after age 45 are uncommon

A

severity of illness, negative symptoms, suicide risk
mood comorbidity, better prognosis, better
social functioning

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38
Q

Etiology of Schiz
_______ idea has strong support: the
subject may have genetic predisposition to develop
schizophrenia but does not manifest it unless other factors are encountered (e.g., environmental stressors)

A

“Two-hit” or “multiple-hit”

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39
Q

In Schiz

Most consistent finding is ______

A

ventricular enlargement,

especially third and lateral ventricles

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40
Q

In Schiz

Selective reduction in size of :

A

frontal lobe, basal ganglia,
thalamus, and limbic regions, including the hippocampus
and medial temporal lobe

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41
Q

In Schiz

Increased incidence of

A

1) Cavum septum pellucidum

2) Partial callosal agenesis

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42
Q

Functional neuroimaging of Schiz

a. __________: negative
symptoms and neurocognitive deficits

b. Positron emission tomographic (PET) studies implicate:

A

Hypofrontality (frontal and prefrontal cortex)

frontal cortex (orbital, dorsolateral, medial), anterior cingulate gyrus, thalamus, several temporal lobe subregions, and cerebellum

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43
Q

anatomic substrate for visual hallucinations
in schizophrenia:

_________ is responsible for visual recognition
of objects and faces

A

Inferotemporal cortex

44
Q

Neuropathology of Schiz

a. Decreased cell density in the _____
b. Displacement of interneurons in _____

A

dorsomedial nucleus of thalamus

frontal lobe cortex

45
Q

1) Dopamine-blocking drugs seemed to ________ psychotic symptoms (antipsychotics)

A

lessen

46
Q

Five types of dopamine receptors: D1, D2, D3, D4,
D5
a) D1: located in ______ and ________
b) D2: located in _______
c) D3 and D4: high concentration in the____
d) D5: located in _________

A

cerebral cortex and basal ganglia

striatum

limbic system

thalamus, hippocampus, and
hypothalamus

47
Q

receptor occupancy of antipsychotic medications

1) ________: D2 receptors (78% receptor occupancy), no
obvious D1 receptors
2) ______: D2 receptors (48%), D1 receptors (38%-
52%),

_______receptors are associated with fewer
extrapyramidal symptoms

A

Typicals

Atypicals

D1

48
Q

Mainstay treatments: antipsychotics (D2 receptor blockers
[postsynaptic])
b. Treatment
1) First line, _____ (may improve neurocognitive impairment in schizophrenia

examples are

A

atypicals

risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), aripiprasole (Abilify)

49
Q

Second line of Tx for Schiz: _____, is atypical, expensive,
and needs monitoring because of the potential
for severe agranulocytosis

A

clozapine (Clozaril)

50
Q

Maintenance duration for Schiz

A

at least 1 to 2 years after the

initial psychotic episode

51
Q

Electroconvulsive therapy (ECT): schizophrenia does
not typically respond to ECT, but it could be considered
for _______

A

catatonic schizophrenia

52
Q

Goal of Psychosocial rehabilitation for Schiz

A
  1. Restore the patient’s ability to function in the
    community
    2) Appropriate/affordable housing, group homes
    3) Vocational training
    4) Assertive community treatment
53
Q

In Schizophreniform d/o, Duration of clinical signs and symptoms is less than ______

A

6

months

54
Q

In Schizophreniform d/o:

At least two of the following:

A

delusions, hallucinations,
disorganized speech, disorganized behavior or catatonia,
or negative symptoms

55
Q

In Schizophreniform d/o:

a. Similar to schizophrenia except for_____
b. ________ fully recover within 6 months
c. 66% usually progress to schizophrenia or schizoaffective
disorder

A

duration

33%

56
Q

In Schizophreniform d/o:

Good prognostic factors:

onset of psychosis within _____weeks after change of behavior/functioning,
good premorbid functioning,
______
________

A

4

positive symptoms,
confusion and disorganization at peak of psychotic symptoms

57
Q

Prominent mood symptoms and at least 2 weeks of

psychotic symptoms in the absence of mood symptoms

A

Schizoaffective Disorder

58
Q

In Schizoaffective Disorder:

a. Uninterrupted period during which a mood disorder
(major depression, mania, or mixed episode) coexists
with symptoms of the _______

b. Must have delusions or hallucinations present for 2
weeks or more in absence of ______

c. Meets criteria for a mood disorder for a substantial periodof time during the illness (active and residual periods)

d. Symptoms not due to substances, medications, or
general medical condition

A

active phase of schizophrenia.

mood symptoms

59
Q

Schizoaffective Disorder

Course
a. Prognosis: better than schizophrenia, but worse than
______
b. Suicide risk: ______

A

major depression

10%

60
Q

_______ is most effective

but not without risk in Tx of Schizoaffective do

A

(clozapine

61
Q

Schizoaffective Disorder

________can worsen illness, selective serotonin reuptake inhibitors (SSRIs), and trazodone can be beneficial for_______

A

tricyclic antidepressants (TCAs)

mood
component

62
Q

Characterized by nonbizarre delusions and does not

affect other areas of a patient’s life

A

Delusional Disorder

63
Q

Delusional disorder ________ is the relatively

more common delusional disorder

A

persecutory type

64
Q

Overview of DSM-IV-TR criteria for delusional disorder

a. Nonbizarre delusions for______ or more months

b. Active-phase symptoms of ______ have not been
met

c. Functioning usually is not impaired, behavior is not odd
d. If present, _______symptoms are brief in relation to period of illness
e. Not caused by substances or general medical condition

A

1

schizophrenia

mood

65
Q

Common defense mechanisms for delusional disorder:

A

denial, reaction formation,

projection

66
Q

Etiology and pathophysiology of Delusional disorder

A

a. Not related to schizophrenia or mood disorders
b. Psychosocial stressors may be involved
c. Genetic factors may be important
d. Neurologic injury may precipitate or worsen the disorder

67
Q

Delusions are nonbizarrre, persistent
Difficult to treat: denial of illness, difficulty with
trust
Prevalence: 0.03%, F>M, onset in middle age
Functioning usually not impaired

A

Delusional Disorder

68
Q

Delusional Disorder

________ antipsychotic agent or high-potency
typical antipsychotic agent
1) Usually helps with anxiety and intensity of delusion
2) _____ can be helpful, even apart from depression
3) ______ is helpful for somatic delusional
disorder

A

atypical

SSRIs

Pimozide (Orap)

69
Q
  1. Shorter duration than other psychotic disorders, sudden onset and termination of symptoms
  2. Is often precipitated by a stressor, may occur without
    an apparent antecedent
A

Brief Psychotic Disorder

70
Q

Overview of DSM-IV-TR criteria for BPS

a. At least one of the following symptoms for 1 or more
days but less than 1 month:

b. Not a mood disorder with psychotic features, schizoaffective disorder, schizophrenia, substance-induced, or due to general medical condition

A

delusions, hallucinations,
disorganized speech, grossly disorganized or catatonic
behavior

71
Q

In BPS

More commonly seen in patients with _____ and _________ disorders

A

personality (borderline or histrionic) and dissociative

72
Q

In BPS course is:

A

Brief, sudden onset of psychosis, with full return to premorbid functioning within a month

73
Q

In BPS

Factors associated with good prognosis:

A 
sudden onset,
short duration, 
severe stressor, 
prominent mood symptoms,
maintenance of affective reactivity,
 prominent confusion at peak of psychosis
74
Q

In BPS

Factors associated with good prognosis:

A 
sudden onset,
short duration, 
severe stressor, 
prominent mood symptoms,
maintenance of affective reactivity,
 prominent confusion at peak of psychosis
75
Q

In BPS

______ completely recover, and in the other 20%
to 50% _______ disorder may be
diagnosed

A

50% to 80%

Schizophrenia or a mood

76
Q

a. Presence of prominent hallucinations or delusions
b. Evidence points to substance or medication as a cause of symptoms
c. Not better accounted for by other psychotic disorder or
as part of a delirium

A

Substance-Induced Psychotic Disorder

77
Q

Work-up for Substance-Induced Psychotic Disorder

1) ________, other stimulants
2) Alcohol, benzodiazepines, barbiturates

3) _______ (lysergic acid diethylamide [LSD],
phencyclidine [PCP], marijuana, mushrooms)

4) ________ (jimson weed, trihexyphenidyl)
5) Medications (glucocorticoids, belladonna alkaloids

A

Cocaine, amphetamines, ephedrine

Hallucinogens

Anticholinergic agents

78
Q

a. Psychotic symptoms are present
b. Not enough information to make a specific diagnosis
c. May have contradictory information

A

Psychotic Disorder Not Otherwise Specified

79
Q

Types of Mood disorders

A 
major depressive disorder, 
dysthymicdisorder, 
bipolar I disorder, 
bipolar II disorder,
cyclothymic disorder, 
substance-induced mood disorder,
mood disorder due to general medical condition,
mood disorder not otherwise specified
80
Q

Characterized by severely depressed mood and/or anhedonia
leading to deterioration and inability to function
socially and occupationally

A

Major Depressive Disorder

81
Q

MDD criteria

“SIG E CAPS” (useful mnemonic for depression)

Need five symptoms for 2 weeks, must also have
depressed mood or anhedonia

A 
S—sleep disturbance
I—loss of interest
G—guilt
E—loss of energy
C—loss of concentration
A—appetite change (gain/loss)
P—psychomotor agitation/retardation
S—suicidal ideations
82
Q

MDD

Chronic if full criteria are met for at least _________—
clinically challenging!

A

2 years

83
Q

In MDD

Melancholic feature specifier
a) Loss of pleasure in all or almost all activities or lack
of reactivity to usually pleasurable stimuli and

b) At least three of the following:

A

distinct quality of depressed mood,
mood worse in the morning,
early morning awakening,
marked psychomotor retardation or agitation,
marked anorexia or weight loss, or excessive or inappropriate guilt

84
Q

In MDD

Atypical feature specifier

a) Mood reactivity: _________
b) At least two of the following:

A

brightens in response to positive events and

considerable weight
gain or increased appetite, 
hypersomnia,
 leaden paralysis, 
long-standing interpersonal rejection sensitivity
85
Q

In MDD

Catatonic feature specifier:

At least two of the following:

A

motoric immobility,
excessive motor activity, extreme negativism, peculiarities
of voluntary movement, echolalia or
echopraxia

86
Q

In MDD

Postpartum onset specifier

a) Onset of episode within _____post partum
b) Can be life-threatening to mother and child
c) High rate of recurrence, _____
d) 1:500 to 1:1,000 births

A

4 weeks

30% to 50%

87
Q

In MDD

Longitudinal course specifier

A

a) With full interepisode recovery

b) Without full interepisode recovery

88
Q

In MDD

Seasonal pattern specifier

a) _______ between onset of mood disorder
and a particular time of year and
b) __________(or change from depression to
mania or hypomania) also occur at a characteristic
time of year

A

Temporal relation

Full remissions

89
Q

In MDD

_________specifier

a) At least four episodes of mood disturbance in 12
months
b) Episodes have either remission or change to opposite
polarity for at least 2 months between episodes

A

Rapid-cycling

90
Q

In MDD

Most episodes clear spontaneously within _____ months

A

6

91
Q

In MDD

________: the most serious complication

A

Suicide risk

92
Q

Suicide in MDD

Females ________suicide more frequently than males Males ______ suicide more frequently than females

A

attempt

complete

93
Q

Risk factors for suicide in MDD:

A

advancing age, feeling hopeless,
psychotic symptoms, severe agitation, substance
abuse, chronic medical illness, living alone

94
Q

low levels of _______, ______, ____ in the limbic

region may result in depression

A

serotonin,

norepinephrine (NE), or dopamine

95
Q

Regulates mood, hunger, sleep, impulsivity, cognition,

pain, sexual responsiveness. What Nt?

A

Serotonin (5-hydroxytryptamine [5HT])

96
Q

_________metabolite levels in cerebrospinal fluid are

usually low in suicidal patients

A

5HT

97
Q

________ maintains mood, energy, interest, motivation

A

NE:

98
Q

______important in motivation, drive, and

pleasure and reward

A

Dopamine:

99
Q

in MDD

Family studies: first-degree relatives of patients with
major depressive disorder are ______more likely
than controls to have major depressive disorder

A

2× to 3×

100
Q

In MDD

Twin studies_____ concordance rate in monozygotic
and ______% rate in dizygotic twins

A

: 50%

10% to 25

101
Q

In MDD

1) Sleep time is usually decreased in patients with major
depressive disorder
2) Patients have shortened______of first rapid eye
movement (REM) period
3) Increased length of ______

A

latency

first REM period

102
Q

Disorders associated with depression and mood disorders

1) Cancer (especially _______): 25% of cancer
patients often develop depression
2) Dementia: _______ of patients with Alzheimer’s disease
have depression
3) Seizure disorders: up to 60% of patients with seizure
disorders (especially _________) develop
depression

A

pancreatic

11%

temporal lobe epilepsy

103
Q

Movement disorders
a) _____ of Parkinson’s patients can have depression
b) ______ incidence of depression among patients with
Huntington’s disease
c) _______ incidence of depression among patients with
Wilson’s disease

A

50%

40%

20%

104
Q

1) _____hemisphere strokes lead to dysphoria

2) ______ hemisphere strokes lead to euphoria

A

Anterior left

Right

105
Q

1) Depressed patients may have increased number of
focal signal hyperintensities in the______
2) Patients with major depressive disorder may have
smaller _______ AND _____

A

white matter

caudate nuclei and frontal lobes

MAYO (4 decks)

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