clinical approach to psychotic disorders

Question 1

What is the peak onset of time for Schizophrenia?

What increases schizophrenia chances by 6x?

Answer 1

• late adolescence and early adulthood
• cannabis use

Question 2

What are the prodromal signs and symptoms of Schizophrenia?

Answer 2

few close friends, minimal social activities with possible schizoid or schizotypical personalities.

Question 3

What was the main point he was trying to get across with Early Life complications (ECLs)?

Answer 3

It was found to have a 1.5-2x increase risk for schizophrenia which was greater than the genetic effect. So early trauma, even intrauterine environment matters.

Question 4

What was virus that if caught when pregnant increased an offspring likelihood of developing schizophrenia by seven fold?

Answer 4

Influenze virus

Question 5

What type of infection during pregnancy can cause a threefold increased risk of schizophrenia in the infant?

Answer 5

Respiratory infection

Question 6

The dopamine system in the _____ is overactive in schizophrenia patients?

Answer 6

Hippocampus

Question 7

What are considered Positive symptoms of psychotic disorders?

Answer 7

Delusions

Hallucinations

disorganized thinking (speech)

grossly disorganized or abnormal motor movements (catatonia)

Question 8

What are delusions?

Answer 8

Fixed beliefs that are not amenable to change in light of conflicting evidence.

• essentially thoughts that dont make rational sense.

Question 9

What is a hallucination?

Which is the most common type?

Answer 9

perceptions that occur without an external stimulus and can occur in a sensory modality?

Auditory Hallucinations most common

Question 10

What is the difference between Hypnagogic and hypnopompic hallucinations?

• are these indicative of psychosis?

Answer 10

Timing

• hypnagogic is when you are going to sleep
• hypnopompic is when you are waking up

These are not indicative of psychosis

Question 11

What is disorganized thinking (speech)?

Answer 11

Word salad

Tendency to speak about topics unrelated to the main topic of discussion, always bouncing around to new topics. cant focus on a topic.

Question 12

What is are the negative symptoms of psychotic disorders?

Answer 12

• diminished emotional expression
• avolition
• alogia
• anhedonia
• asociality

These account for most of the morbidity with schizophrenia

Question 13

Are positive or negative symptoms of schizophrenia more likely to have a morbidity association?

Answer 13

Negative symptoms

Question 14

What are the two particularly prominent negative symptoms in schiophrenia?

Answer 14

• diminished emotional expression
• avolition, which is a decrease in motivated self-initiated purposeful activities.

Question 15

What is the diagnostic criteria for schizophrenia?

Answer 15

Two or more of the following for most of 1 month (think 1 month) atleast one of the first three symptoms

1. delusion
2. hallucinations
3. disorganized speech
4. grossly disorganized or catatonic behavior
5. negative symptoms

Continous signs of the disturbance for (persistent) for atleast 6 months

Question 16

What is the difference in diagnostic criteria for schizophrenia between adults and children?

Answer 16

Adults - most of the time after onset they have decreased function

children - in children because they are developing they fail to meet the next milestone of functioning.

Question 17

What is Schizophrenia Catatonic type?

Answer 17

atleat two of the following symptoms

• motor immobility
• excessive motor activity that is purposeless
• extreme negativism or mutism
• waxy figure can move the patient into positions
• echolalia (repeat speech) or echopraxia (repeat movements)

Question 18

Is there an association between schizophrenia and suicide?

At what point?

Answer 18

Usually near the onset of illness

Question 19

What is a major side effect of Clozapine?

Risperidone?

Olanzapine?

Quetiapine?

Ziprasidone?

Answer 19

Clozapine - agranulocytosis

risperidone - increased prolactin

olanzapine - weight gain* and diabetes

quetiapine - weight gain, excessive sedation, lower risk of Tardive Dykinesia

Question 20

What is the diagnostic criteria for a delusional disorder?

Answer 20

• presence of one delusion witha duration of 1 month or longer.

Note: Functioning is not impaired

example: patient comes in tells you he has an alien in his head. Then proceeds to be normal and act normal for the rest of the encounter.

Just one weird delusion that otherwise does not affect their day to day

Question 21

What is a brief Psychotic Disorder?

Answer 21

delusion, hallucinations, or disorganized speech for atleast 1 day but less than one month

Note: pay attention to the difference between this and schizophrenia, schizophrenia has to be 1 month not less than.

Question 22

What is the diagnostic criteria for Schizophreniform disorder?

Answer 22

Essentially the same a schizophrenia but between 1-6 months time, but less than 6 months.

Note: most people will be diagnosed with this and once they pass the 6 month mark with the same symptoms they will get moved into full blown schizophrenia category.

Question 23

What is Schizoaffective Disorder?

Answer 23

Schizophrenia + Mood disorder

Question 24

How do we know that somone has a psychotic disorder that is not caused by Drugs?

Answer 24

• symptoms preced onset of medication
• symptoms continue 1 month post medication

Question 25

Be able to think through the difference between

• catatonia with another mental disorder
• catatonia due to another medical condition

Answer 25

essentially think if the catatonia is because of depression, schizophrenia, mood disorder, etc.

Or if the catatonia is due to hypothyroid, etc…

Question 26

Outline the timeline of Schizophrenia, schizophreniform, and brief psychotic disorder

Answer 26

Schizophrenia > 6 months

Schizophreniform 1-6 months

Bried psychotic disorder < 1 month

Question 27

What was his slide for board tips - The Schizo spectrum

• Schizoid
• Schizotypical
• Schizophrenia
• Schizoaffective?

Answer 27

• Schizoid - very introverted and voluntarily withdrawn from social interaction
• schizotypical - schizoid symptoms + magical thinking & odd behavior (willy wonka - no one ever saw him and he was in his world of pure imagination)
• Schizophrenia - schizotypical + psychosis
• Schizoaffective - Schizophrenia + mood disorder

Question 28

Are schizophrenia patients more likely to commit homicide? So what should we do?

Answer 28

No, analyze each patient seperately without bias and deteremine if they are dangerous or not.