clinical approach to psychotic disorders Flashcards
What is the peak onset of time for Schizophrenia?
What increases schizophrenia chances by 6x?
- late adolescence and early adulthood
- cannabis use
What are the prodromal signs and symptoms of Schizophrenia?
few close friends, minimal social activities with possible schizoid or schizotypical personalities.
What was the main point he was trying to get across with Early Life complications (ECLs)?
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.
What was virus that if caught when pregnant increased an offspring likelihood of developing schizophrenia by seven fold?
Influenze virus
What type of infection during pregnancy can cause a threefold increased risk of schizophrenia in the infant?
Respiratory infection
The dopamine system in the _____ is overactive in schizophrenia patients?
Hippocampus
What are considered Positive symptoms of psychotic disorders?
Delusions
Hallucinations
disorganized thinking (speech)
grossly disorganized or abnormal motor movements (catatonia)
What are delusions?
Fixed beliefs that are not amenable to change in light of conflicting evidence.
- essentially thoughts that dont make rational sense.
What is a hallucination?
Which is the most common type?
perceptions that occur without an external stimulus and can occur in a sensory modality?
Auditory Hallucinations most common
What is the difference between Hypnagogic and hypnopompic hallucinations?
- are these indicative of psychosis?
Timing
- hypnagogic is when you are going to sleep
- hypnopompic is when you are waking up
These are not indicative of psychosis
What is disorganized thinking (speech)?
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.
What is are the negative symptoms of psychotic disorders?
- diminished emotional expression
- avolition
- alogia
- anhedonia
- asociality
These account for most of the morbidity with schizophrenia
Are positive or negative symptoms of schizophrenia more likely to have a morbidity association?
Negative symptoms
What are the two particularly prominent negative symptoms in schiophrenia?
- diminished emotional expression
- avolition, which is a decrease in motivated self-initiated purposeful activities.
What is the diagnostic criteria for schizophrenia?
Two or more of the following for most of 1 month (think 1 month) atleast one of the first three symptoms
- delusion
- hallucinations
- disorganized speech
- grossly disorganized or catatonic behavior
- negative symptoms
Continous signs of the disturbance for (persistent) for atleast 6 months
What is the difference in diagnostic criteria for schizophrenia between adults and children?
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.
What is Schizophrenia Catatonic type?
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)
Is there an association between schizophrenia and suicide?
At what point?
Usually near the onset of illness
What is a major side effect of Clozapine?
Risperidone?
Olanzapine?
Quetiapine?
Ziprasidone?
Clozapine - agranulocytosis
risperidone - increased prolactin
olanzapine - weight gain* and diabetes
quetiapine - weight gain, excessive sedation, lower risk of Tardive Dykinesia
What is the diagnostic criteria for a delusional disorder?
- 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
What is a brief Psychotic Disorder?
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.
What is the diagnostic criteria for Schizophreniform disorder?
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.
What is Schizoaffective Disorder?
Schizophrenia + Mood disorder
How do we know that somone has a psychotic disorder that is not caused by Drugs?
- symptoms preced onset of medication
- symptoms continue 1 month post medication
Be able to think through the difference between
- catatonia with another mental disorder
- catatonia due to another medical condition
essentially think if the catatonia is because of depression, schizophrenia, mood disorder, etc.
Or if the catatonia is due to hypothyroid, etc…
Outline the timeline of Schizophrenia, schizophreniform, and brief psychotic disorder
Schizophrenia > 6 months
Schizophreniform 1-6 months
Bried psychotic disorder < 1 month
What was his slide for board tips - The Schizo spectrum
- Schizoid
- Schizotypical
- Schizophrenia
- Schizoaffective?
- 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
Are schizophrenia patients more likely to commit homicide? So what should we do?
No, analyze each patient seperately without bias and deteremine if they are dangerous or not.
