[CLMD CIS] Clinical Approach to Psychotic Disorders [Cooley]

Question 1

Describe a person with schizotypical personality disorder

Answer 1

People with schizotypical personaility disorder are described as:

• Odd/eccentric
• Few (if any) close relationships
• Severe anxiety/avoid social situations
• Flat emotions

Question 2

What is the difference between schizotypal personality disorder vs. schizophrenia?

Answer 2

Schizotypal personality disorder may experience brief psychotic episodes with delusions/hallucinations; the episodes are NOT AS FREQUENT, PROLONGED or INTENSE as schizophrenia

Schizotypal personality disorder patients can usually be made aware of the difference b/w their disorted ideas and reality (those w/ schizophrenia generally CANT be swayed from their delusions)

Question 3

What is the peak onset time of schizophrenia?

Answer 3

Late adolescence/early adulthood

Question 4

What are precipitating events for schizophrenia?

Answer 4

Psychosocial stressors

Traumatic events

Drug/alcohol abuse

Question 5

Symptoms of schizophrenia

Positive vs Negative symptoms

Which one is associated with a better/worse diagnosis?

Answer 5

Positive symptoms = better prognosis

Negative symptoms = poor prognosis

Question 6

What are prodromal signs/sx of schizophrenia?

Answer 6

Few close friends as adolescents

Minimal social activities

Question 7

Is there a genetic component to the etiology of schizophrenia?

Answer 7

YES!

Although it does NOT account for the entire eitiology.

In twin studies, monozygotic twins showed 40-50 percent concordance rate. Dizygotic twins showed 10-15 percent concordance.

Question 8

What are potential enviornmental contributors to the etiology of schizophrenia?

Answer 8

Several early life complications (ELCs)

Adverse events in:

• pregnanc
• labor
• delivery
• early in neonatal life

Question 9

What is one particular pre-natal exposure that can increase the risk of aquiring schizophrenia by 7 times?

3 times?

Answer 9

7 times more likely: Prenatal exposure to influenza virus

3 times more likely: Maternal upper respiratory infection during any time in pregnancy

Question 10

What is the “revised dopamine hypothesis“ related to schizophrenia?

Answer 10

Hyperactive dopamine transmission in the mesolimbic areas

and

Hypoactive dopamine transmission in the prefrontal cortex

Question 11

In positron emission tomography (PET) studies, where is schizophrenia particularly overactive with dopamine?

Answer 11

Hippocampus

Question 12

What are features that define positive symptoms of schizophrenia?

Answer 12

Delusions

Hallucinations

Disorganized thinking (speech)

Grossly disorganized or abnormal motor behavior

Question 13

What are delusions?

Answer 13

Delusions are fixed beliefs that are not likely to change in light of conflicting evidence

Question 14

What is a hallucination?

Answer 14

A perception that occurs without an external stimulus

Question 15

What are the most common type of hallucinations in schizophrenia?

Answer 15

Auditory hallucinations

Question 16

What is the term for a hallucination that occurs when you are falling asleep?

Answer 16

Hypnagogic

Question 17

What is the term for a hallucination that occurs when you are waking up?

Answer 17

Hypnopompic

Question 18

Are hypnagogic or hypnopompic hallucinations indicative of psychosis?

Answer 18

NO!!!

Question 19

What are some of the features of disorganized thinking (speech)?

Answer 19

Derailment/loose associations

Incoherence

Word salad

Question 20

Grossly disorganized motor behavior:

[Define]

Catatonic behavior

Answer 20

Marked decrease in reactivity to the enviornment

Question 21

Grossly disorganized motor behavior:

[Define]

Catatonic excitement

Answer 21

Purposeless and excessive motor activity without obvious cause

Question 22

Grossly disorganized motor behavior:

[Define]

Negativism

Answer 22

Resistance to instructions

Question 23

Grossly disorganized motor behavior:

[Define]

Inappropriate or bizarre posture

Answer 23

Waxy flexibility

Question 24

Grossly disorganized motor behavior:

[Define]

Mutism and stupor

Answer 24

Complete lack of verbal and motor responses

Question 25

Grossly disorganized motor behavior: [Define] **Repeated stereotyped movements**

Answer 25

Staring, grimacing, mutism and the echoing of speech

Question 26

What are the features the define **negative symptoms** of schizophrenia?

Answer 26

**-Diminished emotional expression** **-Avolition** - Alogia - Anhedonia - Ascociality

Question 27

What is **avolition?**

Answer 27

Decrease in motivated **self-initiated purposeful activities**

Question 28

What is **alogia?**

Answer 28

Diminished speech output

Question 29

What is **anhedonia?**

Answer 29

Decreased abiilty to experience pleasure

Question 30

What are the specific **diagnostic criteria** for **schizophrenia?**

Answer 30

**Two** or more of the following for most of **1 month;** at least **ONE** of the first 3 symptoms 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganzed or catatonic behavior 5. Negative symptoms \*remember, first 4 symptoms are POSITIVE symptoms

Question 31

What is the time frame for diagnosing long standing **schizophrenia?**

Answer 31

Symptoms persist for at least **6 months**

Question 32

What is the clinical picture of a patient with **schizophrenia (catatonic type)?**

Answer 32

- **Motoric immobility** - Excessive **motor** activity - Extreme **negativism** or **mutism** **-**Peculiarities of voluntary movement (posturing, stereotyped movements, mannerisms, grimacing)

Question 33

Schizophrenics are highly susceptible to \_\_\_\_\_\_\_\_

Answer 33

Schizophrenics are highly susceptible to **SUICIDE**

Question 34

To diagnose **schizophrenia**, what should you do first?

Answer 34

Rule out medical eitiologies: Perform medical screening to rule out: - Seizure disorders - Metabolic disorders - Thyroid dysfunction - Brain tumor - Neurosyphillis - Street drug use

Question 35

What is a major comorbid category of condition associated with **schizophrenia?**

Answer 35

Autoimmune disorders

Question 36

What is the treatment fo **acute psychosis** in schizophrenia?

Answer 36

Hospitalization IM injections of **haloperidol**, **fluphenazine, lorazepam**

Question 37

What is the treatment for **stabilization phase** of _schizophrenia?_

Answer 37

2nd gen antipsychotics

Question 38

What is the second generation antipsychotic drug associated with **agranulocytosis?**

Answer 38

Clozapine

Question 39

What is the second generation antipsychotic drug associated with **QTc prolongation**?

Answer 39

Ziprasidone

Question 40

What has been found to make symptoms of schizophrenia worse?

Answer 40

**Insight oriented group** and **individual psychotherapy** (Making the patient more aware of their symptoms has been shown to make their symptoms WORSE!)

Question 41

What are the **diagnostic criteria** of **Delusional disorder?**

Answer 41

- Presence of one or more delusions lasting at least **1 month** - Functioning is **not impaired**

Question 42

What is the time frame for diagnosis of **brief psychotic disorder?**

Answer 42

Episode disturbance of **at least 1 day but less than 1 month**

Question 43

What is the **time frame** of **schizophreniform disorder?**

Answer 43

Episode of the disorder that lasts **at least 1 month** but **LESS THAN 6 months**

Question 44

What are the **diagnostic criteria** of **schizoaffective disorder?**

Answer 44

Delusions or hallucinations for **2 or more weeks** in the **ABSENCE** of a major mood episode

Question 45

What is **substance/medication-induced** psychotic disorder?

Answer 45

Presence of **delusions** and/or **hallucinations** that develop with the introduction or withdrawal of **substance/medication**

Question 46

What are the timelines for Schizophrenia Schizophreniform Brief psychotic disorder

Answer 46

Schizophrenia = \> 6 months Schizophreniform = 1-6 months Brief psychotic disorder = \<1 month

Question 47

What is **schizoid?**

Answer 47

Very **introverted** Voluntarily **withdraws** from social interactions

Question 48

What is **schizotypal?**

Answer 48

Schizoid symptoms + Magical thinking/odd behavior

Question 49

What is **schizophrenia?**

Answer 49

Schizotypal + Psychosis

Question 50

What is **s****chizoaffective?**

Answer 50

Schizophrenia + Mood Disorder