[CLMD CIS] Clinical Approach to Psychotic Disorders [Cooley] Flashcards
Describe a person with schizotypical personality disorder
People with schizotypical personaility disorder are described as:
- Odd/eccentric
- Few (if any) close relationships
- Severe anxiety/avoid social situations
- Flat emotions
What is the difference between schizotypal personality disorder vs. schizophrenia?
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)
What is the peak onset time of schizophrenia?
Late adolescence/early adulthood
What are precipitating events for schizophrenia?
Psychosocial stressors
Traumatic events
Drug/alcohol abuse
Symptoms of schizophrenia
Positive vs Negative symptoms
Which one is associated with a better/worse diagnosis?
Positive symptoms = better prognosis
Negative symptoms = poor prognosis
What are prodromal signs/sx of schizophrenia?
Few close friends as adolescents
Minimal social activities
Is there a genetic component to the etiology of schizophrenia?
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.
What are potential enviornmental contributors to the etiology of schizophrenia?
Several early life complications (ELCs)
Adverse events in:
- pregnanc
- labor
- delivery
- early in neonatal life
What is one particular pre-natal exposure that can increase the risk of aquiring schizophrenia by 7 times?
3 times?
7 times more likely: Prenatal exposure to influenza virus
3 times more likely: Maternal upper respiratory infection during any time in pregnancy
What is the “revised dopamine hypothesis“ related to schizophrenia?
Hyperactive dopamine transmission in the mesolimbic areas
and
Hypoactive dopamine transmission in the prefrontal cortex
In positron emission tomography (PET) studies, where is schizophrenia particularly overactive with dopamine?
Hippocampus
What are features that define positive symptoms of schizophrenia?
Delusions
Hallucinations
Disorganized thinking (speech)
Grossly disorganized or abnormal motor behavior
What are delusions?
Delusions are fixed beliefs that are not likely to change in light of conflicting evidence
What is a hallucination?
A perception that occurs without an external stimulus
What are the most common type of hallucinations in schizophrenia?
Auditory hallucinations
What is the term for a hallucination that occurs when you are falling asleep?
Hypnagogic
What is the term for a hallucination that occurs when you are waking up?
Hypnopompic
Are hypnagogic or hypnopompic hallucinations indicative of psychosis?
NO!!!
What are some of the features of disorganized thinking (speech)?
Derailment/loose associations
Incoherence
Word salad
Grossly disorganized motor behavior:
[Define]
Catatonic behavior
Marked decrease in reactivity to the enviornment
Grossly disorganized motor behavior:
[Define]
Catatonic excitement
Purposeless and excessive motor activity without obvious cause
Grossly disorganized motor behavior:
[Define]
Negativism
Resistance to instructions
Grossly disorganized motor behavior:
[Define]
Inappropriate or bizarre posture
Waxy flexibility
Grossly disorganized motor behavior:
[Define]
Mutism and stupor
Complete lack of verbal and motor responses
Grossly disorganized motor behavior:
[Define]
Repeated stereotyped movements
Staring, grimacing, mutism and the echoing of speech
What are the features the define negative symptoms of schizophrenia?
-Diminished emotional expression
-Avolition
- Alogia
- Anhedonia
- Ascociality
What is avolition?
Decrease in motivated self-initiated purposeful activities
What is alogia?
Diminished speech output
What is anhedonia?
Decreased abiilty to experience pleasure
What are the specific diagnostic criteria for schizophrenia?
Two or more of the following for most of 1 month; at least ONE of the first 3 symptoms
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganzed or catatonic behavior
- Negative symptoms
*remember, first 4 symptoms are POSITIVE symptoms
What is the time frame for diagnosing long standing schizophrenia?
Symptoms persist for at least 6 months
What is the clinical picture of a patient with schizophrenia (catatonic type)?
- Motoric immobility
- Excessive motor activity
- Extreme negativism or mutism
-Peculiarities of voluntary movement (posturing, stereotyped movements, mannerisms, grimacing)
Schizophrenics are highly susceptible to ________
Schizophrenics are highly susceptible to SUICIDE
To diagnose schizophrenia, what should you do first?
Rule out medical eitiologies:
Perform medical screening to rule out:
- Seizure disorders
- Metabolic disorders
- Thyroid dysfunction
- Brain tumor
- Neurosyphillis
- Street drug use
What is a major comorbid category of condition associated with schizophrenia?
Autoimmune disorders
What is the treatment fo acute psychosis in schizophrenia?
Hospitalization
IM injections of haloperidol, fluphenazine, lorazepam
What is the treatment for stabilization phase of schizophrenia?
2nd gen antipsychotics
What is the second generation antipsychotic drug associated with agranulocytosis?
Clozapine
What is the second generation antipsychotic drug associated with QTc prolongation?
Ziprasidone
What has been found to make symptoms of schizophrenia worse?
Insight oriented group and individual psychotherapy
(Making the patient more aware of their symptoms has been shown to make their symptoms WORSE!)
What are the diagnostic criteria of Delusional disorder?
- Presence of one or more delusions lasting at least 1 month
- Functioning is not impaired
What is the time frame for diagnosis of brief psychotic disorder?
Episode disturbance of at least 1 day but less than 1 month
What is the time frame of schizophreniform disorder?
Episode of the disorder that lasts at least 1 month but LESS THAN 6 months
What are the diagnostic criteria of schizoaffective disorder?
Delusions or hallucinations for 2 or more weeks in the ABSENCE of a major mood episode
What is substance/medication-induced psychotic disorder?
Presence of delusions and/or hallucinations that develop with the introduction or withdrawal of substance/medication
What are the timelines for
Schizophrenia
Schizophreniform
Brief psychotic disorder
Schizophrenia = > 6 months
Schizophreniform = 1-6 months
Brief psychotic disorder = <1 month
What is schizoid?
Very introverted
Voluntarily withdraws from social interactions
What is schizotypal?
Schizoid symptoms
+
Magical thinking/odd behavior
What is schizophrenia?
Schizotypal
+
Psychosis
What is schizoaffective?
Schizophrenia
+
Mood Disorder
