CM: Psychotic Disorders Flashcards
What characterizes psychotic disorders?
impaired reality testing - manifests as hallucinations, disturbed thought content, and disturbed thought process/form
What are hallucinations?
false sensory perceptions without external stimulus
auditory (most common) or visual
tactile, olfactory, and gustatory not common (substance intox or seizures)
What are delusions?
fixed, false beliefs not culturally sanctioned
persecutory, grandiose, religious, somatic, delusions of control (external force controls them), ideas of reference (believe certain things refer to him/her)
What are disturbed thought processes manifestations?
looseness of associations
incoherence
thought blocking (stopping mid-thought w no attempt to resume conversation)
perseveration (same answer for all questions)
verbigeration (meaningless repetition of word or phrase)
What is schizophrenia?
one month of at least 2 symptoms (must have either delusions or hallucinations, disorganized speech, disorganized or catatonic behavior, negative symptoms)
causes social or work dysfunction
total duration of symptoms at LEAST 6 months
prodromal and residual symptoms similar but less acute
What are positive symptoms of schizophrenia?
hallucinations, delusions, bizarre behavior, disordered thought process
What are negative symptoms of schizophrenia?
appear less problematic but affect fxning and PROGNOSIS
flat affect, alogia (poverty of speech), apathy, avolition (lack of motivation), anhedonia, impaired attention
What is the specifier for schizophrenia?
w catatonia - prominent motoric immobility or excessive, purposeless motor activity
may have negativism, mutism, posturing (maintenance of abnormal position), catalepsy (waxy flexibility, person maintains posture someone puts them in), echolalia (repetition of words/phrases spoken by another), echopraxia (imitation of another’s movements)
What is the downward drift hypothesis of schizo?
schizophrenia prohibits people from living up to biological potential
tend to drift into lower socioeconomic positions than when they were born
1/3 to 2/3 of homeless have schizo
What is the stress-diathesis model of schizo?
manifestation of illness requires 2 conditions: diathesis = predisposition, stressor
What is the role of glutamate in psychosis?
PCP and ketamine are anti-glutamate (at NMDA receptor) and can induce psychotic symptoms
What is the role of the hippocampus in psychosis?
allows humans to review past memories and form associations w present
abnormal blood perfusion and task-related cell activation in psychosis –> + symptoms
What is the pharmacological therapy of an acute episode of psychosis?
target symptoms, push dose, 4-6 week trial, switch don’t add, maintain on lowest effective dose
What are other treatment modalities of schizo other than pharm?
behavior therapy (social skills training) family therapy - inform on National Alliance for Mentally Ill case management - focus on care, compliance
What is the recovery-oriented treatment of schizo?
gold standard, places emphasis on consumer having sense of identity, developing personal goals, having sense of meaning in their lives, etc. - includes peer support, supported housing, supported employment
What is brief psychotic disorder?
primarily + symptoms, all resolve w/i 1 month
usually in response to stressful event
greater emotional turmoil and confusion while symptomatic, better prognosis
need to rule out delirium
What is schizophreniform disorder?
symptoms last at least 1 month and resolve w/i 6 months
What is schizoaffective disorder?
symptoms of schizo but also major depression and/or mania - times when psychosis w/o mood symptoms
differentiation from primary mood disorder w psychotic symptoms can only be done by history
prognosis better than schizo but worse than primary mood disorders
What is delusional disorder?
focused disorder of delusions about particular situation
no other psychotic symptoms, often diminishes in time
behavior NOT obviously bizarre or odd
What are medical conditions that can cause catatonic disorder?
neurological - neoplasms, head trauma, cerebrovascular dz, encephalitis
metabolic - hypercalcemia, hepatic encephalopathy, diabetic ketoacidosis
