Diagnoses I Flashcards
Time requirement for
(a) scz
(b) brief psychotic d/o
(c) schizophreniform
(d) schizoaffective
(e) delusional d/o
Time requirement
(a) scz: 6+ mo of symptoms for illness. 2+ symptoms present for at leats 1 mo. 6 mo including prodrome or residual period
(b) brief psychotic d/o: at least 1 day, return to fxn w/in 1 mo
(c) schizophreniform: 1-6 mo
(d) schizoaffective: 2 weeks of positive symptoms (delusions/hallucinations) w/o mood symptoms
(e) delusional d/o: 1+ mo
Percent of scz pts that
(a) attempt suicide
(b) complete suicide
(c) M:F
Scz genetic component
(d) monozygotic twins
(e) first degree relatives
Scz
(a) 50% attempt suicide
(b) 15% complete suicide
(c) M = F (men have worse prognosis)
Genetics
(d) 50% incidence btwn monozygotic twins
(e) 10% incidence btwn first degree relatives
Neurotransmitter etiology of scz
(a) DA
(b) 5HT
(c) NE
Scz etiology
(a) Increased DA in limbic system => positive symptoms
(b) Increased 5HT in prefrontal cortex => negative symptoms
(c) Decreased NE => anhedonia
Brain image findings of scz
- *Ventricular enlargement
- cortical atrophy
- hypoactivity of frontal lobes on PET scan
Prognosis of pts w/ schizophreniform
- 1/3 recover
- 2/3 progress to schizophrenia
Tx for
(a) delusional d/o
(b) schizophreniform
(c) schizoaffective
(d) brief psychotic d/o
Tx
(a) delusional d/o- low dose antipsychotic
(b) schizophreniform- 3-6 mo. antipsychotics + supportive psychotherapy
(c) schizoaffective- concurrent antipsychotics + antidepressants
(d) brief hospitalization, supportive psychotherapy, short course of antipsychotics
What is pseudocyesis
Physiologic signs and symptoms of pregnancy in absence of pregnancy-cultural psychosis/common delusion
What is folie-a-deux?
Literally means “a madness shared by 2”-when delusions/hallucinations are transmitted from one to another
Age of onset for scz
Before 45 yoa
M: 15-25
F: 25-35
Lifetime prevalence of
(a) scz
(b) delusional d/o
(c) schizoaffective
Life prevalence of
(a) scz: 1-1.5%
(b) delusional d/o: .03%
(c) schizoaffective: less than 1%
Scz vs. schizoaffective
(a) link?
(b) prognosis
(c) tx
(d) time course
(e) features
Schizophrenia vs. schizoaffective
(a) Schizoaffective has no clear link to scz, but 6–80% of schizoaffective pts will progress to scz
(b) Schizoaffective has a better prognosis
(c) Scz- first line is atypicals, schizoaffective- use both antipsychotics + antidepressants
(d) Scz at least 6 mo, schizoaffective: at least 2 weeks of positive symptoms and no mood symptoms in absence of psychotic sx
Differentiate scz and delusional d/o
Delusional d/o: only delusions (no other symptoms) and function is NOT impaired
Differentiate the subtypes of scz
(a) disorganized
(b) paranoid
(c) catatonic
(d) residual
(e) undifferentiated
Subtypes of scz
(a) Disorganized: prominent disorganized speech, inappropriate affect,
- characterized by disorganized speech and flat/inappropriate affect
- NOT catatonic. Early onset
(b) Paranoid: preoccupied w/ particular delusion.
- characterized by delusions and AH
- NO: disorganized speech, catatonia, inappropriate affect. Later onset
(c) Catatonic- motor immobility, excessive motoric activity, rigidity, echolalia, echopraxia. Rarest
(d) Residual- absence of (+) symptoms for some time, but still have negative symptoms
- prominent negative symptoms
(e) Undifferentiated- NOS
Which subtype of scz is
(a) early onset
(b) late onset
(c) rarest
Subtype of scz
(a) early onset = disorganized
(b) later onset = paranoid
(c) rarest = catatonia
Prognosis of brief psychotic disorder
50-80% have no further psychiatric problems
-very rare diagnosis
Dx: pt meets scz criteria for btwn 1 day to 1 month
Differentiate
(a) thought insertion
(b) broadcasting
(c) thoughts of reference
Differentiate
(a) thought insertion- think others are putting thoughts in your head
(b) broadcasting- others can hear your thoughts
(c) thoughts of reference- from tv/radio, things are related to pt
What d/o are the following types of hallucinations associated with
(a) auditory
(b) visual
(c) tactile
(d) olfactory
Hallucinations
(a) Auditory- most commonly exhibited in schizophrenic pts
(b) Visual- less common in scz. May accompany drug intoxication, drug/alcohol withdrawal, or delirium
(c) Tactile- drug abuse or EtOH withdrawal
(d) Olfactory- common in seizures, usually an aura associated w/ epilepsy
ADHD
(a) Prevalence
(b) Gender difference
(c) Most common comorbidity
(d) Hormonal mechanism
(e) Prevalence of symptoms continuing into adulthood
ADHD
(a) 5-7% school aged children
(b) Boys > Girls (3-5:1)
(c) 2/3 comorbid w/ CD/ODD. 25% risk of ASPD
(d) Dysregulation of NE
(e) 60% have symptoms into adulthood
Age of onset for ADHD
Symptoms have to be present before age 7.
-onset may be as early as age 3
Signs of ADHD in
(a) Preschool
(b) Elementary
(c) Adolescents
(d) Adults
Signs of ADHD
(a) Preschool- temper tantrums
(b) Elementary- difficult peers/noncompliance
(c) Adolescents- internal sense of restlessness rather than motor
(d) Adults- chronic disorganization
Name the stimulants used to treat ADHD
Stimulants for ADHD
- methylphenidates: Ritalin, Concerta
- dexmethylphenidate: Focalin
- dextroamphetamine: Dexedrine, DextroStat
- dextroamphetamine/amphetamine: Adderall
- Lysine-dextroamphetamine: Vyvanse
Name the non-stimulants used to treat ADHD
Nonstimulants for ADHD
- Atomoxetine (Strattera): NE reuptake inhibitor
- Buspirone (Buspar): 5HT1A partial agonist
- alpha 2 agonists: clonidine, guanfacine
Requirements for diagnosis of ADHD
ADHD diagnosis:
- symptoms present before age 7
- must occur in two settings (ex: home and school)
- Inattention type: 6+ features of inattention for 6+ months
- Hyperactivity/impulsivity: 6+ features
- Mixed = meet criteria for both
Name symptoms of inattention for ADHD
Inattention (6+ features for 6+ months)
- inattention to detail
- difficulty sustaining attention
- does not follow through
- organization fail
- avoids tasks that require sustained effort
- loses things, easily distracted
- doesn’t listen
Name symptoms of the following for ADHD
(a) Hyperactivity
(b) Impulsivity
Hyperactivity/impulsivity (6+)
(a) Hyperactivity
- often leaves seat, runs or climbs
- difficulty playing or leisuring
- often ‘on the go’
- often talks excessively
(b) Impulsively
- often blurts out answers
- often has difficulty awaiting turn
- often interrupts
Tx besides meds for ADHD
- psychotherapy
- parental counseling