First Aid CH3 Psychotic Disorders Flashcards
define psychosis
distorted perception of reality
- delusions, illusions, hallucinations, disorganized thinking/behavior
sx of: schizophrenia, mania, depression, delirium, dementia, substance/med-induced
delusions
fixed false beliefs that remain despite evidence to the contrary and cannot be accounted for by the cultural background of the individual, bizarre (impossible) vs non-bizarre (not impossible)
types of delusions
grandeur paranoid reference thought broadcasting religious somatic
perceptual disturbances
illusion (stim) vs hallucination (no stim)
ddx for psychosis
- psychotic disorder d/t another medical condition (CNS dx, endocrinopathies, vit def, SLE, temporal arteritis)
- substance/med-induced (anesthetics, corticosteroids, anti-convulsants, antihistamines, anti-Ach, antihypertensives, NSAIDs, methylphenidate, chemo agents, ETOH, cocaine, hallucinogens, cannabis, benzos and barbs, PCP… all intoxication or withdrawal)
delirium/dementia
bipolar disorder (manic episodes)
Major depression w/ psychotic fxs
brief psychotic disorder
schizophrenia
schizophreniform disorder
schizoaffective disorder
delusional disorder
schizophrenia sxs: positive vs negative vs cognitive
pos (treatable): hallucinations, delusions, behaviors, disorg speech
neg (tx resistant): flat affect, anhedonia, apathy, lack of socialization
cog: impairments in executive function and memory
three phases of schizophrenia
prodromal: declined functioning prior to first psychotic episode
psychotic: perceptual disturbances, delusions, disordered thought process/content
residual: follows episode of psychosis, negative sxs plus mild delusions or perceptual disturbances
echolalia vs echopraxia
repeats words or phrases mimics behavior (practices behavior)
timelines for schizophrenic pts
brief psychotic disorder < 1 month
schizophreniform 1 - 6 months
schizophrenia > 6 months
do patients w/ schizophrenia have lack of insight into their dx?
yes
M vs F presentation
M = early 20s and poorer outcome F = late 20s
most commonly abused substance in schizophrenia
nicotine > ETOH > cannabis and cocaine
downward drift
schizophrenia found in lower socio-economic groups d/t difficulty in holding good jobs, many homeless people in urban areas are schizophrenic
what neurotransmitter is thought to be associated w/ schizophrenia?
dopamine both high and low levels (pending on brain region), dopamine antagonists seem to be most effective tx, cocaine and amphetamine use inc dopamine and can cause schizo-like sxs
prefrontal cortex: low DA activity > neg sxs
mesolimbic: inc DA activity > pos sxs
elevated serotonin also plays a role
akathisia
unpleasant subjective sense of restlessness, inability to sit still
does schizophrenia have a genetic component?
yes, if one identical twin has schizo there’s 50% other twin has it
adopted kids whose bio parents have schizo is at inc risk for schizo
CT results for schizo pt
enlarged ventricles and diffuse cortical atrophy, reduced brain volume
neologisms
newly coined word or expression that has meaning only to the person who uses it, seen in schizo
schizo tx outcomes
50% remain impaired, 30% can function well in society, 20% attempt suicide
associated w/ good prognosis of schizo
later and acute onset good social support positive sxs F gender good pre-morbid functioning
associated w/ bad prognosis of schizo
early and gradual onset poor social support negative sxs fam history M gender comorbid substance abuse
schizo tx
antipsychotic (typicals and atypicals) meds, behavioral therapy
typicals tx positive sxs, not neg
what needs to be monitored with second-gen antipsychotics?
metabolic syndrome
- wt, BMI, fasting glucose, lipid panel, BP
NMS
seen in first-gen high-potency anti-psychotics, widespread m contraction
- AMS, high fever, labile BP, tachy, diaphoresis, “lead pipe” rigidity, elevated CPK, metabolic acidosis
