First Aid CH3 Psychotic Disorders

Question 1

define psychosis

Answer 1

distorted perception of reality
- delusions, illusions, hallucinations, disorganized thinking/behavior

sx of: schizophrenia, mania, depression, delirium, dementia, substance/med-induced

Question 2

delusions

Answer 2

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)

Question 3

types of delusions

Answer 3

grandeur
paranoid
reference
thought broadcasting
religious
somatic

Question 4

perceptual disturbances

Answer 4

illusion (stim) vs hallucination (no stim)

Question 5

ddx for psychosis

Answer 5

• 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

Question 6

schizophrenia sxs: positive vs negative vs cognitive

Answer 6

pos (treatable): hallucinations, delusions, behaviors, disorg speech
neg (tx resistant): flat affect, anhedonia, apathy, lack of socialization
cog: impairments in executive function and memory

Question 7

three phases of schizophrenia

Answer 7

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

Question 8

echolalia vs echopraxia

Answer 8

repeats words or phrases 
mimics behavior (practices behavior)

Question 9

timelines for schizophrenic pts

Answer 9

brief psychotic disorder < 1 month
schizophreniform 1 - 6 months
schizophrenia > 6 months

Question 10

do patients w/ schizophrenia have lack of insight into their dx?

Answer 10

yes

Question 11

M vs F presentation

Answer 11

M = early 20s and poorer outcome
F = late 20s

Question 12

most commonly abused substance in schizophrenia

Answer 12

nicotine > ETOH > cannabis and cocaine

Question 13

downward drift

Answer 13

schizophrenia found in lower socio-economic groups d/t difficulty in holding good jobs, many homeless people in urban areas are schizophrenic

Question 14

what neurotransmitter is thought to be associated w/ schizophrenia?

Answer 14

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

Question 15

akathisia

Answer 15

unpleasant subjective sense of restlessness, inability to sit still

Question 16

does schizophrenia have a genetic component?

Answer 16

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

Question 17

CT results for schizo pt

Answer 17

enlarged ventricles and diffuse cortical atrophy, reduced brain volume

Question 18

neologisms

Answer 18

newly coined word or expression that has meaning only to the person who uses it, seen in schizo

Question 19

schizo tx outcomes

Answer 19

50% remain impaired, 30% can function well in society, 20% attempt suicide

Question 20

associated w/ good prognosis of schizo

Answer 20

later and acute onset
good social support
positive sxs
F gender
good pre-morbid functioning

Question 21

associated w/ bad prognosis of schizo

Answer 21

early and gradual onset
poor social support
negative sxs
fam history
M gender
comorbid substance abuse

Question 22

schizo tx

Answer 22

antipsychotic (typicals and atypicals) meds, behavioral therapy

typicals tx positive sxs, not neg

Question 23

what needs to be monitored with second-gen antipsychotics?

Answer 23

metabolic syndrome

- wt, BMI, fasting glucose, lipid panel, BP

Question 24

NMS

Answer 24

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

Question 25

elevated prolactin levels result from?

Answer 25

risperidone

causes gynecomastia, galactorrhea, amenorrhea, diminished libido, impotence

Question 26

tardive dyskinesia cumulative risk from antipsychotics

Answer 26

5% per year

Question 27

prognosis for schizoaffective disorder

Answer 27

worse w/ poor premorbid ajustment, slow and early onset, predominance of psychotic sxs, long course, family history

Question 28

tx of schizoaffective disorder

Answer 28

antipsychotics (second gen), mood stabilizers

Question 29

treatment for delusional disorder

Answer 29

antipsychotics and supportive therapy

avoid group therapy d/t pt’s suspiciousness of others