First Aid Psychiatry: Psychotic Disorders Flashcards
Delusion
fixed, false beliefs that remain despite evidence to the contrary
bizarre vs. nonbizarre delusion
bizarre: impossible
nonbizarrie: possible
Delusions of persecution/paranoid delusions
Irrational belief that one is being persecuted
Ideas of reference
Belief that cues in the external environment are uniquely related to the individual
Delusions of control: 2 types
- thought broadcasting
2. thought insertion
thought broadcasting
belief that one’s thoughts can be heard by others
thought insertion
belief that others’ thoughts are being placed in one’s head
Delusions of grandeur
Belief that one has special powers beyond those of a normal person
Delusions of guilt
belief that one is guilty or responsible for something
Somatic delusions
belief that one is infected with a disease or has a certain illness
” I am responsible for all world’s war”
Delusion of guilt
“The TV characters are speaking directly to me”
Ideas of reference
“The CIA is after me and tapped my phone”
Delusions of persecution/paranoid delusions
command hallucinations
auditory hallucinations that directly tell the patient to perform certain acts
auditory hallucinations are seen in
schizophrenic patients
visual hallucinations are seen in
drug intoxication, drug and alcohol withdrawal or delirium
olfactory hallucination seen in
epilepsy
tactile hallucination seen in
drug use or alcohol withdrawal
difference between illusion and hallucination
illusion: existing sensory stimulus
hallucination: no external stimulus
DSM- 5 criteria for psychotic disorder due to another medical condition
- prominent hallucinations or delusions
- symptoms do not occur only during an episode of delirium
medical causes of psychosis
- CNS disease
- Endocrinopathies ( cushing, addison)
- Nutritional/Vitamin deficiency (B12/folate)
Elderly, medically ill patients who present with psychotic symptoms such as hallucinations, confusion, or paranoia should be carefully evaluated for what
delirium
what are the three categories for schizophrenia symptoms
Positive
negative
cognitive
three phases of schizophrenia
- Prodromal
- Psychotic
- Residual
prodromal phase
decline in functioning that precedes the 1st psychotic episode
-withdrawn, decline school performance
psychotic phase
- perceptual disturbances
- delusions
- disordered thought
Residual phase
following an episode of active psychosis
- mild hallucinations or delusions, social withdrawal and negative symptoms
what drug is considered when a patient fails both typical or other atypical antipsychotic? Potential adverse effects
Clozapine: agranulocytosis
Name 5 negative symptoms of schizophrenia
Anhedonia affect (flat) Alogia ( poverty of speech) Avolition (apathy) Attention (poor)
DSM 5 criteria for schizophrenia
2 or more must be present for 1 month 1. delusions 2. hallucinations 3. Disorganized speech 4. disorganied behavior 5. negative symptoms 1 of them must be 1,2,or3
when do men present with schizophrenia
mid 20s
when do women present with schizophrenia
late 20s
most commonly comorbid abused substance for schizophrenia
- nicotine
- alcohol
- cannabis
- cocaine
downward drift hypothesis
lower socioeconomic groups have higher rate of schizophrenia
a phenomenon of schizophrenic patients develop what after resolution of their psychotic symptoms
post-psychotic depression
children born when have higher incidence of schizophrenia
late winter or early spring
akathesis
restlessness
what is the main neurotransmitter that causes schizophrenia? pathways?
dopamine increase
- prefrontal cortical: decrease dopamine causes negative symptoms
- mesolimbic: increase dopamine causes positive symptoms
- tuberoinfundibular: blocked my antipsychotic
- nigrostriatal: blocked by antipsychotics
blocking nigrostriatal pathway causes what symptoms
parkinsonism, tremor, slurred speech
blocking tuberoinfundibular pathway causes what symptoms
gynecomastia
other neurtransmitter abnormalities in Schizophrenia
- elevated serotonin
- elevated NE
- decrease GABA
- Decrease glutamate
CT and MRI for schizophrenia shows
- enlarged ventricles
- diffuse cortical atrophy
- reduced brain volume
neologisms
newly coined term or expression that has meaning only to the person who uses it
Prognosis for schizophrenia: late onset
good
Prognosis for schizophrenia: early onset
bad
Prognosis for schizophrenia: good social support
good
Prognosis for schizophrenia: positive symptoms
good
Prognosis for schizophrenia: negative symptoms
bad
Prognosis for schizophrenia: family history
bad
Prognosis for schizophrenia: mood symptoms
good
Prognosis for schizophrenia: gradual onset
bad
Prognosis for schizophrenia: acute onset
good
Prognosis for schizophrenia: female
good
Prognosis for schizophrenia: male
bad
MOA for second generation antipsychotics
antagonize serotonin and dopamine
what type of therapy is good for schizophrenia
behavioral, family and group
Treatment for extrapyramidal symptoms
Benztropine, diphenhydramine,
- Benzodiazepine, beta blockers (akathesia)
Treatment for tardive dyskinesia
Benzodiazepine, Botox and vitamin E
what medication usually causes neuroleptic malignant syndrome
high-potency first-generation antipsychotics
how to diagnose Schizoaffective
- meet criteria for either major depressive or manic episode during which psychotic symptoms of schizophrenia are met also
- Delusions or hallucinations for 2 weeks in absence of mood disorder
who usually gets delusional disorder
middle-aged or older patients after age 40
Erotomanic type
delusion that another person is in love with the individual
grandiose type
delusions of having great talent
somatic type
physical delusions
persecutorytype
delusions of being persecuted
Jealous type
delusions of unfaithfulness
mixed type
more than one type of delusion
Difference between Schizophrenia and Delusional disorder
Delusional disorder: nonbizarre delusions
- daily functioning not significantly impaired
- does not meet criteria for schizophrenia
Koro
Southeast Asia
- intense anxiety that the penis will recede into the body, possibly death
Amok
Malaysia
- Sudden unprovoked outbursts of violence, often followed by suicide
Brain fag
Africa
Headache, fatigue, eye pain, cognitive difficulties in make students
Schizoid
Solitary activities, lack of enjoyment from social interactions
- NO psychosis
Schizotypal
odd or magical beliefs
- criteria for overt psychosis are not met
Echolalia
repeat words or phrases
echopraxia
mimic behavior
PRAxia: Practice behavior
what drugs create schizophrenic like symtpoms
cocaine and amphetamines
What disorder usually has has neologism
Schizophrenia
how long should second generation antipsychotics be tried before quitting
4weeks
what causes extrapyramidal symptoms
high-potency first generation antipsychotics
treatment for extrapyramidal symptoms
Benztropine
Diphenhydramine
Benzodiazepines/Beta blocker for akathisia
what are the extrapyramidal symptoms
ADAPT
what causes anticholinergic symtpoms
Low-potency first generation antipsychotics
what causes metabolic symptoms
second-generation antipsychotics
what causes neuroleptic malignant syndrome
high-potency first-generation antipsychotics
how is schizoaffective and mood disorder with psychotic features distinguished
schizoaffective: delusions or hallucinations for 2 weeks in absence of mood disorder
Can you diagnosed brief psychotic disorder with someone with borderline personality
no, psychotic features are part of personality
criteria for delusional disorder
one or more delusions for at least 1 month
