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PSYCH ROTATION > First Aid: Psychotic Disorders > Flashcards

First Aid: Psychotic Disorders Flashcards

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1
Q

What are 3 symptoms that automatically tell you a patient is psychotic?

A
  • Perceptual disturbances (hallucinations)
  • Delusional thinking
  • Disordered thought process
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2
Q

Sensory perception without an actual external stimulus.

A

Hallucination

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3
Q

What is the most common type of hallucination exhibited by schizophrenics?

A

auditory

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4
Q

Which type of hallucination is most commonly seen with drug intoxication?

A

visual

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5
Q

Which type of hallucination is usually an aura associated with epilepsy?

A

olfactory

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6
Q

Which type of hallucination is usually secondary to drug abuse or alcohol withdrawal?

A

tactile

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7
Q

Misinterpretation of an existing sensory stimulus.

A

illusion

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8
Q

What is a loss of ego boundaries?

A

Unawareness of where one’s mind and body end and those of others begin

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9
Q

List the 3 major broad categories of medical causes of psychosis.

A

1) CNS disease
2) Endocrinopathies
3) Nutritional/Vitamin Deficiency States

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10
Q

What are the 3 major nutritional/vitamin deficiency causes of psychosis?

A
  • B12
  • Folate
  • Niacin
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11
Q

What is psychosis due to heavy metal toxicity grouped under?

A

Psychosis secondary to medication or substance use

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12
Q

To diagnosis psychosis secondary to a medical condition or medication/substance use, when must the prominent hallucinations or delusions occur?

A

NOT only during episodes of delirium

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13
Q

Name the positive symptoms of schizophrenia.

A
  • Hallucinations
  • Delusions
  • Disorganized speech
  • Grossly disorganized or catatonic behavior
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14
Q

Name the negative symptoms of schizophrenia.

A
  • Affect (flat/blunted)
  • Anhedonia
  • Apathy (avolition)
  • Attention (poor)
  • Alogia (poverty of speech)
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15
Q

What are the DSM-IV stipulations for diagnosing schizophrenia?

A
  • 2 or more of positive/negative symptoms that last for at least 1 month and cause significant social or occupational functional deterioration
  • Duration of illness for at least 6 months (including prodromal and residual phases)
  • Symptoms not due to medical, neurological or substance-induced disorder
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16
Q

List the 3 phases of schizophrenia.

A
  • Prodromal
  • Psychotic
  • Residual
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17
Q

What are some s/s of the prodromal phase of schizophrenia?

A

Decline in functioning preceding the first psychotic episode:

  • Social withdrawal
  • Irritability
  • Psysical complaints
  • Newfound interest in religion or the occult
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18
Q

What are some s/s of the psychotic phase of schizophrenia?

A
  • Perceptual disturbances
  • Delusions
  • Disordered thought process/content
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19
Q

What are some s/s of the residual phase of schizophrenia?

A

Occurs between episodes of psychosis:

  • Flat affect
  • Social withdrawal
  • Odd thinking or behavior
  • May have hallucinations (even with treatment)
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20
Q

Name the 5 subtypes of schizophrenia (DSM-IV).

A
  • Paranoid
  • Disorganized
  • Catatonic
  • Undifferentiated
  • Residual
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21
Q

How does a schizophrenic usually respond to proverbs/similarities?

A

Concrete understanding (no abstraction)

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22
Q

What is the typical level of insight for a schizophrenic patient?

A

Lack insight into disease

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23
Q

What is the typical age of presentation for schizophrenia?

A

Males- 20
Females- 30
NOT before 15 or after 45 (usually)

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24
Q

True or false: schizophrenia is more severe in women

A

FALSE: men have more negative symptoms and may be less able to function in society

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25
Q

Is schizophrenia genetic?

A
  • 12% risk if you have first degree relative

- 40% risk if both parents are affected

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26
Q

What is a common comorbidity affecting 50% of schizophrenics?

A

Postpsychotic depression

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27
Q

What is the “downward drift hypothesis”?

A

People suffering from schizophrenia are unable to function well in society and enter lower SES groups

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28
Q

Schizophrenia pathophysiology is thought to be related to what chemical?

A

increased dopamine activity

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29
Q

What drugs can induce a schizophrenia like episode?

A

cocaine and amphetamines

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30
Q

What dopamine pathway is thought to be responsible for negative symptoms of schizophrenia?

A

Prefrontal cortical

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31
Q

What dopamine pathway is thought to be responsible for positive symptoms of schizophrenia?

A

mesolimbic

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32
Q

Which dopamine pathway is blocked by neuroleptics and causes hyperprolactinemia?

A

tuberoinfundibular

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33
Q

Which dopamine pathway is blocked by neuroleptics and causes EPS?

A

nigrostriatal

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34
Q

CT scans of brains of schizophrenia patients show what?

A

enlargement of ventricles and diffuse cortical atrophy

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35
Q

List the other neurotransmitter abnormalities of schizophrenia?

A
  • Elevated serotonin
  • Elevated NE
  • Decreased GABA
36
Q

How does GABA potentially affect schizophrenia?

A
  • Loss of GABAergic neurons in hippocampus

- This possibly indirectly activates DA and NE pathways

37
Q

List some antipsychotics that antagonize 5-HT as well as DA?

A
  • Risperidone

- Clozapine

38
Q

What percentage of schizophrenics can function fairly well in society with medication?

A

20-30%

39
Q

What factors are associated with better prognosis for schizophrenics?

A
  • Later onset
  • Good social support
  • Positive symptoms
  • Mood symptoms
  • Acute onset
  • Female sex
  • Few relapses
  • Good premorbid functioning
40
Q

What factors are associated with worse prognosis for schizophrenics?

A
  • Early onset
  • Poor social support
  • Negative symptoms
  • Family Hx
  • Gradual onset
  • Male sex
  • Many relapses
  • Poor premorbid functioning
41
Q

What percentage of schizophrenics show significant improvement on medication?

A

70%

42
Q

What is another word for neuroleptic?

A

antipsychotic

43
Q

List the typical neuroleptics.

A
  • Chlorpromazine (low potency)
  • Thioridazine (low potency)
  • Trifluoperazine
  • Haloperidol
44
Q

What is the MOA of typical neuroleptics?

A

Mostly D2 antagonists

45
Q

List the atypical neuroleptics.

A
  • Risperidone
  • Ziprosidone
  • Clozapine
  • Olanzapine
  • Quetiapine
  • Aripiprazole
46
Q

What is the MOA of atypical neuroleptics?

A

Block DA and 5-HT receptors

47
Q

How long must you try a neuroleptic before efficacy is determined?

A

at least 4 weeks

48
Q

EPS are seen mostly with what type of antipsychotics?

A

High potency typical neuroleptics

haloperidol, trifluoperazine

49
Q

List the 3 major EPS.

A
  • Dystonia (spasms)
  • Parkinsonism (resting tremor, rigidity, bradykinesia)
  • Akathisia (restlessness)
50
Q

How do you treat EPS?

A

Antiparkinsonian agents (benzotropine, amantadine), benzodiazepines

51
Q

Anticholinergic sympoms are seen mostly with what type of antipsychotics?

A

Low potency typical neuroleptics

chlorpromazine, thioridazine

52
Q

List the common anticholinergic symptoms of antipsychotics.

A
  • Dry mouth
  • Constipation
  • BLurred vision
53
Q

What is the treatment plan for tardive dyskinesia?

A

Stop offending agent
Substitute atypical neuroleptic
Possible benzos, cholinomimetics, and beta-blockers

54
Q

Who gets tardive dyskinesia?

A

-Older women after at least 6 months of medication

55
Q

What are s/s of NMS?

A
  • Confusion
  • High fever
  • Elevated BP
  • Tachycardia
  • “Lead pipe” rigidity
  • Sweating
  • High CPK
56
Q

Is NMS an allergic reaction?

A

NO

57
Q

List some of the other s/s of antipsychotics.

A
  • Weight gain
  • Sedation
  • Orthostatic hypotension
  • ECG changes
  • Hyperprolactinemia
  • Dermatologic conditions
  • Hyperlipidemia
  • Glucose intolerance
58
Q

Which antipsychotic requires weekly blood draws?

A

clozapine (agranulocytosis)

59
Q

Which antipsychotic causes irreversible retinal pigemtnation at high doses?

A

thioridazine

60
Q

Which antipsychotic may cause deposits in the lens and corena?

A

chlorpromazine

61
Q

Who gets NMS?

A

men who have recently started medication

62
Q

What is the prognosis for NMS?

A

20% mortality

63
Q

What is the DSM-IV criteria for diagnosing schizophreniform disorder?

A

Same as schizophrenia but s/s last between 1-6 months rather than >6 months

64
Q

What is the prognosis for schizophreniform disorder?

A
  • 1/3 recover completely
  • 2/3 progress to schizoaffective or schizophrenia

(Mood disorder > brief psychotic disorder > schizoaffective disorder >
schizophreniform disorder > schizophrenia)

65
Q

How do you treat schizophreniform disorder?

A
  • Hospitalize
  • 3-6 months of antipsychotics
  • Supportive psychotherapy
66
Q

What is the DSM-IV criteria for diagnosing schizoaffective disorder?

A
  • Meet criteria for either major depressive episode, manic episode or mixed episode (during which criteria for schizophrenia are also met)
  • Have had delusions or hallucinations for 2 weeks in ABSENCE of mood disorder sympoms**
  • Have mood sympoms present for substantial portion or psychotic illness
  • Symptoms not due to general medical condition or drugs
67
Q

What is the prognosis for schizoaffective disorder?

A
  • Better than schizophrenia/schizophreniform
  • Worse than mood disorder

(Mood disorder > brief psychotic disorder > schizoaffective disorder >
schizophreniform disorder > schizophrenia)

68
Q

How do you treat schizoaffective disorder?

A
  • Hospitalization
  • Supportive psychotherapy
  • Antipsychotics (short term control of psychosis)
  • Mood stabilizers, antidepressants, or ECT for mania or depression
69
Q

What is the DSM-IV criteria for diagnosing brief psychotic disorder?

A

Same as schizophrenia but s/s last

70
Q

What is more common, brief psychotic disorder or schizophrenia?

A

schizophrenia

71
Q

What is the prognosis for brief psychotic disorder?

A
  • 50-80% recovery rate (worse than mood, better than schizoaffective)
  • 20-50% later diagnosed with schizophrenia or mood disorder
72
Q

How do you treat brief psychotic disorder?

A
  • Brief hospitalization
  • Supportive psychotherapy
  • Course of antipsychotics for psychosis
  • Benzos for agitation
73
Q

Who more commonly gets delusional disorder?

A
  • Older patients (>40)
  • Immigrants
  • Hearing impaired
74
Q

What is the DSM-IV criteria for diagnosing delusional disorder?

A
  • Non-bizarre, fixed delusion for at least 1 month
  • Does NOT meet criteria for schizophrenia
  • Functioning in life is NOT significantly impaired
75
Q

What type of delusion revolves around love?

A

erotomanic

76
Q

What type of delusion is associated with inflated self-worth?

A

grandiose

77
Q

What type of delusion is physical?

A

somatic

78
Q

What is the prognosis for delusional disorder?

A
  • 50% full recovery
  • 20% decreased sympoms
  • 30% no change
79
Q

What is the treatment for delusional disorder?

A
  • Psychotherapy

- Trial of high-potency typical antipsychotic or atypical (usually NOT effective)

80
Q

What is folie a deux?

A

shared psychotic disorder

81
Q

Who gets shared psychotic disorder?

A

family members (usually)

82
Q

What is the treatment/prognosis for shared psychotic disorder?

A
  • 20-40% improve upon removal from inducing person
  • Psychotherapy
  • Antipsychotic meds if symptoms not improved in 1-2 weeks after separation
83
Q

What is Koro?

A

Asian belief that pt’s penis is shrinking and will disappear causing death

84
Q

What is Amok?

A

Malaysian (SE Asian) people have sudden unprovoked outbursts of violence after-which the person has no recollection

85
Q

What is Brain fag?

A

African male students get HA, fatigue and visual disturbances

86
Q

What is a schizotypical personality?

A

Person has paranoid, odd or magical beliefs
Eccentric
Lacks friends
Social anxiety
(does not meet criteria for true psychosis)

87
Q

What is a schizoid personality?

A

Person is withdrawn
Lacks enjoyment from social interactions
Emotionally restricted

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