L8: Schizophrenia & Other Psychotic Disorders Flashcards
Def of Schizophrenia
A clinical syndrome of disruptive psychopathology characterized by:
- Disturbance in: Thinking, Emotions and Behavior
- Chronic course
- 3 phases: Prodromal → Active → Residual
Etiology of Schizophrenia
- Biological
- Psychosocial and Environmental factors
Epidemeology of Schizophrenia
Biological factors related of Schizophrenia
Psychosocial & Environmental factors of Schizophrenia
High expressed emotion families (High E E): Over critical, overinvolved, hostile - high relapse rate.
Clincal types of Schizophrenia
Types of symptoms of Schizophrenia
Clinical Picture aspects of Schizophrenia
- Onset & Course
- Talk
- Disorder of Thought
- Disorder of Perception
- Disorder of affect
- Motor symptoms Catatonic Symptoms
- Cognitive symptoms
- Hostility & Aggression
- Think of +ve symptoms as things that are …. onto normal behavior.
- Think of -ve symptoms as things that are ……. or missing from normal behavior.
- Added, Subtracted
DSM5Cr of Schizophrenia
Onset & Course of Schizophrenia
Disorders of thought in Schizophrenia
Talk in Schizophrenia
Disorders of Affect in Schizophrenia
Disorders of perception in Schizophrenia
Motor symptoms (Catatonic Symptoms) of Schizophrenia
Cognitive symptoms of Schizophrenia
Suicide Risk in Schizophrenia
Hostility & Aggression in Schizophrenia
DDx of Schizophrenia
Indications of hospitalization of schizophrenia
Prognosis of Schizophrenia
- From 10-20% have good outcome
- Up to 50% have poor outcome, with repeated hospitalizations, exacerbations of symptoms, and suicide attempts.
- 20% to 30% of patients continue to experience moderate symptoms.
Good Prognosis indicators in Schizophrenia
Managment of Schizophrenia
Antipsychotics in TTT of Schizophrenia
Select the right drug carefully in TTT of Schizophrenia, evaluating:
- Efficacy
- How it makes the patient feel (eg, sedated)
- How it affects patient health (eg, weight gain, metabolic risks)
- Include evidence-based psychosocial treatment or rehabilitation
Elderly, medically ill patients who present with psychotic symptoms such as hallucinations, confusion, or paranoia should be carefully evaluated for …….. , which is a far more common finding in this population.
Delirium
Stereotyped movement, bizarre posturing, and muscle rigidity are examples of …….., a syndrome which can be seen in …………
- catatonia
- schizophrenia, depression, bipolar disorder, and other psychiatric conditions.
Response of Positive & Negative Symptoms to antipsychotics
- Positive symptoms tend to respond more robustly to antipsychotic medications
- Negative symptoms are more often treatment resistant and contribute significantly to the social isolation and impaired function of schizophrenic patients
what are other psychotic disorders?
- Brief psychotic disorders.
- Schizophreniform disorders.
- Schizoaffective disorders.
- Delusional disorders.
- Psychotic disorders not otherwise specified. (Postpartum psychosis)
- Psychotic disorders due to GMC & SAD.
Characters of Brief Psychotic Disorder
Epidemeology of Brief Psychotic Disorder
Managment of Brief Psychotic Disorder
DSM5Cr of Brief Psychotic Disorder
Epidemeology of Schizophreniform Disorder
A. Lifetime prevalence of is approximately 0.2%.
B. Males : females are equal
C. Depressive symptoms commonly coexist and are associated with an increased suicide risk.
DSM5Cr of Schizophreniform Disorder
Managment of Schizophreniform Disorder
DSM5Cr of Schizoaffective Disorder
Clinical Features in Schizophreniform Disorder
- Symptomatology, including positive and negative psychotic features, is the same as schizophrenia.
- Social and occupational functioning may or may not be impaired.
Types of Schizoaffective Disorder
Bipolar Type:
- Diagnosed when a manic or mixed episode occurs Major depression may also occur.
Depressive type:
- Diagnosed if only major depressive episodes occur.
Epidemeology of **Schizoaffective D
- The lifetime prevalence is < 1%
- First-degree biological relatives of schizoaffective disorder patients have an increased risk of schizophrenia as well as mood disorders
Managment of Schizoaffective Disorder
DSM5Cr of Delusional Disorder
Epidemeology of Delusional Disorder
- The prevalence is about 0.03%.
- Mean age of onset is between 35-45 years
- Males and females are equal
Clinical Features of Delusional Disorder
- The presence of a non-bizarre delusion is the cardinal feature of this disorder.
- The delusion must be plausible, such as believing that someone is trying to harm them.
- Patient’s thought processes are normal except when discussing the specific delusion.
- The insight of patients into their illness is generally poor.
Types of Delusional Disorder
Managment of Delusional Disorder
Antipsychotics:
1. Start low and go slow to gain the compliance of the patient
2. Give trial for 6 weeks the either augment or substitute.
3. Delusional disorders are often refractory to antipsychotic medication.
4. The previous response is the best guide to antipsychotic selection.
Psychotherapy:
- family or couples therapy, may offer some benefit
Prognastic factors in Schizophrenia
Time Course of schizophrenia spectrum disorders
Prognosis of psychotic disorders from Best to Worst
Mood disorder with psychotic features > schizoaffective disorder > schizophreniform disorder > schizophrenia.
Difference between schizophrenia & delusional disorder
