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(C) BD > Lecture 16: Schizo Disorders > Flashcards

Lecture 16: Schizo Disorders Flashcards

1
Q

What is psychosis?

A

A disturbance in the perception of reality.

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2
Q

What characterizes psychosis?

A

1+ of the following:
* Hallucinations
* Delusions
* Disorganized or incoherent speech
* Disorganized or catatonic behavior
* Abnormal emotions
* Cognitive difficulties

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3
Q

What is a hallucination?

A

SENSORY perceptions in the ABSENCE of any external stimuli.

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4
Q

What is an illusion?

A

SENSORY MISPERCEPTIONS of ACTUAL external stimuli

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5
Q

What is a delusion?

A

FIXED FALSE BELIEFS that persist even with evidence to the contrary.

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6
Q

Name that symptom!

Pt claims every time clothing touches her skin, it feels like it is “burning”

A

Illusion

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7
Q

Name that symptom!

Pt insists that the government is able to spy on him through his television, even when it is turned off, unless he leaves it unplugged and turns the screen to face the wall

A

Delusion

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8
Q

Name that symptom!

Pt reports hearing people laughing at her and insulting her; others around her are unable to hear these voices/comments

A

Hallucination

Auditory

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9
Q

Name that symptom!

Pt reports that he cannot eat because all food smells “like raw sewage”; he denies smelling this unless food is present in front of him.

A

Illusion

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10
Q

What is schizophrenia?

A

A psychiatric disorder with chronic or recurrent psychosis.
* Impaired functioning
* Severely disabling

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11
Q

What qualifies as schizophrenia?

A
  • Characteristic symptoms
  • Social/occupational dysfunction
  • 6 months
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12
Q

What is the hallmark sign or pathognomic finding for schizophrenia?

A

None. Every S/S can be seen in a different disorder.

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13
Q

What are positive symptoms?

A

Exaggeration of normal processes, usually due to increased dopamine activity.

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14
Q

What falls under positive symptoms?

A
  • Hallucinations
  • Delusions
  • Disorganized speech/thought/behavior
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15
Q

What are negative symptoms?

A

Diminution or absence of normal processes, usually due to decrease dopamine activity.

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16
Q

What is the most common type of hallucination?

A

Auditory.

Usually responsive to antipsychotics

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17
Q

What are the subtypes of delusions?

A
  • Delusions of persecution (someone is out to get me)
  • Delusions of grandeur (I’m a celebrity)
  • Cotard delusion/Nihilistic delusion (I do not really exist)
  • Erotomania (someone loves me)
  • Delusions of reference (A TV ad is speaking to me personally)
  • Delusions of control (Someone else is controlling my thoughts)
  • Somatic delusions (My body is infected)
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18
Q

What are the more commonly observed disorganized speech patterns?

A

Tangentiality (slowly goes off-course)
Circumstantiality (a lot of unneeded detail to get to the answer, often in a roundabout way)

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19
Q

What are the more severe disorganized speech patterns?

A
  • Derailment (rapid topic shift with no logical connection)
  • Neologisms (Creation of new, nonsensical words)
  • Incoherence (word salad)
  • Clanging (excessive rhyming or alliteration)
  • Concrete speech (inability to use abstract speech)
  • Preservation of ideas (consistenly returning to one topic despite conversation going differently)
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20
Q

What is catatonic behavior?

A

The inability to move normally.
Can be either negative or positive.

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21
Q

What is negative catatonic behavior?

A

Motiveless, abnormally decreased movement.
* Immobility
* Mutism
* Stupor
* Negativism
* Waxy Flexibility
* Posturing/catalepsy
* Staring

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22
Q

What is positive catatonic behavior?

A
  • Motiveless, abnormal increased movement
  • Grimacing
  • Teeth clicking
  • Rocking
  • Touching or tapping
  • Speech mannerisms
  • Echolalia (repeating someone’s words)
  • Echopraxia (repeating someone’s actions)
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23
Q

What are negative symptoms in schizophrenia?

A
  • Social withdrawal
  • Anhedonia
  • Flattened affect
  • Loss of motivation
  • Alogia (Decreased verbal communication)
  • Loss of hygiene
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24
Q

What is deficit schizophrenia?

A
  • Mostly negative symptoms
  • Mainly males
  • Less prone to addiction, suicidality, depression, or emotional delusions.
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25
Q

What is the most common psychiatric finding in schizophrenic patients?

A

Suicidal ideation

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26
Q

What is the most common substance abused in schizophrenic pts?

A

Nicotine

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27
Q

Why is schizophrenia considered a global issue?

A

Top 10 contributors to global disease burden.

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28
Q

What is the typical age of onset of schizophrenia?

A
  • Men: 10-25
  • Women: 25-35
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29
Q

What are the risk factors for schizophrenia?

A
  • 1st degree relative with schizophrenia
  • Male
  • OB complications or maternal malnutrition
  • Infections
  • Inflammation/autoimmune
  • Cannabis use
  • Immigrant use
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30
Q

What kind of twin has the highest risk for schizophrenia if the other has it?

A

Monozygotic/identical twins (50%)

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31
Q

A patient has a first-degree relative with schizophrenia. What familial factor would make them even more likely to develop schizophrenia?

A

Both parents being positive as well.

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32
Q

What gender is more likely to develop schizophrenia? What gender gets diagnosed later?

A

Males are slightly more likely to develop schizophrenia.
Women are more likely to be diagnosed later.

Men tend to have worse symptoms and worse prognosis.

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33
Q

What is the overall theory behind obstetrical complications leading to schizophrenia?

A

Maternal stress negatively impacts pregnancy

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34
Q

What infections in maternity or early childhood are linked to schizophrenia?

A
  • Influenza
  • Toxoplasma gondii (risk up to 70%)
  • HSV2 (maybe)
  • Measles antibodies
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35
Q

Increase of what in inflammation and autoimmune disorders is most linked to schizophrenia?

A

Increased cytokines.

Lower incidence of RA.

36
Q

Use of what drug is most commonly associated with psychosis in schizophrenia?

A

Cannabis use (dose-dependent)

37
Q

What are the neurochemical abnormalities that may cause schizophrenia?

A
  1. Dopamine hypothesis
  2. Glutamate/NMDA hypothesis
  3. GABA hypothesis
  4. Acetylcholine hypothesis
38
Q

How do antipsychotics work on dopamine?

A

All of them block dopaminergic D2 receptors.

39
Q

What is the now defunct serotonin hypothesis?

A

Excess serotonin causes psychosis

40
Q

How is glutamate related to schizophrenia?

A
  • Glutamate is the main excitatory NT.
  • Low functioning NMDA/glutamate receptors have psychosis symptoms.
41
Q

How is GABA related to schizophrenia?

A
  • Main inhibitory NT
  • Decreased functioning of GABAergic neurons in schizophrenic patients.
42
Q

How is acetylcholine related to schizophrenia?

A
  • Higher likelihood of smoking in schizophrenic patients.
  • Treatment with nicotinergic substances improve eye-tracking and some EEGs.
43
Q

How does the brain structure change in schizophrenia?

A
  • Decreased tissue overall
  • Larger ventricle size
  • Increase rate of brain tissue loss
  • Cognitive symptoms tend to appear before positive symptoms.
44
Q

What treatment option is best for positive symptoms?

A

Antipsychotics

45
Q

What treatment option is best for negative symptoms?

A

Atypical 2nd gen, specifically Cariprazine.

46
Q

How do we screen patients prior to starting therapy for schizophrenia?

A
  • BMI, waist circumference, HR, BP, EKG
  • AIMs score
  • CBC, Fasting CMP, Lipids, TFTs.
47
Q

How long should we trial a medication for schizophrenia?

A

6 weeks, as we may see a response in 1 week, but it could take much longer.

48
Q

When are typical 1st gen antipsychotics used typically?

A

Positive symptoms (dopamine receptor antagonists)

More SE.

49
Q

What are the higher potency 1st gen antipsychotics? Lower potency?

A
  • Lower potency: Chlorpromazine, thioridazine
  • Higher potency: Haloperidol, prochlorperazine

HP = higher potency, CT = low potency

50
Q

When are atypical 2nd gen antipsychotics used?

A

Positive and negative symptoms.
Dopamine and 5-HT antagonist.

Less SE

51
Q

What is neuroleptic malignant syndrome (NMS)?

A

A slow onset syndrome from the use of antipsychotics.
* Rigidity, fever, AUTONOMIC INSTABILITY, AMS
* Leads to fatal HTN crisis and metabolic acidosis
* Happens with any antipsychotics

52
Q

How do we treat NMS?

A
  • Cooling measures
  • Supportive tx
  • Dopaminergic meds.
53
Q

When is hyperprolactinemia seen as a SE?

A
  • Typicals (1st gen)
  • Risperidone
  • High dose olanzapine/ziprasidone
54
Q

When are anticholinergic SE seen as a SE?

A
  • Low potency typicals (CT)
  • Clozapine
  • High dose olanzapine/quetiapine
55
Q

When is sedation typically seen as a SE?

A
  • Low-potency typicals (CT) and clozapine
  • Olanzapine
  • Quetiapine
56
Q

What are extra-pyramidal SE?

A
  • Pseudoparkinsonism
  • Akathisia
  • Dystonia
  • Tardive dyskinesia
  • High-potency typical antipsychotics
57
Q

When is hypotension typically seen as a SE?

A
  • Low-potency typicals and clozapine
  • Risperidone/quetiapine in rapid titration.

Avoid in elderly or hypotensive patients!!

58
Q

Which antipsychotic can cause agranulocytosis?

A

Clozapine

59
Q

What do all antipsychotics do to a seizure threshold?

A

Decreases it, especially if it is even sedating.
Most likely in low-potency typicals or clozapine

60
Q

How do antipsychotics affect cardiac rhythm?

A
  • Causes arrthymias, prolonged QT and Torsades.
  • Most often seen with thiorizadine and ziprasidone
61
Q

What antipsychotics tend to cause metabolic syndrome? Which ones is it worst in?

A

Clozapine and olanzapine.

62
Q

What is the most common adverse SE of antipsychotics?

A

Weight gain

63
Q

What antipsychotics tend to cause dyslipidemia in the worst in metabolic syndrome?

A
  • Low-potency typicals
  • Clozapine
  • Olanzapine
  • Quetiapine
64
Q

How do we treat acute psychosis?

A
  • Lower doses
  • AVOID clozapine or olanzapine
65
Q

How do we manage psychosis post-episode?

A
  • Continue antipsychotic indefinitely
  • Psychotherapy to reintegrate into society
  • Close clinical followups.
66
Q

What would suggest a good prognosis for schizophrenia?

A
  • Later onset
  • Good social support
  • Positive symptoms
  • Acute onset
  • Female
  • Few relapses
  • Good premorbid functioning
  • Mood symptoms
67
Q

What are the two shorter forms of schizophrenia?

A
  • Brief psychotic disorder (< 1 month)
  • Schizophreniform disorder (1-6 months)
68
Q

What qualifies as brief psychotic disorder?

A
  • 1+ psychotic symptom
  • Acute onset
  • Episode at least 1 day but < 1 month.
  • Eventual return to pre-morbid level of functioning.
69
Q

What would suggest to us that a patient just has a brief psychotic disorder?

A
  • Marked stressor prior to episode
  • LACK of negative symptoms
  • Confusion early in illness
  • Short duration < 1 month.
70
Q

How do we treat brief psychotic disorder?

A

Usually an antipsychotic, up to 1-3 months after episode ends.

71
Q

What qualifies as schizophreniform disorder?

A
  • 2+ psychotic symptoms (more than brief)
  • Symptoms > 1 month but < 6 months
  • NEGATIVE SYMPTOMS present.
  • More rapid onset than classic schizo!
72
Q

What would suggest that schizophreniform has a good prognosis?

A
  • Acute onset, brief prodrome, good pre-morbid functioning, prominent mood symptoms.
73
Q

How do we treat schizophreniform disorder?

A
  • 2nd gen atypical antipsychotic
  • Hospitalization for acute psychosis
  • Psychotherapy

Pretty much same as schizophrenia.

74
Q

What qualifies as secondary psychotic disorder?

A
  • 1+ psychotic symptoms
  • Determined to be SECONDARY to another condition.
75
Q

What are some common medical causes of secondary psychotic disorder?

A
  • CNS infections
  • Cancer
  • Seizures
  • Thyroid/parathyroid/adrenal disease
  • Hypoxia
  • Hypoglycemia
  • Hepatic/renal impairment
  • SLE
76
Q

What are some common substances that can lead to secondary psychotic disorder?

A
  • Alcohol
  • Cannabis
  • Barbs/Benzos
  • Cocaine/meth
  • LSD/MDMA/PCP
  • Fluoroquinolones, antihistamines, steroids, levodopa
77
Q

What psychological disorders are often associated with secondary psychotic disorder?

A
  • MDD
  • BPD
78
Q

What are the big diagnostic clues for secondary psychotic disorder?

A
  • Presence of another disorder
  • Improvement of underlying cause + improvement of psychotic symptoms
  • Psychosis only present when underlying cause is active.
79
Q

What is the treatment of a secondary psychotic disorder?

A
  • Treating the underlying cause.
  • Antipsychotics if they are agitated
  • Psychotherapy
80
Q

What is the diagnostic criteria for schizoaffective disorder?

A
  • Meets criteria for schizo AND a major mood disorder
  • Both sets of symptoms are PROMINENT
  • 1+ 2 week period of hallucinations/delusions without the mood episode present.
  • Not due to a med.

Must have an episode that is JUST psychosis.

81
Q

Which mood disorder has a better outcome when paired with schizo in Schizoaffective disorder?

A
  • Bipolar has a better outcome.
  • Having both BPD and MDD together is actually better than having schizophrenia without mood symptoms.
82
Q

What is the first-line treatment for schizoaffective disorder?

A

Antipsychotics

83
Q

What is delusional disorder?

A
  • Isolated delusions in an otherwise high-functioning person for at least 1 month.
  • No other psychotic symptoms.
  • Hallucinations may be present, but are isolated to the theme of the delusion.

Typically NON-bizarre, such as being followed or being deceived.

84
Q

What are the 6 types of delusional disorders?

A
  • Erotomania: someone is in love with you
  • Grandiose: Powerful, special
  • Jealous: sexual partner is unfaithful
  • Persecutory: Someone out to get me
  • Somatic: I have a physical defect or medical condition
  • Mixed: No single theme predominates.
85
Q

How do we treat delusional disorder?

A
  • Antipsychotics, preferably atypical.
  • Difficult to get pts to take the med.
  • 2/3 of patients tend to improve significantly.

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