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NU615 Management/Care Clients Acute/Chronic Mental Health Conditions 1 > Module 4 psychotic disorders > Flashcards

Module 4 psychotic disorders Flashcards

1
Q

What are persecutory delusions?

A

belief that one is going to be harmed or harassed by an individual or group

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2
Q

What is a grandiose delusion?

A

an individual believes he has exceptional abilities

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3
Q

What are erotomanic delusions?

A

believes falsely someone else is in love with them

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4
Q

What is referential delusions?

A

Everything around them has meaning to them or refers to them

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5
Q

What is nihilistic delusions?

A

The thought that a maor catastrophe will occur

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6
Q

What is a somatic delusion?

A

Preoccupation with health and organ function

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7
Q

What are bizarre delusions?

A

Clearly implausible, not understandable based on cultural context, includes:
Thought withdrawal, thought insertion, or delusions of control of mind or body by outside force

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8
Q

What is the most common type of hallucination?

A

auditory

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9
Q

Tell me about auditory hallucinations as you fall asleep.

A

They are considered normal

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10
Q

What is included in disorganized thinking (speech)?

A

derailment or loose associations (one topic to another) or word salad (severely disorganized)

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11
Q

What is catatonic behavior?

A

decreased reactivity to environment, can occur in many mental, medical disorders

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12
Q

What are the 5 negative symptoms?

A

Affective blunting, avolition, anhedonia, alogia, asociality

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13
Q

What does affective blunting mean?

A

decreased range of emotions

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14
Q

What does avolition mean?

A

Reduced desire, motivation, persistence

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15
Q

What is anhedonia

A

reduced ability to experience pleasure

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16
Q

What does alogia mean?

A

poverty of speech

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17
Q

What does asociality mean?

A

reduced social drive and interaction

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18
Q

What are some observable signs of negative symptoms?

A

reduced speech, poor grooming, limited eye contact

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19
Q

What are some identified signs of negative symptoms with questioning?

A

reduced emotional responsiveness, reduced interest, reduced social drive

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20
Q

What symptoms are considered part of schizophrenia? (5)

A

delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms

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21
Q

How long should symptoms last in schizophrenia?

A

6 months

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22
Q

In schizophrenia, how long should predromal or residual symptoms as well as criterion A be present?

A

1 month

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23
Q

How many criterion A symptoms must be present in schizophrenia?

A

2

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24
Q

How many Criterion A must be present in schizophreniform be present?

A

2 or more

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25
Q

How long should symptoms be present in schizophreniform be present?

A

greater than 1 month but less than 6 months

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26
Q

What is the difference of impairment between schizophrenia and schizophreniform?

A

In schizophrenia, function must be severely impaired while schizophreniform may be impaired but it is not criteria

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27
Q

What is the prevalence of schizophrenia?

A

0.3-1%

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28
Q

What are the biggest indicators of brief psychotic disorder?

A

Sudden onset, does not include negative symptoms, and lasts longer than 1 day but less than 1 month, returns to premorbid function

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29
Q

What is the prevalence of brief psychotic disorder?

A

9% of first onset psychosis, twice as common in females, average onset in mid 30’s

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30
Q

What are the biggest indicators of delusional disorder?

A

presence of 1 or more delusions for more than 1 month, hallucinations are only related to theme and not prominent if present, function is not markedly impaired

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31
Q

What is the prevalence of delusional disorder?

A

0.2%

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32
Q

What psychotic symptoms are present in substance/medication induced psychotic disorder?

A

hallucination and delusion

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33
Q

When do symptoms occur with substance/medication induced psychotic disorder?

A

during or soon after substance intoxication withdrawal, or after exposure to a medication

34
Q

What is the level of impairment with substance/medication-induced psychotic disorder?

A

significant impairment or distress in various functional domains

35
Q

What symptoms indicate schizoaffective disorder?

A

2 or more symptoms present in schizophrenia criterion A, delusions or hallucinations for 2 or more weeks without a major mood episode during the lifetime of the illness.

36
Q

What is the function level of a person with pschizoaffective disorder?

A

impaired, but not as impaired as schizophrenia

37
Q

Explain specified/ unspecified schizophrenia disorder

A

Specified: significant distress in various functional domains but doesn’t meet full criteria for disorder and the clinician explains the reasoning. Unspecified: same but the clinician does not explain the reasoning

38
Q

What setting would specified schizophrenia disorder occur in?

A

outpatient settings with initial visit

39
Q

What setting would specified schizophrenia disorder occur in?

A

ED with insufficient historical information

40
Q

Catatonia is associated with what 5 other disorders?

A

neurodevelopmental, psychotic, bipolar, depressiv

41
Q

What are the essential features of catatonia?

A

marked psychomotor disturbance; ranges from marked unresponsiveness to marked agitation

42
Q

What are some of the features of catatonia?

A

stupor (severe motor immobility); cataplexy (passive induction of a posture held against gravity); waxy flexibility (slight even resistance to positioning by examiner); mutism (no, or very little response); negativism (opposition or no response to instructions or external stimuli); posturing (spontaneous and active maintenance of a posture against gravity); mannerism (add, circumstantial caricature of normal actions); stereotypy (repetitive, abnormally frequent, non-goal-directed movements); grimacing; echolalia (mimicking another’s speech); echopraxia (mimicking another’s movements)

43
Q

How many of the features of catatonia must be present to qualify?

A

3 or more

44
Q

What are abnormal brain structures of schizophrenia?

A

enlarged ventricles, smaller frontal temporal lobes, cortical atrophy, decreased cerebra blood flow, hippocampal and amygdala reduction

45
Q

Positive symptoms include (7)

A

delusions, hallucinations, distortions/exaggerations in language and communication, disorganized speech, disorganized behavior, catatonic behavior, agitation

46
Q

The mesocortical dopamine pathway is responsible for what types of symptoms in treated and untreated psychosis?

A

Treated and untreated

47
Q

what is the consequence of neurodevelopmental abnormalities in NMDA system?

A

Mesocortical Dopamine pathway

48
Q

In treated psychosis, the mesolimbic is…..

A

normal

49
Q

In treated psychosis, the mesocortical is….

A

normal or continued low, depending on medication chosen

50
Q

In treated psychosis, what happens to the nigrostriatal pathway?

A

normal or low resulting in extrapyramidal side effects EPS) depending on medication

51
Q

What is tardive dyskinesia the result of?

A

result of chronic D2 blockade in the nigrostriatal pathway

52
Q

How does D2 cause tardive dyskinesia?

A

compensatory upregulation of dopamine receptors with compensatory increase in dopamine release

53
Q

What is the treatment of tardive dyskinesia?

A

dopamine blockers, withdrawal of D2 antagonist, different D2 antagonist (SGA)

54
Q

What happens to the tuberoinfundibular pathway with treatment?

A

normal or low dopamine levels resulting in elevated prolactin depending on the medication

55
Q

What is glutamate?

A

Major excitatory neurotransmitter, controls many other NT’s including DA

56
Q

There are 3 glutamate receptors. What is the most relevant one to psychotic symptoms?

A

NMDA

57
Q

What is the relation of release of glutamate and dopamine?

A

If there is too much glutamate, there is too much dopamine

58
Q

What glutamate pathway includes the mesolimbic and mesocortical DA pathways?

A

Cortico-brainstem

59
Q

What symptoms are related to the cortico brainstem glutamate pathway?

A

positive and negative

60
Q

The cortico-brainstem dopamine pathway projects to what neurotransmitter centers?

A

Raphe Nucleus, VTA and SN, and Locus Coerelus

61
Q

Which NT is found in the Raphe Nucleus?

A

Seratonin

62
Q

Which NT is found in the VTA and SN?

A

Dopamine

63
Q

Which NT is found in the Locus Coerelus?

A

Norepinephrine

64
Q

What type of pathway is the cortico brainstem dopamine pathway?

A

descending from top to bottom and outer to inner brain

65
Q

What type of receptor is the NMDA receptor?

A

ligand gated ion channel

66
Q

What blocks the gate of the ion channel in the NMDA receptor?

A

Magnesium

67
Q

What is necessary for a ligand gated ion channel to work properly?

A

glutamate must be in the receptor, glycine or D-serine, and both are synthesized by neighboring glial cells for depolarization

68
Q

What symptoms are produced in untreated psychosis in the VTA to VMPFC in the mesocortical dopamine pathway?

A

negative and affective symptoms due to hypoactive pathway

69
Q

What symptoms are produced in untreated psychosis in the VTA to DLPFC in the mesocortical dopamine pathway?

A

negative and cognitive symptoms due to hypoactive pathway

70
Q

What is the difference in the nigrostriatal dopamine pathway with treated and untreated schizophrenia?

A

the pathway is normal i untreated psychosis. The pathway is abnormal with treated.

71
Q

What is the pathway in the nigrostriatal dopamine pathway?

A

substantia nigra to basal ganglia

72
Q

What is the pathway in the tuberoinfundibular dopamine pathway?

A

hypothalamus to anterior pituitary

73
Q

What is the function of the tuberoinfundibular dopamine pathway in treated and untreated psychosis?

A

pathway is normal in untreated psychosis and abnormal in untreated psychosis

74
Q

In untreated psychosis, what is the activity in the 4 dopamine pathways?

A

mesocortical is underactive, mesolimbic is overactive, nigrostriatal is normal, tuberfundibular is normal

75
Q

What is the function of the dopamine pathways with treated psychosis?

A

mesolimbic is normal, mesocortical is normal or continued low depending on the medication, Nigrostriatal is normal or low resulting in EPS or TD depending on the medication, Tuberoinfundibular is normal or low, resulting in elevated prolactin level depending on medication

76
Q

WHat is the moa in first generation antipsychotic agents

A

pure D2 antagonists in all DA pathways

77
Q

What is the result of blocking D2 receptors?

A

decreases positive symptoms but blocks “the pleasure center and does not treat negative symptoms or co-occuring substance abuse

78
Q

What 2 drugs are considered high metabolic risk?

A

Clozaril, Zyprexa

79
Q

What 4 drugs are considered moderate metabolic risk?

A

Risperdal, Invega, Seroquel, Fanapt

80
Q

Which 6 drugs are considered low metabolic risk?

A

Geodon Abilify, Latuda, Fanapt, Saphris, Rexulti, Vraylar

NU615 Management/Care Clients Acute/Chronic Mental Health Conditions 1 (4 decks)

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