OnlineMedEd: Psychiatry - Psychotic Disorders

Question 1

What is the pathology of schizophrenia?

Answer 1

It is a thought disorder with a genetic component that involves distortions of the dopaminergic system.

Question 2

It might not be true, but it seems that the negative symptoms of schizophrenia arise from excesses in what neurotransmitter?

Answer 2

Serotonin

Question 3

What are the diagnostic criteria for schizophrenia?

Answer 3

At least three of the following (with at least one of the three from the first four):
•Delusions
•Hallucinations
•Disorganized speech
•Disorganized behavior
•Negative symptoms (flat affect, anhedonia, psychomotor retardation, speech delay, paucity of speech)

Question 4

How should you approach psychosis in a young person without a history of psychiatric problems?

Answer 4

1) . Rule out drug use (with history and urine toxicology)
2) . Document the duration of symptoms (for classification and subsequent prognostic prediction)
3) . Assess presence of mood symptoms (for possible schizoaffective disorder or MDD with psychotic features)
4) . Treat with antipsychotics or mood agents

Question 5

Why do psychiatrists differentiate between schizophrenia and schizophreniform disorders?

Answer 5

After six months of psychotic symptoms, the disorder is unlikely to go away on its own. Within six months, about one-third of people spontaneously improve.

Question 6

In those with schizoaffective disorder or major depressive disorder with psychotic features, you should treat the ______________ first.

Answer 6

mood symptoms

Question 7

What are the diagnostic criteria for delusional disorder?

Answer 7

• Presence of one or more non-bizarre delusions for at least one month
• No impairment of life

Question 8

OnlineMedEd breaks down the pharmacologic treatment of schizophrenia into four categories. List them!

Answer 8

• “Normal” schizophrenic who takes their own meds: use atypical antipsychotics like quetiapine, olanzapine, or risperidone
• Combative schizophrenic: first-generation antipsychotics like haloperidol or fluphenazine
• Noncompliant patients: long-acting injectable antipsychotics like haloperidol or aripiprazole
• “All else fails” schizophrenic: clozapine