Psych Flashcards
Psychosis
Break from reality involving delusions, perceptual disturbances, and/or disordered thinking
Delusions
Fixed, false beliefs that cannot be altered by rational arguments and cannot be accounted for by the cultural background of the individual.
Types of delusions
Paranoid delusions: irrational belief of persecutions.
Ideas of reference: thinking events are related to individual
Thought broadcasting: others can hear thoughts
Delusions of grandeur: belief of special powers
Delusions of guilt: false belief of responsibility
Hallucinations and associations
Auditory hallucinations: most commonly exhibited by schizophrenic patients.
Visual hallucinations: commonly seen with drug intoxication
Olfactory hallucinations: usually an aura associated with epilepsy
Tactile hallucination: usually secondary to drug abuse or alcohol withdrawal.
Illusion
Misinterpretation of an existing sensory stimulus. eg cat for shadow.
Differential diagnosis of psychosis
Psychosis secondary to general medical condition Substance induced psychotic disorder Delirium/dementia Bipolar disorder MDD w/ psychotic features Schizophreniform disorder Schizoaffective disorder Delusional disorder
Psychosis secondary to general medical condition
CNS disease: CVA, MS, neoplasm, PD, Huntington, temporal lobe epilepsy, encephalitis, prion disease.
Endocrinopathies: Addison/Cushing disease, hyper/hypothyroidism.
Nutritional/Vitamin def: B12, folate, niacin
Other: SLE, temporal arteritis, porphyria
Criteria for psychosis secondary to general medical condition
Prominent hallucinations or delusions
Symptoms do not occur only during episode of delirium
Evidence to support medical cause from lab area data, history, or physical
Psychosis secondary to medication or substance use
Prominent hallucinations or delusions
Symptoms do not occur only during episode of delirium
Evidence to support medication or substance-related cause from lab data, history, or physical
Disturbance is not better accounted for by a psychotic disorder that is not substance-induced
Schizophrenia positive symptoms
Hallucinations
Delusions
Bizarre behavior
Thought disorder
Schizophrenia negative symptoms
Blunted affect
Anhedonia
Apathy
Inattentiveness
Prodromal phase of schizophrenia
Decline in function preceding first psychotic episode, pt becomes socially withdrawn and irritable, w/w/o physical complaints or new found interest in religion
Psychotic phase of schizophrenia
Perceptual disturbances, delusions, and disordered thought process/content
Residual phase of schizophrenia
Occurs between episodes of psychosis. Marked by flat affect, social withdrawal, and odd thinking/behavior (negative symptoms). Note, pts can continue to have hallucinations despite treatment
Three phases of schizophrenia
Prodromal, psychotic, and residual
5 A’s of schizophrenia (negative symptoms)
Anhedonia Affect (flat) Alogia (poverty of speech) Avolition (apathy) Attention (poor)
Diagnosis of schizophrenia
2 or more at least 1 month: Delusions, Hallucinations, Disorganized speech, Grossly disroganized or catatonic behavior, Negative symptoms
- significant social/occupational deterioration
- duration of illness > 6 months (including early phases)
- symptoms not due to medical condition
Subtypes of schizophrenia and associations
Paranoid - highest functioning, older age of onset.
Disorganized - poor functioning, younger age of onset.
Catatonic - mute w/w/o motor immobility, echolalia (repeats words) and echopraxia (practices behaviors).
Undifferentiated - a little bit of everything
Residual - prominent negative symptoms
Schizophrenia pathways and associations
Dopamine pathways:
Prefrontal cortical - responsible for negative symptoms
Mesolimbic - responsible for positive symptoms
Tuberoinfandibular - blocked by neuroleptics, causing hyperprolactinemia
Nigrostridal - blocked by neuroleptics, causing EPS s/e
Schizophrenic head CT
enlargement of ventricles and diffuse cortical atrophy
Poor prognosis factor in schizophrenia
Early onset Poor social support Negative symptoms Family hx Gradual onset Male sex Many relapses Poor premorbid function (social isolation, etc)
List of typical neuroleptics
Chlopromazine
Thioridazine
Trifluoperazine
Haloperidol
Mechanism of typical neuroleptics
Mostly D2 receptor antagonist.
Side effects of typical neuroleptics
EPS
NMS
Tardive dyskinesia
List of atypical neuroleptics
Risperidone Clozapine Olanzapine Quetiapine Aripiprazole Ziprasidone
Mechanism of atypical neuroleptics
Serotonin receptor antagonist, some dopamine receptor antagonist effect
Side effects of atypical neuroleptics
Lower incidence of EPS.
Schizophreniform diagnosis
same as schizophrenia but lasting between 1 and 6 months.
Anti-psychotic medications s/e EPS
Dystonia (spasm)
Parkisonism (resting tremor, rigidity, bradykinesia)
Akathisia (feeling restlessness)
Treatment of EPS 2/2 antipsychotics
Benztropine, amantadine, benzodiazepines
Anti-psychotic medications s/e anticholinergic symptoms
Dry mouth, constipation, blurred vision
Treatment of anticholinergic symptoms
symptomatic
Anti-psychotic medication s/e Tardive diskinesia
Darting or writhing movements of face, tongue, and head
Treatment of Tardive diskinesia
D/C offending agent, substitute with atypical. Benzodiazepines, beta blockers, and cholinenomimetics for short term.
Diagnosis of NMS
Confusion, high fever, elevated blood pressure, tachycardia, “lead pipe” rigidity, sweating, and elevated CPK levels
Schizoaffective disorder
meets criteria for MDD, manic episode, or mixed episode.
Delusion and hallucinations for 2 weeks in absence of mood disorder (otherwise you might be looking as schizoaffective d/o vs mood d/o w/ psychotic features).
Brief psychotic d/o
psychotic symptoms between 1 day to 1 month
Treatment for brief psychotic d/o
brief hospitalization, supportive psychotherapy, course of antipyschotics for psychosis with benzodiazepines for agitation
Diagnosis of delusional disorder
Non-bizarre, fixed delusions for at least 1 month
Does not meet criteria for schizophrenia
Not significantly affecting functioning
