Psych Flashcards
Components of Mental Status Exam
- Physical appearance
- Arousal/attention (consciousness/concentration)
- Speech (rate, rhythm, prosody, articulation, coherence, vocabulary)
- Mood (pt’s self reported emotional state)
- Affect (pts immediate visible emotions)
- Thought process (organization of pts thoughts)
- Thought content (nature of thought)
- Cognition (includes memory and exec functioning; i.e. MMSE/MOCA)
- Insight (does pt understand illness/impact on their life)
- Judgement (ability to follow provider instructions)
Schizophrenia diagnostic criteria
2+
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Etiology of Schizophrenia
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Schizophrenia Treatment
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Major Depressive disorder
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examples of Mood disorders with psychotic features
Major Depressive Disorder (MDD) w/psychotic features
BIpolar disorder with psychotic features
Schizoaffective disorder
MDD with psychotic features definition/treatment
- meets major depressive episode criteria plus has delusions and/or hallucinations
- occurs in about 18.5% those diagnosed with MDD
Treat: Antidepressants with antipsychotics; ECT (esp in pregnant and elderly)
Bipolar with psychotic features definition/treatment
- Pt experiencing bipolar disorder and delusions or hallucinations
- Prevalence may be as high as 25% of those with bipolar
Treat:
- Mood Stabilizer and antipsychotic (atypical often used since they allow use of one medication)
- ECT may be considered if poor medication response
- Pt may present w/catatonia, which responds to treatment with benzodiazepines
Schizoaffective Disorder Dx and treatment
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Delusional disorder
- presence of 1+ delusions lasting at least 1 month
- never met criteria for schizophrenia
- little to no functional impairment and behavior appears relatively normal
- Not due to mood disorder or substance
- Lifetime prevalence about 0.2%
- Mean onset = 40
Delusional Disorder subtypes
Erotomanic (more frequent in women) Grandiose Jealous Persecutory- more often in men Somatic Mixed Unspecified
Brief Psychotic disorder
Presence of 1+ of the following with at least 1 of the first 3
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized or catatonic behavior
- Lasts from 1 day to
Schizophreniform Disorder
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Substance/med induced psychotic disorder characteristics
- Significant hallucinations/delusions
- Evidence from hx, physical, or lab findings of both:
hallucinations or delusions developed during or within a reasonable pd of substance intoxication or withdrawal or after exposure to such a medication - Substance in question can produce hallucinations or delusions
**Sxs should not precede ingestion of substance/meds, nor should they persist for substantial pd of time (typically > 1 month) after acute withdrawal or severe intoxication)
Substance known to induce psychosis
Alcohol Cocaine amphetamine cannabis opioids synthetic cannabinoids and cathinones (bath salts) LSD Psilocybins (mushrooms) MDMA/ecstasy Inhalants Phencyclidine (PCP, angel dust, ketamine)
