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psych psychotic disorders Flashcards

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1
Q

axis 1

A

all diagnoses of mental illness (incl substance abuse and developmental disorders) not including personality disorders and mental retardation

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2
Q

axis 2

A

developmental (mental retardation) and personality disorders

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3
Q

axis 3

A

physical disorders (genral medical conditions)

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4
Q

axis 4

A

severity of psychosocial factors (homelessness, divorce, etc.)

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5
Q

axis 5

A

global assessment of function on scale of 0-100

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6
Q

GAF limit for hospitalization

A

less than 30

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7
Q

roschach test

A

interpretation of inkblots used to identify thought disorders and defense mechanisms

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8
Q

thematic apperception test

A

test taker creates stories based on pictures of people in various situations; used to evaluate motivations behind behaviors

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9
Q

psychosis def

A

distorted perception of reality

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10
Q

delusions

A

fixed false beliefs that cannot be accounted fro by the cultural background of the individual; categorized as bizarre or non-bizarre

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11
Q

bizarre delusions

A

false belief that is impossible

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12
Q

ideas of reference

A

belief that cues in the external environment are uniquely related to that individual

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13
Q

thought broadcasting

A

belief that one’s thoughts can be heard by others

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14
Q

thought insertion

A

belief that other people’s thoughts are being placed in one’s head

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15
Q

delusions of grandeur

A

belief that one has special powers beyond those of a normal person

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16
Q

somatic delusions

A

false belief that one is infected with a disease or has a certain illnes

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17
Q

illusion vs hallucination

A

illusion is misinterpretation of existing sensorystimulus, whereas hallucination is sensory perception without external stimulus

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18
Q

auditory hallucinations typical of who?

A

schizophrenic

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19
Q

visual hallucinations typical in who?

A

drug intox, drug and alc withdrawal, or delirium

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20
Q

olfactory hallucinations

A

seen in epilepsy

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21
Q

tactile hallucinations

A

usually secondary to drug abuse or alc withdrawal

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22
Q

medical causes of psychosis

A

CNS disease, endocrinopathies, nitritional/vit deficient states, other

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23
Q

meds that may cause psychosis in some patients include

A

corticosteroids, antiparkinsonian agents, anticonvulsants, antihistamines, anti-cholinergics, some antihypertensives like beta blockers, digitalis, methylphenidate, and fluoroquinolones

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24
Q

drugs (not meds) that cause psychosis

A

alcohol, cocaine, hallucinogens (LSD, ecstasy), marijuana, benzos, barbiturates, and PCP

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25
Q

to make the dx of schizophrenia, patient must have sx for at least how long?

A

6 mos

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26
Q

schizophrenia def

A

constellation of abnormalities in thinking, emotion, and behavior

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27
Q

positive symptoms of schizophrenia

A

hallucinations, delusions, bizarre behavior, disorganized speech; these tend to respond more robustly to meds

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28
Q

neg symptoms of schizophrenia

A

blunted affect, anhedonia, apathy, alogia, and lack of interest in socialization; often tx resistant

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29
Q

cognitive sx of schizophrenia

A

impairments in attention, exec function, and working memory

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30
Q

three phases of schizophrenia

A

prodromal, psychotic, residual

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31
Q

prodrome of schizophrenia

A

decline in functioning that precedes the first psychotic episode

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32
Q

psychotic phase of schizophrenia

A

perceptual disturbances, delusions , and disordered thought process

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33
Q

residual phase of schizophrenia

A

occurs between episodes of psychosis; marked by flat affect, social withdrawal, and off thinking or behavior (neg symptoms)

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34
Q

catatonic schizophrenic patients

A

stereotyped movement, bizarre posturing, rigidity

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35
Q

what drug is considered when a patient fails typical and atypical psychotics?

A

clozapine

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36
Q

criteria for schizophrenia

A

two or more of: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, neg symptoms; cause signif functional impairment; last at least 6 mos; sx not due to another cause

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37
Q

five subtypes of schizophrenia

A

paranoid, disorganized, catatonic, undifferentiated, residual

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38
Q

paranodi schizophrenic

A

often higher functioning, older patient

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39
Q

disorganized schizophrenic

A

poor functioning, early onset; must have disorganized speech and behavior; mut have flat or inapprop affect

40
Q

catatonic schizophrenic

A

must meet at least 2 of the following: motor immobility, excessive purposeless motor activity; extreme negatism or mutism; peculiar movements; echolalia or echopraxia

41
Q

undifferentiated schizophrenic

A

characteristic of more than one or none of subtypes

42
Q

residual type schizophrenic

A

prominent negative symptoms (flattened affect or social withdrawal) with only minimal evidence of positive sx (such as hallucinations or delusions)

43
Q

echolalia

A

repeats words or phrases

44
Q

echopraxia

A

mimics behavior

45
Q

presentation in men vs women of schizophrenia

A

equal frequency, but men average of 20 years and women are 30 years; men tend to have more neg sx and more impaired social functioning than women

46
Q

genetic predisposition in schizophrenia

A

high

47
Q

postpsychotic depression

A

phenomenon of schizophrenic pateitns developing a major depressive episode after resolution of their psych sx

48
Q

downward drift hypothesis

A

people suffering from schizophrenia are unable to function well in society and hence enter lower socioeconomic groups

49
Q

pathophys of schizophrenia

A

increased dopamine in prefrontal cortex and mesolimbic pway

50
Q

prefrontal cortex

A

inadequate dopaminergic activity responsible for neg sx for schizophrenia

51
Q

mesolimbic dopamine pway in schizophrena

A

excessive dopaminergic activity responsible to pos symptoms

52
Q

tuberoinfundibular pway

A

blocked by neuroleptic; causes hyperprolactinemia, which may cause gynecomastia, galactorrhea, and menstrual irregularities

53
Q

nigrostriatal pway

A

blocked by neuroleptics; causes extrapyramidal sx

54
Q

akathisia

A

subjective sense or restlessness; inability to sit still

55
Q

other neurotransmitter abnormalities in schizophrenia other than dopamine

A

elevated serotonin, elevated norepi, decreased GABA, decreaed glutamate (NMDA) receptors

56
Q

ketamine

A

NMDA antagonist

57
Q

CT scans of patients with schizophrenia

A

enlarged ventricles and diffuse cortical atrophy

58
Q

neologism

A

use of words that have meaning only to the person who used them and is different from the orthodox meaning of the word

59
Q

first gen anti-psychotics used for schizophrenia

A

chlorpromazine, thioridazine, trifluoperazine, haloperidol; these are D2 antags

60
Q

first gen anti-psychotics and their use in schizophrenia

A

more effective against pos sx, with minimal impact on neg sx; side effects incl extrapyramidal sx, neuroleptic malignant syndrome, and tardive dyskinesia

61
Q

what are the second gen antipsychotics?

A

risperidone, clozapine, olanzipine, quetiapine, ariprazole, ziprosidone

62
Q

how are the second gen different than first gen anti-pscyhotics

A

second gen antagonize serotonin receptors as well as dopamine receptors, much lower incidence of EPS but incr risk of metabolic syndrome

63
Q

clozapine risk

A

agranulocytosis

64
Q

important side effects of antipsych medications

A

extrapyramidal sx, anticholinergic sx, metabolic syndrome, tardive dyskinesia, neuroleptic malignant syndrome, prolonged QT

65
Q

treatment for extrapyramidal sx associated with anti-psych use

A

antiparkinsonian agents (benztropine, diphenhydramine, etc.), benzos, beta blockers (specifically for athisia)

66
Q

anticholnergic sx

A

dry mouth, constipation, blurry vision

67
Q

treatment for metabolic syndrome assoc with second gen antipsychotics

A

consider switching to first gen antipsych or a more weight neutral second gen like ariprazole, or ziprasidone

68
Q

treatment of tardive dyskinesia assoc with second gen antipsychotics

A

discontinue offending agent and consider switching to atypical neuroleptc; benzos, beta blockers, and cholinomimetics can be used short term

69
Q

movements of tardive dyskinesia

A

usually persist even after withdrawal of offending drug; although less common, atypical neuroleptics can cause tardive dyskinesia in some patients

70
Q

symptoms of neuroleptic malig sydnrome

A

change in mental status, autonomic changes, “lead pipe” rigidity, sweating, elevated CPK, leukocytosis, and metabolic acidosis

71
Q

treatment of malignant neuroleptic syndrome

A

emergency withdrawal of meds

72
Q

major optho complication of thioridazine

A

irreversible retinal pigmentation

73
Q

major optho complication of chlorpromazine

A

deposits in lens and cornea

74
Q

schizophreniform disorder

A

same criteria as schizophrenia but sx last between 1 and 6 mos

75
Q

prognosis of schizophreniform

A

1/3 recover, whereas 2/3 progress to schizophrenia or schizoaffective

76
Q

treatment of schizophreniform disorder

A

3-6 mos of antipsychotics

77
Q

schizoaffective disorder

A

patients meet criteria for major depress disorder, manic episode, or mixed episode (during which criteria for schizophrenia are also met); have had delusions or hallucinations for 2 wks in absence of mood disorder sx

78
Q

prognosis for schizoaffective disorder patients

A

60-80 percent will progress to schizophrenia

79
Q

treatment for schizoaffective disorder

A

hospitalization and supportive psychotherapy; med therapy with antipsychotics and mood stabilizers; antidepressants or ECT may be indicated for treatment of mood symptoms

80
Q

brief psychotic disorder

A

patient with pscyh sx as defined for schizophrenia, but sx last from 1 day to 1 month; may be seen in reaction to extreme stress like bereavement, sexual assault

81
Q

treatment for brief psychotic disorder

A

brief hospitalization, supportive psychotherapy, course of antipsychotics for psychosis itself, and/or benzos for agitation

82
Q

delusional disorder

A

nonbizarre, fixed delusions for at least 1 month; does not meet criteria for schizophrenia, functioning in life not signif impaired

83
Q

delusional disorder occurs most commonly in what populations

A

patients over 40, immigrants, and the hearing impaired

84
Q

erotomanic type delusion

A

revolves around love

85
Q

gradiose type delusion

A

inflated self worth

86
Q

somatic type delusion

A

physical delusions

87
Q

persecutory type delusions

A

delusions of being persecuted

88
Q

jelous type delusion

A

delusions of unfaithfulness

89
Q

mixed type delusions

A

more than one type of delusions

90
Q

treatment for delusional disorder

A

try anti-psych meds, though these are usually ineffective;

91
Q

shared psychotic disorder

A

when a patient develops the same delusional sx as someone he or she is in a close relationship with;

92
Q

treatment for shared psychotic disorder

A

separate the patient from person who is the source of shared delusions; try psychotherapy and psych meds if sx do not resolve in 1-2 weeks

93
Q

koro

A

paient believes that his penis is shrinking and wlll disappear causing his deat; seen in Asian cultures

94
Q

Amok

A

sudden unprovoked outbursts of violence of which person has no recollection; person often commits suicide after; seeen in malayasia, southeast asia

95
Q

brain fag

A

headache, fatigue, and visual disturbances in male students; seen in Africa

96
Q

schizotypal

A

personality disorder; paranoid, odd or magical beliefs, eccentric, lack of friends, social anziety; criteria for true psychosis are not met

97
Q

schizoid

A

personality disoder; withdrawn, lack of enjoyment from social interactions, emoionally restricted

Psych (23 decks)

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