psych psychotic disorders Flashcards
axis 1
all diagnoses of mental illness (incl substance abuse and developmental disorders) not including personality disorders and mental retardation
axis 2
developmental (mental retardation) and personality disorders
axis 3
physical disorders (genral medical conditions)
axis 4
severity of psychosocial factors (homelessness, divorce, etc.)
axis 5
global assessment of function on scale of 0-100
GAF limit for hospitalization
less than 30
roschach test
interpretation of inkblots used to identify thought disorders and defense mechanisms
thematic apperception test
test taker creates stories based on pictures of people in various situations; used to evaluate motivations behind behaviors
psychosis def
distorted perception of reality
delusions
fixed false beliefs that cannot be accounted fro by the cultural background of the individual; categorized as bizarre or non-bizarre
bizarre delusions
false belief that is impossible
ideas of reference
belief that cues in the external environment are uniquely related to that individual
thought broadcasting
belief that one’s thoughts can be heard by others
thought insertion
belief that other people’s thoughts are being placed in one’s head
delusions of grandeur
belief that one has special powers beyond those of a normal person
somatic delusions
false belief that one is infected with a disease or has a certain illnes
illusion vs hallucination
illusion is misinterpretation of existing sensorystimulus, whereas hallucination is sensory perception without external stimulus
auditory hallucinations typical of who?
schizophrenic
visual hallucinations typical in who?
drug intox, drug and alc withdrawal, or delirium
olfactory hallucinations
seen in epilepsy
tactile hallucinations
usually secondary to drug abuse or alc withdrawal
medical causes of psychosis
CNS disease, endocrinopathies, nitritional/vit deficient states, other
meds that may cause psychosis in some patients include
corticosteroids, antiparkinsonian agents, anticonvulsants, antihistamines, anti-cholinergics, some antihypertensives like beta blockers, digitalis, methylphenidate, and fluoroquinolones
drugs (not meds) that cause psychosis
alcohol, cocaine, hallucinogens (LSD, ecstasy), marijuana, benzos, barbiturates, and PCP
to make the dx of schizophrenia, patient must have sx for at least how long?
6 mos
schizophrenia def
constellation of abnormalities in thinking, emotion, and behavior
positive symptoms of schizophrenia
hallucinations, delusions, bizarre behavior, disorganized speech; these tend to respond more robustly to meds
neg symptoms of schizophrenia
blunted affect, anhedonia, apathy, alogia, and lack of interest in socialization; often tx resistant
cognitive sx of schizophrenia
impairments in attention, exec function, and working memory
three phases of schizophrenia
prodromal, psychotic, residual
prodrome of schizophrenia
decline in functioning that precedes the first psychotic episode
psychotic phase of schizophrenia
perceptual disturbances, delusions , and disordered thought process
residual phase of schizophrenia
occurs between episodes of psychosis; marked by flat affect, social withdrawal, and off thinking or behavior (neg symptoms)
catatonic schizophrenic patients
stereotyped movement, bizarre posturing, rigidity
what drug is considered when a patient fails typical and atypical psychotics?
clozapine
criteria for schizophrenia
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
five subtypes of schizophrenia
paranoid, disorganized, catatonic, undifferentiated, residual
paranodi schizophrenic
often higher functioning, older patient
disorganized schizophrenic
poor functioning, early onset; must have disorganized speech and behavior; mut have flat or inapprop affect
catatonic schizophrenic
must meet at least 2 of the following: motor immobility, excessive purposeless motor activity; extreme negatism or mutism; peculiar movements; echolalia or echopraxia
undifferentiated schizophrenic
characteristic of more than one or none of subtypes
residual type schizophrenic
prominent negative symptoms (flattened affect or social withdrawal) with only minimal evidence of positive sx (such as hallucinations or delusions)
echolalia
repeats words or phrases
echopraxia
mimics behavior
presentation in men vs women of schizophrenia
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
genetic predisposition in schizophrenia
high
postpsychotic depression
phenomenon of schizophrenic pateitns developing a major depressive episode after resolution of their psych sx
downward drift hypothesis
people suffering from schizophrenia are unable to function well in society and hence enter lower socioeconomic groups
pathophys of schizophrenia
increased dopamine in prefrontal cortex and mesolimbic pway
prefrontal cortex
inadequate dopaminergic activity responsible for neg sx for schizophrenia
mesolimbic dopamine pway in schizophrena
excessive dopaminergic activity responsible to pos symptoms
tuberoinfundibular pway
blocked by neuroleptic; causes hyperprolactinemia, which may cause gynecomastia, galactorrhea, and menstrual irregularities
nigrostriatal pway
blocked by neuroleptics; causes extrapyramidal sx
akathisia
subjective sense or restlessness; inability to sit still
other neurotransmitter abnormalities in schizophrenia other than dopamine
elevated serotonin, elevated norepi, decreased GABA, decreaed glutamate (NMDA) receptors
ketamine
NMDA antagonist
CT scans of patients with schizophrenia
enlarged ventricles and diffuse cortical atrophy
neologism
use of words that have meaning only to the person who used them and is different from the orthodox meaning of the word
first gen anti-psychotics used for schizophrenia
chlorpromazine, thioridazine, trifluoperazine, haloperidol; these are D2 antags
first gen anti-psychotics and their use in schizophrenia
more effective against pos sx, with minimal impact on neg sx; side effects incl extrapyramidal sx, neuroleptic malignant syndrome, and tardive dyskinesia
what are the second gen antipsychotics?
risperidone, clozapine, olanzipine, quetiapine, ariprazole, ziprosidone
how are the second gen different than first gen anti-pscyhotics
second gen antagonize serotonin receptors as well as dopamine receptors, much lower incidence of EPS but incr risk of metabolic syndrome
clozapine risk
agranulocytosis
important side effects of antipsych medications
extrapyramidal sx, anticholinergic sx, metabolic syndrome, tardive dyskinesia, neuroleptic malignant syndrome, prolonged QT
treatment for extrapyramidal sx associated with anti-psych use
antiparkinsonian agents (benztropine, diphenhydramine, etc.), benzos, beta blockers (specifically for athisia)
anticholnergic sx
dry mouth, constipation, blurry vision
treatment for metabolic syndrome assoc with second gen antipsychotics
consider switching to first gen antipsych or a more weight neutral second gen like ariprazole, or ziprasidone
treatment of tardive dyskinesia assoc with second gen antipsychotics
discontinue offending agent and consider switching to atypical neuroleptc; benzos, beta blockers, and cholinomimetics can be used short term
movements of tardive dyskinesia
usually persist even after withdrawal of offending drug; although less common, atypical neuroleptics can cause tardive dyskinesia in some patients
symptoms of neuroleptic malig sydnrome
change in mental status, autonomic changes, “lead pipe” rigidity, sweating, elevated CPK, leukocytosis, and metabolic acidosis
treatment of malignant neuroleptic syndrome
emergency withdrawal of meds
major optho complication of thioridazine
irreversible retinal pigmentation
major optho complication of chlorpromazine
deposits in lens and cornea
schizophreniform disorder
same criteria as schizophrenia but sx last between 1 and 6 mos
prognosis of schizophreniform
1/3 recover, whereas 2/3 progress to schizophrenia or schizoaffective
treatment of schizophreniform disorder
3-6 mos of antipsychotics
schizoaffective disorder
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
prognosis for schizoaffective disorder patients
60-80 percent will progress to schizophrenia
treatment for schizoaffective disorder
hospitalization and supportive psychotherapy; med therapy with antipsychotics and mood stabilizers; antidepressants or ECT may be indicated for treatment of mood symptoms
brief psychotic disorder
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
treatment for brief psychotic disorder
brief hospitalization, supportive psychotherapy, course of antipsychotics for psychosis itself, and/or benzos for agitation
delusional disorder
nonbizarre, fixed delusions for at least 1 month; does not meet criteria for schizophrenia, functioning in life not signif impaired
delusional disorder occurs most commonly in what populations
patients over 40, immigrants, and the hearing impaired
erotomanic type delusion
revolves around love
gradiose type delusion
inflated self worth
somatic type delusion
physical delusions
persecutory type delusions
delusions of being persecuted
jelous type delusion
delusions of unfaithfulness
mixed type delusions
more than one type of delusions
treatment for delusional disorder
try anti-psych meds, though these are usually ineffective;
shared psychotic disorder
when a patient develops the same delusional sx as someone he or she is in a close relationship with;
treatment for shared psychotic disorder
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
koro
paient believes that his penis is shrinking and wlll disappear causing his deat; seen in Asian cultures
Amok
sudden unprovoked outbursts of violence of which person has no recollection; person often commits suicide after; seeen in malayasia, southeast asia
brain fag
headache, fatigue, and visual disturbances in male students; seen in Africa
schizotypal
personality disorder; paranoid, odd or magical beliefs, eccentric, lack of friends, social anziety; criteria for true psychosis are not met
schizoid
personality disoder; withdrawn, lack of enjoyment from social interactions, emoionally restricted
