Psychiatric Disorders II Flashcards
Which gender has: an earlier onset with schizophrenia?
Males
Which gender has: poorer premorbid adjustment with schizophrenia?
Males
Which gender has: less cognitive impairment with schizophrenia?
Females
Which gender has: more brain structural abnormalities with schizophrenia?
Males
Which gender has: a better outcomes with schizophrenia?
Females
Which gender has: a later onset with schizophrenia?
Females
Which gender has: more negative s/sx with schizophrenia?
Males
Which gender has: symptoms that are more affect laden onset with schizophrenia?
Females
Which gender has: tend not to marry with schizophrenia?
Males
What percent of schizophrenics develop by age 30 in males?
90%
What is the most common presentation of bipolar disorder?
Depression and anxiety
True or false: there is a high comorbidity of anxiety with schizophrenia
True
What are the comorbidities that are common in the schizophrenic population? (3)
- Anxiety
- OCD
- Panic
True or false: Schizotypal or paranoid personalities often proceed the onset of schizophrenia
True
True or false: there are high rates of substance abuse with schizophrenia
True (50% use tobacco)
What is the usual age range in prison? How does this compare to the onset of schizophrenia?
Both young
What percent of schizophrenics smoke?
50%
What is the effect of smoking with schizophrenia?
Decreases hallucinations
What is a schizoaffective disorder?
a mental disorder characterized by abnormal thought processes and deregulated emotions. The diagnosis is made when the patient has features of both schizophrenia and a mood disorder—either bipolar disorder or depression—but does not strictly meet diagnostic criteria for either alone
What are the diagnostic criteria for schizoaffective disorder? What is the duration that is needed?
Delusions or hallucinations for 2 or more weeks in the absence of a major episode during the lifetime duration of the illness
How do the negative s/sx with schizoaffective disorder compare to full schizophrenia
less severe and less persistent
True or false: anosognosia is common, and more severe and pervasive with schizoaffective disorder than in schizophrenia
False–less severe and pervasive
What is the prevalence of schizoaffective disorder? How does this compare to schizophrenia?
1/3 as common as schizophrenia, with a lifetime prevalence of 0.3%
Which gender has a higher prevalence of schizoaffective disorder?
Females
What is the duration of substance induced psychotic disorder?
s/sx that persist more than 1 month after stopping acute withdrawal or severe intoxication
True or false: s/sx of substance induced psychotic disorder precede the onset of use
True
What percent of individuals with a first episode of psychosis are reported to have substance induced psychotic disorder?
7-25%
True or false: in order to diagnose substance induced psychotic disorder, the disturbances must not occur during a delirium
True
What are the three major categories of medical disorders that can cause psychosis?
- Neurological conditions
- Endocrine conditions
- Metabolic conditions
What is the prevalence of psychotic disorders 2/2 a medical condition?
0.21% to 0.54%
What is the prevalence of psychotic disorders in the 65+ age group?
0.74%
What is the disease that appears over 80 years old that is the usual cause for psychosis?
One of the major neurocognitive disorders that causes dementia
What are the criteria for catatonia?
-Associated with a mental or medical condition
What is the usual clinical picture of catatonia?
- stupor
- Cataplexy
- Waxy flexibility
- Mutism
What is echolalia seen with catatonia?
Mimicking speech of others
What is echopraxia seen with catatonia?
Mimicking others’ movements
What is stereotypy seen with catatonia?
Repetitive, abnormal frequent non-goals directed movement
What is the negativism form of catatonia?
Opposition or no response to external stimuli
What is the mannerism form of catatonia
Odd, circumstantial caricature of normal actions
What percent of inpatients with schizophrenia have catatonia?
35%
In order to call catatonia medical, what must be true?
Must be directly related to the medical condition
The majority of cases of catatonia are related to what disorders?
Bipolar or MDD
Before catatonia can be used as a specifier in a neurodevelopmental disorder, what must be true?
Medical conditions must be ruled out
The risk of schizophrenia increases with the age of the mother or father?
Father
What is the dopamine model of psychosis?
Increased mesolimbic dopaminergic activity mediated by reciprocal prefrontal dopaminergic hypoactivity
What is the glutamate model?
Glutamate NMDA antagonists like PCP produce psychotic, negative and cognitive symptoms in normal and psychotic relapse in schizos
What is the viral hypothesis of schizophrenia?
Associated with prenatal infx with flu / rubella
What is the diathesis and stress model of schizophrenia?
The patient has inherited vulnerability to schizophrenia that may be manifested by neuropsychological deficits
What are the histopathological changes that occur with psychosis (what 4 areas of the brain are smaller)?
Decreased volume of:
- hippocampus
- thalamus
- temporal
- prefrontal cortex
True or false: there is a decrease in total gray matter volume with schizophrenia
True
What happens to the ventricles with schizophrenia?
Lateral and third ventricles are enlarged
Hypofrontality at rest in chronic patients correlates with what type of symptoms?
Negative symptoms
What happens to the prefrontal cortex during performance of cognitive tasks with schizophrenia?
Failure to activate
What may happen to the cognitive deficits that present at the time of diagnosis with schizophrenia?
May progress
What are the three major components of treatment for acute psychotic disorders?
- Containment
- Avoid medication side effects
- Educate and support family
What is the homicide rate of psychotic disorders (relative and total incidence)?
Increased 10x but still less than 1% of the population
What is the only risk factor for violence within the context of the delusional system?
Auditory command hallucinations
True or false: as a group, schizophrenics are more frequently victimized than other individuals
True
What is the suicide rate of psychotics? When is the risk highest?
10-15%
Within the first 5 years of illness
What percent of schizophrenics die by suicide?
5-6%
What is the relative rate of violence with schizophrenia? What happens with treatment?
Higher rates of arrest which decreases with appropriate treatment
What is stupor catatonia?
Not relating to the environment
What is cataplexy form of catatonia?
Passive induction of posture against gravity
What is the waxy flexibility form of catatonia?
Slight ven resistance to positioning
What are the criteria for “other specified schizophrenia spectrum and psychotic disorders”?
Does not meet full criteria for one of the disorders listed, but still has symptoms and significant social, occupational, or other functional deficits
What is unspecified schizophrenia spectrum and psychotic disorder?
When the clinician chooses not to specify why the criteria are not met like presentations where there is insufficient information
Are D1 and D2 receptors increased or decreased in the striatum of patients with schizophrenia?
Increased (maybe)
What is the basis for the nicotinic theory of schizophrenia?
nicotine normalizes auditory evoked potential gating deficit in schizophrenic pts
What is the basis for the glutamate theory of schizophrenia?
Altered receptor densities and subunit compensation in hippocampus and prefrontal cortex
