Psychiatry Flashcards
What is psychosis?
What is the age of onset of Schizophrenia?
15-25 in males
25-35 in females
What are the neurologic findings associated with schizophrenia?
1) Hyperactivity of dopaminergic, serotonergic, and noradrenergic systems; increased evidence for disordered glutamate utilization
2) Enlargement of lateral and third ventricles of the brain
3) Abnormalities of the frontal lobes
Schizophrenia – General
Chronic psychiatric disorder characterized by episodes of psychosis and abnormal behavior >6 months
Two or more of following symptoms for at least one month:
• Hallucinations
• Delusions
• Disorganized speech
• Disorganized behavior
• Negative symptoms
Symptoms must be causing functional impairment and are not due to any other medical condition or substance abuse
Catatonic Schizophrenia
Motor disturbances with strange posturing, incoherent speech; can involve extreme motion or no motion
Paranoid Schizophrenia
Delusions (e.g. persecutory), but with better social functioning than other types and best prognosis
Disorganized Schizophrenia
Inappropriate emotional responses (e.g. emotional blunting), disheveled appearance. Severe impairment and poor prognosis.
Undifferentiated Schizophrenia
Characteristics of multiple subtypes.
Residual Schizophrenia
One or more psychotic episodes in the past, residual flat affect, withdrawal, off behavior or thinking, but no severe psychotic symptoms.
Is memory and orientation normal in Schizophrenia?
Yes
Positive Symptoms
Thoughts, sensory perceptions, behaviors that are abnormal
Negative Symptoms
Thoughts, sensory perceptions, behaviors that are present in a normal person but are absent in a person with mental illness
Schizophrenia Positive Symptoms
- Delusions
- Loose associations
- Strange behavior
- Hallucinations, typically auditory (e.g. hearing voices)
Schizophrenia Negative Symptoms
- Social withdrawal
- Flat affect
- Lack of motivation
- Thought blocking (starts talking then stops and is unable to continue with what he was saying)
- Poverty of speech (alogia)
Schizophrenia Treatment
- Antipsychotic agents (e.g. Dopamine receptor blockers); atypical antipsychotics lack side effects of earlier ones
- Psychosocial (therapy)
Which responds better to typical antipsychotics – negative or positive Schizophrenia symptoms?
Positive symptoms; negative symptoms respond better to the atypical agents.
Schizophrenia prognosis
Treatment non-compliance is not good, earlier onset can interfere with brain development.
Suicide is common; more than 50% attempt rate.
Better prognosis with family support (low-expressed emotion, that is, they are not critical of the person, understand the disorder) and absence of comorbid substance abuse.
Is there a difference in ethnic prevalence of mood disorders?
No but patients in lower socioeconomic classes often come to the attention of providers later and may be misdiagnosed
Pathophysiology of Depression
- Altered neurotransmitter activity
- Depression is associated with decreased levels of serotonin, norepinephrine, and possibly dopamine (it is not the increase in these NTs that improves the depression; it is believed that there are more downstream cellular effects)
- Limbic H-P axis abnormalities
Major Depressive Disorder Presentation
• History of sustained, depressed mood with anhedonia, and may feel guilty/worthless; must exhibit five or more of below symptoms for longer than two weeks with a symptom-free period lasting longer than two months
SIG E CAPS:
• Sleep disturbances (usually too little)
• Loss of Interests
• Guilt/worthlessness
• Loss of Energy
• Loss of Concentration
• Appetite changes /weight (usually loss)
• Psychomotor retardation or agitation
• Suicidal Ideation
MDD with melancholic features (melancholia)
- Depression with profound anhedonia and dysphoria (depression)
- Worse mood in the morning
- Early morning waking
- Psychomotor agitation or retardation
- Weight loss or decreased appetite
- Excessive or inappropriate guilt
- Respond well to antidepressants and ECT
MDD with atypical features
- Mood reactivity (mood improves in response to positive events)
- Weight gain or increased appetite
- Hypersomnia
- Leaden paralysis
- Sensitivity to rejection
- Difficult to treat; combination of psychotherapy and medications (esp. MAO inhibitors)
Chronic MDD
- >2 years
- Generally refractive to treatment
Postpartum-onset depression
- Depressive, manic, or mixed episode occurring within the first 4 weeks after delivery
- Not the postpartum “blues”, which is more common
- High risk of recurrence in subsequent deliveries (30-50%)
- Pharmacologic or psychotherapy or both
