Psychosis Flashcards
psychosis
break from reality involving delusions, perceptual disturbances (hallucinations), and/or disordered thinking
disordered thought types
thought content disorders: reflect idea, belief, and interpretations of surrounding e.g. paranoid delusions.
disorder of thought process- pt links idea and orders incorrectly- tangentiality, circumstantiality, loose associations, thought block, preservation
delusions
fixed belief. can’t be altered by rational argument and not accounted for by cultural background
idea of reference
delusion that some event is uniquely related to individual etc jesus is speaking to me though tv characters
hallucination type v most common pt
auditory- schizophrenics
visual- drug into
olfactory- aura with epilepsy
tactile- secondary to drug abuse or alcohol withdrawal
medical causes of psychosis
1) CNS disease
2) endocrinopathies: addison/cushings, hyper/hypothyrouidism, hyper/hypocalcemia, hypopituitarism
3) nutritional/ vit def (B12, folate, niacin)
4) other: lupus, porphyria
DSM pyschotic disorder secondary to general medical condition criteria
1) prominent hallucionation or delusions
2) sx do not occur only during episode of delirium
3) evidence to support medical cause from lab, hx or physical
psychosis 2nd to med or substance use DSM
1) prominent hallucionation or delusions
2) sx do not occur only during episode of delirium
3) evidence to support medical cause from lab, hx or physical
4) disturbance not better accounted for by a psychotic disorder that is not substance induced
schizophrenia sx
positive- hallu, delusions, bizarre behavior, thought disorder
neg- 5 As blunted Affect, anhedonia, apathy, inAttentiveness, allege (poverty of speech)
schizophrenia dx DSM
have sx for at least 6mo
2 or more of 5 present for 1mo
1) delusion
2) hallu
3) disordered speech
4) grossly disorganized or catatonic behavior
5) negative sx
most cause sig social or occupational func deterioration
sx not due to medical, neurological or substance induced disorder
schizophrenia phases
Phase 1: prodromal- decline in function that precedes first psychotic epi. socially withdrawn and irritable. may have physical complaints or new interest in religion or occult
phase 2: psychotic- perceptual disturbances, delusions, disordered thought process/content
Phase 3: residual: occur btw epic of psychosis. flat affect, social w/d, odd thinking or behavior (neg sx), can have hallu even with tx
schizophrenic exam
disheveled appearance, psychosis sx, intact memory and orientation, auditory hall, paranoid delusions, ideas of reference, concrete understanding of similarities/proverbs, lack of insight into their disease
schizophrenia epi
1% of ppl
M~20yo, F~30yo
course of disease more severe in men- more neg sx
rare bf 14 and after 45
strong genetic. associated with substance use = attempt at self medication and depression. post psychotic depression in 50% pt
downward drift hypothesis
ppl with schizo can’t func in society –> enter lower socioeconomic groups. many homeless ppl have it
dopamine hypothesis
incr in dopamine activity in prefrontal (neg sx) and mesolimbic (pos sx) may cause schizo. evidence: tx is anti-dopaminergic drugs, and amphetamines that incr drop activity lead of schozo like sx
CT schizo
enlarged ventricles and diffuse cortical atrophy
schizophrenia NT
incr dopamine, HT5, NE, decr GABA
schizo prog
pos: later onset, social support, pos sx, mood sx, acute onset, female, few relapses, good premorbid functioning
neg: opp of pos, family hx
schizo tx
70% improve on antipsychotic med= neuroleptics.
take at least 4wk bf determine efficacy. if failed, with to dif class of med
Behavioral therapy: social skills, self sufficiency, public deportment
family and group therapy
typical neuroleptics
chlorpromazine, thioridazine, trifluoperazine, haloperidol. all dop (D2) antagonist. tx more pos than neg sz.
SE: extrapyramidal sx, neuroleptic malig syndrome, tardive dyskinesis
negative neuroleptics
Risperidone, clozapine, olanzapine, quetiapine, aripiprazole, ziprosidone. antag 5HT2 and dop R. better tx neg sx than traditional neuroleptics. less extrapyramidal SE
antipsychotic med SE
1) extrapyramidal sx: dystonia (spasm) of face neck, tongue, parkinsonism (resting tremor, rigidity, braydkinesia), akathesia. tx with antiparkinsonian agent (benztropine)
2) antichoinergic sx: dry mouth, contipation, blurred vision
3) tardive dyskinesia- tx by discount drug
4) neuroleptic malig syndrome- confusion, high fever, incr BP, tachycardia, lead pipe rigidity, stating, incr CPK- can be life threatening.
5) wt gain, sedation, orthostatic hypotension, ECG changes, hyperprolactinemia, hematologic effects
shizophreniform disorder dx, prog, tx
same as schizophrenia except sx last 1- 6mo. 1/3 recover completely. 2/3 –> schizoaffective disorder or schizophrenia.
tx: hospitalization, 3-6mo antipsychotics, supportive psychotherapy
schizoaffective DSM
1) meet criteria for either major depressive episode, manic episode or mixed episode during which criteria for schizophrenia are also met
2) had delusions or hallu for 2wks without mood disorder sx (dd schizo from mood disorder with psychotic features),
3) mood sx present for substantial psychotic illness portion
4) sx not due to general med condition or drugs
schizoaffective prog and tx
prog better than schizo but worse than mood disorder
tx: hospitalization and supportive psychotherapy. antipsychotics, mood stabilizer, antidepressants, or electroconvulsive therapy
brief psychotic disorder
schizo for 1d-1mo. prog-80% recover, tx: hospitalize, supportive psychotherapy, anti psych or bento
delusional disorder
in older (>40), immigrants, hearing impaired. DSM: need to have non bizarre, fixed delusins for at least 1mo, doesn't meet criteria for schizo, function in life not sig impaired prog: 50% full recovery, 20% decr sx, 30% no change tx: psychotherapy. try anti-psychotic me but often ineffective
shared psychotic disorder
dsm- pt dev some delusional sx as someone he is close with.
prog- 40% recover when remove from inducing person
tx- sep pt. psychotherapy
DD schizo
Schizophrenia—lifelong psychotic disorder
Schizophreniform—schizophrenia for
