Psychosis

Question 1

psychosis

Answer 1

break from reality involving delusions, perceptual disturbances (hallucinations), and/or disordered thinking

Question 2

disordered thought types

Answer 2

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

Question 3

delusions

Answer 3

fixed belief. can’t be altered by rational argument and not accounted for by cultural background

Question 4

idea of reference

Answer 4

delusion that some event is uniquely related to individual etc jesus is speaking to me though tv characters

Question 5

hallucination type v most common pt

Answer 5

auditory- schizophrenics
visual- drug into
olfactory- aura with epilepsy
tactile- secondary to drug abuse or alcohol withdrawal

Question 6

medical causes of psychosis

Answer 6

1) CNS disease
2) endocrinopathies: addison/cushings, hyper/hypothyrouidism, hyper/hypocalcemia, hypopituitarism
3) nutritional/ vit def (B12, folate, niacin)
4) other: lupus, porphyria

Question 7

DSM pyschotic disorder secondary to general medical condition criteria

Answer 7

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

Question 8

psychosis 2nd to med or substance use DSM

Answer 8

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

Question 9

schizophrenia sx

Answer 9

positive- hallu, delusions, bizarre behavior, thought disorder
neg- 5 As blunted Affect, anhedonia, apathy, inAttentiveness, allege (poverty of speech)

Question 10

schizophrenia dx DSM

Answer 10

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

Question 11

schizophrenia phases

Answer 11

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 socially withdrawn and irritable.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

Question 12

schizophrenic exam

Answer 12

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

Question 13

schizophrenia epi

Answer 13

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

Question 14

downward drift hypothesis

Answer 14

ppl with schizo can’t func in society –> enter lower socioeconomic groups. many homeless ppl have it

Question 15

dopamine hypothesis

Answer 15

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

Question 16

CT schizo

Answer 16

enlarged ventricles and diffuse cortical atrophy

Question 17

schizophrenia NT

Answer 17

incr dopamine, HT5, NE, decr GABA

Question 18

schizo prog

Answer 18

pos: later onset, social support, pos sx, mood sx, acute onset, female, few relapses, good premorbid functioning
neg: opp of pos, family hx

Question 19

schizo tx

Answer 19

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

Question 20

typical neuroleptics

Answer 20

chlorpromazine, thioridazine, trifluoperazine, haloperidol. all dop (D2) antagonist. tx more pos than neg sz.
SE: extrapyramidal sx, neuroleptic malig syndrome, tardive dyskinesis

Question 21

negative neuroleptics

Answer 21

Risperidone, clozapine, olanzapine, quetiapine, aripiprazole, ziprosidone. antag 5HT2 and dop R. better tx neg sx than traditional neuroleptics. less extrapyramidal SE

Question 22

antipsychotic med SE

Answer 22

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

Question 23

shizophreniform disorder dx, prog, tx

Answer 23

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

Question 24

schizoaffective DSM

Answer 24

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

Question 25

schizoaffective prog and tx

Answer 25

prog better than schizo but worse than mood disorder
tx: hospitalization and supportive psychotherapy. antipsychotics, mood stabilizer, antidepressants, or electroconvulsive therapy

Question 26

brief psychotic disorder

Answer 26

schizo for 1d-1mo. prog-80% recover, tx: hospitalize, supportive psychotherapy, anti psych or bento

Question 27

delusional disorder

Answer 27

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

Question 28

shared psychotic disorder

Answer 28

dsm- pt dev some delusional sx as someone he is close with.
prog- 40% recover when remove from inducing person
tx- sep pt. psychotherapy

Question 29

DD schizo

Answer 29

Schizophrenia—lifelong psychotic disorder

􏱦 Schizophreniform—schizophrenia for