- Impaired reality perception (loss of contact w/reality) - Manifested by hallucinations, delusions, affective instability

- Strongly held false belief not typical of patient's cultural or religious background - Can be categorized as bizarre or non-bizarre

- Type of thought disorganization a/w psychosis - Very little information conveyed by speech (poverty of content)

- Type of thought disorganization a/w psychosis - Answers to interview questions diverging increasingly from the topic being asked about

- Type of thought disorganization a/w psychosis - Using words in a sentence that are linked by rhyming or phonetic similarity

- Type of thought disorganization a/w psychosis - Real words are linked together incoherently, yielding nonsensical content

- Type of thought disorganization a/w psychosis - Repeating words or ideas persistently often even after the interview topic has changed

Psychosis Flashcards by Megan MacNabb

Define psychosis

Impaired reality perception (loss of contact w/reality)

- Manifested by hallucinations, delusions, affective instability

How well did you know this?

Not at all

Perfectly

Define delusion

Strongly held false belief not typical of patient’s cultural or religious background
Can be categorized as bizarre or non-bizarre

How well did you know this?

Not at all

Perfectly

Define hallucination

Wakeful sensory experiences of content that is not actually present

How well did you know this?

Not at all

Perfectly

Define illusion

Distortion or misinterpretation of real sensory stimuli

How well did you know this?

Not at all

Perfectly

Define alogia

Type of thought disorganization a/w psychosis

- Very little information conveyed by speech (poverty of content)

How well did you know this?

Not at all

Perfectly

Define thought blocking

Type of thought disorganization a/w psychosis

- Suddenly losing train of thought, exhibited by abrupt interruption in speech

How well did you know this?

Not at all

Perfectly

Define loosening of association

Type of thought disorganization a/w psychosis

- Speech content notable for ideas presented in sequence that are not closely related

How well did you know this?

Not at all

Perfectly

Define tangentiality

Type of thought disorganization a/w psychosis

- Answers to interview questions diverging increasingly from the topic being asked about

How well did you know this?

Not at all

Perfectly

What is tangentiality called if eventually the answer returns to the original topic?

Circumstantiality

How well did you know this?

Not at all

Perfectly

Define circumstantiality

Type of thought disorganization a/w psychosis

- Answers a question and diverges from the topic being asked but eventually returns to the topic

How well did you know this?

Not at all

Perfectly

Define clanging

Type of thought disorganization a/w psychosis

- Using words in a sentence that are linked by rhyming or phonetic similarity

How well did you know this?

Not at all

Perfectly

Define word salad

Type of thought disorganization a/w psychosis

- Real words are linked together incoherently, yielding nonsensical content

How well did you know this?

Not at all

Perfectly

Define perseveration

Type of thought disorganization a/w psychosis

- Repeating words or ideas persistently often even after the interview topic has changed

How well did you know this?

Not at all

Perfectly

What are examples of medical conditions that can induce psychosis?

Endocrine
Hepatic encephalopathy
HIV, syphilis, Lyme
SLE, MS
Alzheimer’s
Head trauma
B12 deficiency

How well did you know this?

Not at all

Perfectly

What drugs can induce psychosis?

Cocaine
Ecstasy
LSD
Marijuana
Amphetamines
Withdrawal from alcohol

How well did you know this?

Not at all

Perfectly

What is the MC cause of drug related hallucinations?

Withdrawal from alcohol

How well did you know this?

Not at all

Perfectly

Define delirium

Confusional state characterized by increased vigilance with psychomotor and autonomic overactivity

How well did you know this?

Not at all

Perfectly

Diagnostic features of delirium

Disturbance in attention and awareness
Develops over short period of time
Disturbance in cognition
Not better explained by another neurocognitive disorder
Caused by a medical condition, substance intoxication/withdrawal, med side effect or multiple etiologies

How well did you know this?

Not at all

Perfectly

Etiologies of delirium

Fluid and electrolyte disturbances
Infections (UTI)
Drugs/alcohol or withdrawal
Metabolic disorders
Low perfusion states
Post-op esp elderly

How well did you know this?

Not at all

Perfectly

Treatment of delirium

Treat underlying condition

How well did you know this?

Not at all

Perfectly

What is schizophrenia?

Psych disorder involving chronic or recurrent psychosis

How well did you know this?

Not at all

Perfectly

Define schizophreniform disorder

Equivalent to schizophrenia’s clinical presentation but duration is 1-6 months with or w/o decline in functioning

Define schizoaffective disorder

Periodic manifestations of major depression and/or mania overlap with symptoms of schizophrenia

Define delusional disorder

At least 1 month of non-bizarre OR bizarre delusions W/O other active phase symptoms of schizophrenia

Define brief psychotic disorder

Psychosis that lasts more than 1 day but resolves by 1 month

Epidemiology of schizophrenia

- Males slightly MC - Women diagnosed later in life - Possibly worse prognosis in males - Younger onset, worse prognosis - Rarely occurs over 45 yo

Define downward drift

Psychosis is more likely to be diagnosed in poorer patients

Neuropsychopathology of psychosis

- Frontal/temporal lobes affected - Mesolimbic DA hyperactivity - Mesocortical DA hypoactivity - Glutamate excitatory - GABA inhibitory

What is the major CNS inhibitory neurotransmitter?

GABA

Relation of ACh and schizophrenia

- Increased smoking is seen in people w/schizophrenia | - Has led to hypothesis that nicotine (which stimulates ACh receptors) may ameliorate some of their symptoms

Diagnosis of schizophrenia

2 or more of the following (at least 1 has to be of the first 3 listed) for 1 month or more: - Hallucinations - Delusions - Disorganized thinking/speech/writing - Grossly disorganized behavior or catatonia

Subtypes of schizophrenia

- Paranoid - Disorganized - Catatonic - Undifferentiated - Residual

What are "positive" symptoms of schizophrenia?

- Acute symptoms d/t DA dysregulation (increased DA in mesolimbic system) - Hallucinations, delusions, disorganized thought - Potentially reversible (respond best to neuroleptics)

What are "negative" symptoms of schizophrenia?

- Insidious and progressive due to "deficit syndrome" of DA in mesocortical system - Social withdrawal, flat affect, poverty of speech, avolition

Poor prognosis of schizophrenia

- Negative symptoms | - Impaired cognition

Negative symptoms of schizophrenia are related to what physiologically?

Deficit syndrome of DA in mesocortical system

Positive symptoms of schizophrenia are related to what physiologically?

Increased DA in mesolimbic system

Genetic factors of schizophrenia?

- Monozygotic twin studies 40-50% concordance | - MC polymorphism is on chromosome 22

Risk factors for schizophrenia

- Advanced paternal age at conception - 1st-2nd trimester viral infection - Toxoplasmosis in utero - Infant starvation - Late winter-early spring DOB - Psychoactive drugs

Anatomic risk factor for schizophrenia

Smaller brain w/cortical thinning, ventricular enlargement

Family influences on schizophrenia

Families don't cause schizophrenia, but degree of emotional conflict increases relapse

Clinical presentation of schizophrenia

- Hallucinations - Delusions (fixed beliefs) - Disorganized thoughts - Personality changes - 4 As (Autism, Ambivalence, Affectivity, Association)

Describe disorganized schizophrenia

- Incoherence - Blunted, inappropriate affect - Early, insidious onset - Chronic severe course

Describe catatonic schizophrenia

- Restless catatonia (purposeless excitement w/injury risk) - Stupor, rigid catatonia - Mutism or echopraxia - Can maintain awkward position for hours

MC subtype of schizophrenia?

Paranoid

Describe paranoid schizophrenia

- MC w/most favorable prognosis - Delusions of persecution, suspiciousness, grandeur - Generally intact intellectually/cognitively - Onset may be later (later is better prognosis)

Describe residual schizophrenia

- Under treatment and mostly stable - Has had at least 1 schizophrenic episode - Still has negative symptoms or milder positive symptoms

Describe undifferentiated schizophrenia

- Severely disorganized behavior - Psychotic (incoherent, hallucinatory) - Does not fit any other subtype

Phases of schizophrenia treatment

1. Acute (reduce harm - hospitalize) 2. Behavior stabilization (case management to link back to community) 3. Stable (minimize relapse)

Drug classes used in schizophrenia

- Antipsychotics (increases mortality in elderly) | - Atypical antipsychotics (2nd generation)

1st line drug treatment of schizophrenia

Atypical antipsychotics (2nd generation - risperdal, zyprexa, seroquel, clozapine)

Role of psychotherapy in schizophrenia?

May be useful in higher functioning patients (but often does not help)

MC comorbidity with schizophrenia?

Substance use (including smoking - 75% of pts)

Violence and schizophrenia

- Schizophrenia itself is NOT an independent factor for violence - Substance use and hx of violence/abuse are predictive