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Clin Med III - Psych, Genetics > Psychosis > Flashcards

Psychosis Flashcards

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1
Q

Define psychosis

A
  • Impaired reality perception (loss of contact w/reality)

- Manifested by hallucinations, delusions, affective instability

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2
Q

Define delusion

A
  • Strongly held false belief not typical of patient’s cultural or religious background
  • Can be categorized as bizarre or non-bizarre
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3
Q

Define hallucination

A

Wakeful sensory experiences of content that is not actually present

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4
Q

Define illusion

A

Distortion or misinterpretation of real sensory stimuli

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5
Q

Define alogia

A
  • Type of thought disorganization a/w psychosis

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

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6
Q

Define thought blocking

A
  • Type of thought disorganization a/w psychosis

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

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7
Q

Define loosening of association

A
  • Type of thought disorganization a/w psychosis

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

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8
Q

Define tangentiality

A
  • Type of thought disorganization a/w psychosis

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

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9
Q

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

A

Circumstantiality

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10
Q

Define circumstantiality

A
  • Type of thought disorganization a/w psychosis

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

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11
Q

Define clanging

A
  • Type of thought disorganization a/w psychosis

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

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12
Q

Define word salad

A
  • Type of thought disorganization a/w psychosis

- Real words are linked together incoherently, yielding nonsensical content

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13
Q

Define perseveration

A
  • Type of thought disorganization a/w psychosis

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

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14
Q

What are examples of medical conditions that can induce psychosis?

A
  • Endocrine
  • Hepatic encephalopathy
  • HIV, syphilis, Lyme
  • SLE, MS
  • Alzheimer’s
  • Head trauma
  • B12 deficiency
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15
Q

What drugs can induce psychosis?

A
  • Cocaine
  • Ecstasy
  • LSD
  • Marijuana
  • Amphetamines
  • Withdrawal from alcohol
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16
Q

What is the MC cause of drug related hallucinations?

A

Withdrawal from alcohol

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17
Q

Define delirium

A

Confusional state characterized by increased vigilance with psychomotor and autonomic overactivity

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18
Q

Diagnostic features of delirium

A
  • 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
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19
Q

Etiologies of delirium

A
  • Fluid and electrolyte disturbances
  • Infections (UTI)
  • Drugs/alcohol or withdrawal
  • Metabolic disorders
  • Low perfusion states
  • Post-op esp elderly
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20
Q

Treatment of delirium

A

Treat underlying condition

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21
Q

What is schizophrenia?

A

Psych disorder involving chronic or recurrent psychosis

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22
Q

Define schizophreniform disorder

A

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

23
Q

Define schizoaffective disorder

A

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

24
Q

Define delusional disorder

A

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

25
Q

Define brief psychotic disorder

A

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

26
Q

Epidemiology of schizophrenia

A
  • Males slightly MC
  • Women diagnosed later in life
  • Possibly worse prognosis in males
  • Younger onset, worse prognosis
  • Rarely occurs over 45 yo
27
Q

Define downward drift

A

Psychosis is more likely to be diagnosed in poorer patients

28
Q

Neuropsychopathology of psychosis

A
  • Frontal/temporal lobes affected
  • Mesolimbic DA hyperactivity
  • Mesocortical DA hypoactivity
  • Glutamate excitatory
  • GABA inhibitory
29
Q

What is the major CNS inhibitory neurotransmitter?

A

GABA

30
Q

Relation of ACh and schizophrenia

A
  • Increased smoking is seen in people w/schizophrenia

- Has led to hypothesis that nicotine (which stimulates ACh receptors) may ameliorate some of their symptoms

31
Q

Diagnosis of schizophrenia

A

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
32
Q

Subtypes of schizophrenia

A
  • Paranoid
  • Disorganized
  • Catatonic
  • Undifferentiated
  • Residual
33
Q

What are “positive” symptoms of schizophrenia?

A
  • Acute symptoms d/t DA dysregulation (increased DA in mesolimbic system)
  • Hallucinations, delusions, disorganized thought
  • Potentially reversible (respond best to neuroleptics)
34
Q

What are “negative” symptoms of schizophrenia?

A
  • Insidious and progressive due to “deficit syndrome” of DA in mesocortical system
  • Social withdrawal, flat affect, poverty of speech, avolition
35
Q

Poor prognosis of schizophrenia

A
  • Negative symptoms

- Impaired cognition

36
Q

Negative symptoms of schizophrenia are related to what physiologically?

A

Deficit syndrome of DA in mesocortical system

37
Q

Positive symptoms of schizophrenia are related to what physiologically?

A

Increased DA in mesolimbic system

38
Q

Genetic factors of schizophrenia?

A
  • Monozygotic twin studies 40-50% concordance

- MC polymorphism is on chromosome 22

39
Q

Risk factors for schizophrenia

A
  • Advanced paternal age at conception
  • 1st-2nd trimester viral infection
  • Toxoplasmosis in utero
  • Infant starvation
  • Late winter-early spring DOB
  • Psychoactive drugs
40
Q

Anatomic risk factor for schizophrenia

A

Smaller brain w/cortical thinning, ventricular enlargement

41
Q

Family influences on schizophrenia

A

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

42
Q

Clinical presentation of schizophrenia

A
  • Hallucinations
  • Delusions (fixed beliefs)
  • Disorganized thoughts
  • Personality changes
  • 4 As (Autism, Ambivalence, Affectivity, Association)
43
Q

Describe disorganized schizophrenia

A
  • Incoherence
  • Blunted, inappropriate affect
  • Early, insidious onset
  • Chronic severe course
44
Q

Describe catatonic schizophrenia

A
  • Restless catatonia (purposeless excitement w/injury risk)
  • Stupor, rigid catatonia
  • Mutism or echopraxia
  • Can maintain awkward position for hours
45
Q

MC subtype of schizophrenia?

A

Paranoid

46
Q

Describe paranoid schizophrenia

A
  • MC w/most favorable prognosis
  • Delusions of persecution, suspiciousness, grandeur
  • Generally intact intellectually/cognitively
  • Onset may be later (later is better prognosis)
47
Q

Describe residual schizophrenia

A
  • Under treatment and mostly stable
  • Has had at least 1 schizophrenic episode
  • Still has negative symptoms or milder positive symptoms
48
Q

Describe undifferentiated schizophrenia

A
  • Severely disorganized behavior
  • Psychotic (incoherent, hallucinatory)
  • Does not fit any other subtype
49
Q

Phases of schizophrenia treatment

A
  1. Acute (reduce harm - hospitalize)
  2. Behavior stabilization (case management to link back to community)
  3. Stable (minimize relapse)
50
Q

Drug classes used in schizophrenia

A
  • Antipsychotics (increases mortality in elderly)

- Atypical antipsychotics (2nd generation)

51
Q

1st line drug treatment of schizophrenia

A

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

52
Q

Role of psychotherapy in schizophrenia?

A

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

53
Q

MC comorbidity with schizophrenia?

A

Substance use (including smoking - 75% of pts)

54
Q

Violence and schizophrenia

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

Clin Med III - Psych, Genetics (9 decks)

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