psychosis

Question 1

gross brain changes in schizophrenic

Answer 1

symmetric enlargement of ventricles. diffuse cortical atrophy.

Question 2

medical categories of psychosis (4)

Answer 2

CNS disease
endocrinopathy-
nutritional deficiency (B12, folate, niacin)
other- SLE, temporal arteritis, porphyria

Question 3

CNS diseases that can cause psychosis

Answer 3

encephalitis, prion disease, temporal lobe epilepsy, huntingtons chorea, MS, cerebrovascular disease, neoplasm, parkinsons, neoplasm

Question 4

endocrinopathy that can cause psychosis

Answer 4

Addisons/Cushing’s, hyper/hypothyroidism, hyper/hypoclcemia, hypopituitarism

Question 5

what can cause medication/substance induced psychosis

Answer 5

antidepressants, antiparkinsonian, antiHTN, antihistamine, anticonvulsant, digitialis, beta blocker, anti-TB, corticosteroids, hallucinogens, amphetamines, opiates, bromide, heavy metal, alcohol

Question 6

72 yo woman with metastatic breast cancer has change in mental status over past 3 days. hallucinating. not oriented to person, place or time.

Answer 6

prob hypercalcemia-> psychosis (from metastatic disease)

Question 7

25 yo woman who lives alone and has no friends and talks to horses and says that the horses have been given special powers by God. most likely diagnosis is ..

Answer 7

schizophrenia, not schizoid, because she has bizarre delusions. schizoid is lifelong. schizophrenia has onset around 20.

Question 8

altered neurotransmitters in schizophrenia

Answer 8

increased dopamine, increased serotonin, increased norepinephrine, decreased GABA in hippocampus (that may indirectly activate dopaminergic and noradrenergic pathways)

Question 9

are mood sxs in schizophrenia associated with bad prognosis

Answer 9

they are associated with good prognosis

Question 10

how do you qualify for schizoaffective

Answer 10

need to have delusions or hallucinations for 2 weeks in the absence of mood disorder sxs (to differentiate from mood disorder with psychotic features). have mood disorder present for most of psychotic features.

Question 11

delusional disorder vs brief psychotic disorder

Answer 11

delusional: nonbizarre fixed delusions for >1mo with functioning in life not severely impaired. common in elderly, deaf, and immigrants.
psychotic: bizarre/nonbizarre delusions for

Question 12

how to treat delusional disorder. prognosis?

Answer 12

psychotherapy can be helpful. try antipsychotic (high dose typical) though they usually don’t work. prognosis: 50% full recovery, 20% decreased sxs, 30% no change

Question 13

brain fag

Answer 13

culture specific psychosis to africa- male students get headache fatigue and visual disturbances

Question 14

koro

Answer 14

culture specific psychosis in asia- pt believes penis is shrinking and will lead to death

Question 15

amok

Answer 15

culture specific psychosis to malaysia- sudden unprovoked bursts of violence where person often commits suicide afterwards

Question 16

what is a predisposing factor to paranoid psychosis

Answer 16

deafness

Question 17

what heart meds can cause psychosis

Answer 17

beta blocker and digoxin

Question 18

what percent of long term hospitalized patients treated with antipsychotics end up suffering from TD

Answer 18

20%

Question 19

what percent of schizoaffective progress to schizophrenia

Answer 19

60-80%

Question 20

normal grief vs depression

Answer 20

normal grief: 2 mo.

Question 21

can you breastfeed with antidepressants and lithium

Answer 21

no- relative contraindication