Psychosis Flashcards

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1
Q

Mini Mental Status Exam:

-what is this?

A

11 question interview that tests five areas of cognitive function.

  • orientation
  • registration
  • attention
  • calculation
  • recall
  • language
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2
Q

Psychosis:

  • definition
  • psychotic states are high risk periods for what kind of behavior?
A

definition: a loss of contact with reality

high risk behaviors:

  • agitation
  • aggression
  • impulsivity (suicide)
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3
Q

Clinical Manifestations of Psychosis:

- what are the types of delusions?

A

Delusions:
-persecutory (police are out to get them/harm them, etc)

  • grandiose (convinced they have special powers, talents, or abilities, famous, very powerful)
  • erotomanic (believe another person is in love with them)
  • somatic (the body is somehow dzed abnormal or changed, ex. parasitosis; think they are infested with parasites, mites, etc)
  • delusions of reference (falsely believe that insignificant events have personal meaning or significance)

-delusions of control
(Think other people are controling ones general feelings, thoughts, or behavior)

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4
Q

Clinical Manifestations of Psychosis:

  • Hallucinations
  • -what are these?
  • -what are the types? which is MC?
A

Hallucinations:
-wakeful experiences of content that is not actually present.

  • Types: any of the 5 senses.
  • -visual, auditory, tactile, olfactory, and gustatory
  • -Auditory is most common.
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5
Q

Clinical Manifestations of Psychosis:

  • Thought disorganization-speech:
  • -describe the different types.
A

Alogia: poverty of speech; short answers.

Thought blocking: suddenly loosing train of thought

Loose association: sequences not well connected, flight of ideas (lacking logical relationship)

Tangentially: answers to questions veering off topic

Clanging or clang association: using rhyming words

Word Salad: real words linked incoherently

Perservation: repeating words or ideas even when topic is changed.

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6
Q

Schizophrenia

  • Peak ages of onset in men and women?
  • DSMV Dx
A

Onset:

  • Men: 12-25YO
  • Women: 25-35YO

DSM V: 2 or more of the following, each present for a significant portion of time during a 1mo period:

  • delusions
  • hallucination
  • disorganized speech
  • grossly disorganized or catatonic behavior
  • negative sx (affective flattening or poverty of speech)
  • only one of these criterion are necessary if:
  • delusions are bizarre
  • hallucinations consist of a voice
  • keeping up a running commentary, or two or more voices conversing.
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7
Q

Schizophrenia:

  • what are the positive sx
  • what are the negative sx
  • T/F, pts with positive sx have poor response to treatment?
A

Positive:

  • delusions
  • hallucinations

Negative:

  • affective flattening
  • poverty of speech
  • blocking
  • poor grooming
  • lack of motivation
  • anhedonia
  • social withdrawal

FALSE!! pts with predominantly positive sx have relatively good response to tx.

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8
Q

Schizophrenia

-subtypes

A

Paranoid type: preoccupation with one or more delusions or frequent auditory hallucinations
-no disorganized speech, disorganized catatonic behavior, or flat or inappropriate affect.

Disorganized type:
-disorganized speech, disorganized behavior, flat or inappropriate affect

Catatonic type:

  • motoric immobility
  • exccessive purposeless motor activity
  • extreme negativism or mutism
  • peculiarities of voluntary movement (bizarre positioning)
  • echolalia or echopraxia (mimic your movements or what you say)
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9
Q

What is the mental status exam?

A

-General description: ranges from completely discheveled screaming and agitated to obsessively groomed, completely silent, and immobile.

–Behavior: talkative, exhibit bizarre postures, may become agitated or violent in an unprovoked manner or in response to hallucinations, may be catatonic stupor, tics, echopraxia

-Mood, feelings, affect:reduced emotional responsiveness to overly active and inappropriate emotions such as extremes in rage, happiness, and anxiety

  • Perception: all five senses may be affected by hallucinatory experiences
  • -illusions? distortions of real images.

-Thought: core sx of schizoprenia; thought content = what the person is thinking (delusion/false belief)

Thought process = how the person is thinking what they are thinking.. (flight of ideas, thought blocking, poverty of content, tangentiality, derailment)

  • Sensorium/Cognition:
  • -usually AOx3
  • -memory usually intact
  • -classically described as having poor insight
  • impulsiveness:
  • -agitated and have little impulse control when ill
  • -decreased social sensitivity
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10
Q

What are the following types of delusions:

  1. I cant believe that they’ve now sabotaged my car! last week they stole my mail and i know they are following me every time i leave the house.
  2. God has chosen me to be the worlds representative at the universal meeting at Mars next month.
  3. Invaders of space have infiltrated my testicles so i wouldnt be allowed to father any children.
  4. It doesnt matter anyway with how my thoughts are controlled by the government
  5. The DJ is really giving me instructions on what to do. He just disguises it so no one will pick up on it.
A
  1. Delusion of persecution
  2. Delusion of Grandeur
  3. Bizarre Delusion
  4. Delusion of control
  5. Delusion of reference
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11
Q

Schizophrenia:

  • etiology
  • what NT are involved?
  • signs prior to dx
A

Etiology: likely a group of disorders with differing causes leading to somewhat similar sx.
-may be genetic; 47% for monozygotic twins

NT:

  • dopamine; decrease***
  • glutamate; hypofunction of NMDA glutamate receptor
  • GABA (inhibitory NT)
  • Ach
  • serotonin*

Signs:

  • quiet, passive, and introverted,
  • few friends, no dates, avoid team sports
  • enjoy movies, tv, or listening to music to exclude self from social activities
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12
Q

Schizophrenia:

  • prognosis
  • are violent behaviors common in untreated patients?
  • approximately what % of schizophrenics attempt suicide?
A

Prognosis:

  • 10-20% of pts have good outcome
  • 50% have poor outcome; repeated hospitalizations, suicide attempts
  • 20-30% are able to lead somewhat normal lives.

Yes, emergency tx may include restraints and seclusion, acute sedation w/ lorazepam 1-2mg IM may be repeated q1hr to prevent pt from harm.

50% attempt suicide.

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13
Q

Schizoaffective Disorder

-dx

A

Dx:
-affective disorder (bipolar/depression) must be met AND the pt must also have experienced delusions/hallucinations (psychosis) in the ABSENCE of the affective disorder.

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14
Q

Brief Psychotic Disorder:

  • dx
  • T/F: 50-80% of pts dx with brief psychotic disorder never have another psychotic episode?
A

dx: sx of delusions, hallucinations, disorganized speech, or disorganized behavior persist for more than 1 day but less than 1 mo.

TRUE!!!!

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15
Q

Delusional Disorder:

  • dx
  • important to assess what?
A

Dx: delusion w/o other signs or sx of psychosis
*delusions are nonbizarre (address situations that occur in everyday life.

be careful to assess pts risk of endangering self or others!! (im going to shoot him because hes going to shoot me)

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16
Q

Schizophreniform Disorder:

-dx

A

schizophrenia like sx for more than 1mo but less than 6mo

17
Q

Anti-psychotic meds

  • what are the first generation meds?
  • -MOA
    • SE of these meds
  • -indications
A

1st Gen: Phenothiazines
-haloperidol (holdol), chlorpromazine (thorazine), thioridazine (mellaril)

MOA: antagonize dopamine receptors.

SE:

  • Extra-pyramidal sx (parkinsonian syndrome, akathisia, acute dystonias)
  • tardive dyskinesia
  • hyperprolactinemia (b/c you’re antagonizing dompamine)
  • neuroleptic malignant syndrome
  • QT prolongation
  • sudden death
  • weight gain

Indications: IV for emergent situations w/ careful cardiac monitoring

18
Q

Anti-psychotic Meds:

  • second generation meds
  • -MOA
  • -SE
A

Meds: Respirdone (Resperdol), aripiprazole (Abilify), Olanzapine (zyprexa), Quetiapine (Seroguel), Clozapine (Clozaril),

MOA: post-synaptic blockade of D2 receptors

SE: weight gain, hyperglycemia, hyperlipidemia, EPS, tardive dyskinesia, neurolleptic malignant syndrome, hyperprolactinemia

19
Q

Describe the MC SE of the following medications:

  • Respiridone
  • Zyprexa
  • Seroquel
  • abilify
  • clozaril
A

Respiridone: sedation, hypotension, akathisia, prolactin elevation, weight gain NO anticholinergic effects

Zyprexa: weight gain*, sedation, akathisia, hypotension, dry mouth, constipation
levels decreased some by cigarette smoking

Seroquel: sedation, orthostatic hypotension, akathisia, dry mouth, moderate weight gain

Abilify: HA, N/V, akathisia, tremor, constipation, minimal weight gain

Clozaril: orthostatic hypotension, tachycardia, weight gain, metabolic syndrome, sialorrhea, sedation, constipation, and sx at high doses. agranulocytosis

20
Q

SE management of extrapyramidal sx

  • akathisia
  • parkinsonian syndrome
  • dystonias
A

akathisia = feeling of inner restlessness, rocking, stand-sitting, etc.
–tx is antipsychotic dose reduction, benzodiazepine, beta blocker, benztropine (anti-tremor)

parkinsonian syndrome: benztropine(cogentin), amantadine (dopamine promotor)

dystonias: change to anti-psychotic with lower EPS, benztropine, diphenhydramine.

21
Q

Tardive Dyskinesia:

  • what is this?
  • tx
A

What: sucking smacking of lips

  • choreoathetoid movement of the tongue
  • facial grimacing
  • lateral jaw movments/clenching

NO pharmocologic tx

22
Q

which anti-psychotics are first line? why?

A

second generation anti-psychotics are first line, they have less EPS SE.

23
Q

WHat are the Psychosocial interventions Tx

A

Family psychoeducation intervention: educated family that this IS a dz, how to help person with the dz & foster optimism.

Social skills training: personal care, cooking, paying bills, dating Uses behaviorally based instruction, role modeling, rehearsal, corrective feedback, and positive reinforcement.

Cognitive Behavioral therapy: used to treat medication resistant psychosis