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Psychosis Flashcards

1
Q

Define Psychosis

A

A loss of contact with reality

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2
Q

Define Delusions

A

Strongly held false beliefs that are not part of the patient’s cultural or religious backgrounds

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3
Q

Types of Delusions

A 
Persecutory
Grandiose
Erotomanic
Somatic
Delusions of reference
Delusions of control
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4
Q

Define Hallucinations

A

Wakeful experiences of content that is not actually present

Auditory most common

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5
Q

Thought Disorganization

A

Alogia/poverty of content
Thought blocking
Loosening of association
Tangentiality
Clanging or clang association: rhyming words
Word salad: words linked incoherently
Perseravation: repeating words phrases no matter the topic

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6
Q

Differential Diagnosis of Psychotic Disorders

A 
Schizophrenia
Bipolar disorder + psychotic features
Major depression + psychotic features
Schizoaffective disorder
Schizophreniform disorder
Brief psychotic disorder
Substance induced psychotic disorder
Delusional disorder
Psychosis secondary to medical condition
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7
Q

Define Schizoaffective Disorder

A

Affective disorder but have psychotic features at a separate time than the affective disorder

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8
Q

Define Schizophreniform Disorder

A

Schizophrenia that doesn’t quite meet the criteria for Schizophrenia

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9
Q

Labs for Psychosis Work-up

A 
CBC
CMP
RPR/VDRL
TSH
HIV
UA
Urine drug screen
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10
Q

What is the peak age of schizophrenia?

A

Men: 12-25
Women: 25-35

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11
Q

Items that make schizophrenia difficult to deal with

A

Highly disabling
Persists throughout patient’s life
Poor care & social ostracism
Only 1/2 obtain treatment

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12
Q

DSM-5 Criteria: 2 of the following characteristics during a 1 month period

A

Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior
Negative symptoms
Social or occupational dysfunction
Continuous signs of disturbance persisting for at least 6 months within 1 month of “active-phase” symptoms

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13
Q

Positive Symptoms of Schizophrenia

A

Delusions

Hallucinations

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14
Q

Negative Symptoms of Schizophrenia

A 
Affective flattening
Poverty of speech (Alogia)
Blocking
Poor grooming
Lack of motivation
Anhedonia
Social withdrawal
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15
Q

Which types of symptoms have better responses to treatment?

A

Positive symptoms

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16
Q

Subtypes of Schizophrenia

A

Paranoid type
Disorganized type
Catatonic type

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17
Q

Define Paranoid Schizophrenia

A

Preoccupation with one or more delusions or frequent auditory hallucinations
No disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect

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18
Q

Characteristics of Disorganized Schizophrenia

A

Disorganized speech
Disorganized behavior
Flat or inappropriate affect

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19
Q

Characteristics of Catatonic Schizophrenia

A 
Motoric immobility
Excessive purposeless motor activity
Extreme negativism or mutism
Peculiarities of voluntary movement
Echolalia or echopraxia
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20
Q

Define Echolalia & Echopraxia

A

Mimic your movements or your speech

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21
Q

Four Components of Delusions

A

False belief
Based on incorrect inference about external reality
Not consistent with patient’s intelligence & cultural background
Cannot be corrected by reasoning

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22
Q

Name this type of Delusion: “I can’t believe that they’ve now sabotaged my car! Last week they stole my mail and I know they are following me overtime I leave the house”

A

Delusion of Persecution

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23
Q

Name this type of Delusion: “God has chosen me to be the world’s representative at the universal meeting at Mars next month”

A

Delusion of Grandeur

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24
Q

Name this type of delusion: “Invaders from space have infiltrated my testicles so I wouldn’t be allowed to father any children.”

A

Bizarre Delusion

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25
Name this type of delusion: "It doesn't matter anyway with how my thoughts are controlled by the government."
Delusion of Control
26
Name this type of delusion: "The DJ is really giving me instructions on what to do. He just disguises it so no one will pick up on it."
Delusion of Reference
27
Different Thought Form & Process's
``` Flight of ideas Thought blocking Incoherence Poverty of content Poor abstraction abilities Verbigeration Tangentiality Circumstantiality Loose associations Derailment Neologisms ```
28
Parts of a Mental Status Examination
``` General description Mood, feelings, affect Perception Thought: content, form & process Sensorium & cognition: oriented x3, memory intact, poor insight Impulsiveness ```
29
Neurotransmitters Associated with Schizophrenia
``` Dopamine Glutamate Gamma-amino-butyric-acid (GABA) Acetylcholine Serotonin ```
30
Dopamine in Schizophrenia
Decreased dopamine: cognitive & negative symptoms
31
Glutamate in Schizophrenia
Major CNS excitatory neurotransmitter | Hypofunction of glutamate receptor may contribute to pathology
32
Gamma-amino-butyric-acid (GABA) in Schizophrenia
Major CNS inhibitory neurotransmitter Important for regulation of the prefrontal cortical function Interneurons are dysfunction in schizophrenia
33
Acetylcholine in Schizophrenia
Nicotine can normalize some eye-tracking & EEG abnormalities
34
Serotonin in Schizophrenia
Antagonism at 5-HT2 receptors reduces psychotic symptoms
35
Pattern of Symptoms in Schizophrenia
Quiet, passive, & introverted personality Few friends growing up Adolescents may have no close friends, dates, & may avoid team sports Enjoy movies & TV or listening to music instead of social activities
36
Poor Outcomes of Schizophrenic Patients
Repeated hospitalizations Exacerbation of symptoms Episodes of major mood disorders Suicide attempts
37
What is common among untreated schizophrenic patients?
Violent behavior
38
What percent of schizophrenic patients attempt suicide?
50%
39
How is Schizoaffective Disorder Different from Schizophrenia
Major depressive or manic episode | AND patient must have experienced delusions or hallucinations IN THE ABSENCE of the mood symptoms
40
How is Brief Psychotic Disorder Different from Schizophrenia
Symptoms of delusions, hallucinations, disorganized speech, or disorganized behavior that persist for more than 1 day but less than 1 month
41
How is Delusional Disorder Different from Schizophrenia?
Delusion WITHOUT other signs/symptoms of psychosis | Delusions are non bizarre
42
How is Schizophreniform Disorder Different from Schizophrenia?
Schizophrenia like symptoms for more than 1 month but less than 6 months
43
Examples of First Generation Antipsychotics (FGAs)
Haloperidol (Haldol) Chlorpromazine (Thorazine) Thioridazine (Mellaril)
44
MOA of First Generation Antipsychotics (FGAs)
Antagonism of D2 receptors in both cortical & stratal areas
45
SE of First Generation Antipsychotics (FGAs)
``` Extra-pyramidal symptoms (EPS) Tardive dyskinesia (TD) Hyperprolactinemia Neuroleptic malignant syndrome (NMS) QT prolongation Sudden death Increased risk of mortality when treating elderly patients with dementia Akinesia Weight gain ```
46
Extra-pyramidal Symptoms
Akathisia Parkinsonian syndrome Acute dystonias
47
Examples of Second Generation Antipsychotics (SGAs)
Respirdone (Resperdol) | Aripiprazole (Abilify)
48
MOA of Second Generation Antipsychotics (SGAs)
Post-synaptic blockade D2 receptors PLUS 5HT2 receptor binding
49
SE of Second Generation Antipsychotics (SGAs)
``` Weight gain Hyperglycemia Hyperlipidemia EPS TD NMS- neuromalignant syndrome Hyperprolactinemia Increased mortality in elderly patients with dementia ```
50
Primary Use of FGAs
IV for emergent situations | Depot preparations
51
SE of Risperidone (Risperdal)
``` Sedation Hypotension Akathisia Prolactin elevation Weight gain ```
52
SE of Olanzapine (Zyprexa)
``` Weight gain Sedation Akathisia Hypotension Dry mouth Constipation ```
53
What is quetiapine (Seroquel) used to treat?
Mood disorders Anxiety disorders PTSD Parkinson disease
54
SE of Quetiapine (Seroquel)
``` Sedation Orthostatic hypotensions Akathisia Dry mouth Weight gain ```
55
Pharmacokinetics of Aripipraole (Abilify)
Agonist at D2 receptors Partial agonist at 5HT1a receptors Antagonist at 5HT2a, H1 & alpha-1-adrenergics
56
SE of Aripipraole (Abilify)
``` Headache N/V Akathisia Tremor Constipation Minimal weight gain ```
57
What does clozapine (Clozaril) have a high risk of?
Agranulocytosis
58
When do we use clozapine (Clozaril)?
Treatment-Resistant patients
59
SE of Clozapine (Clozaril)
``` Orthostatic hypotension Tachycardia Weight gain Metabolic syndrome Sialorrhea Sedation Constipation Seizure risk that increases with dose ```
60
How to treat akathisia as a SE of antipsychotics?
Benzodiazepine Beta-blocker Benztropine
61
How to treat parkinsonian syndrome as a SE of antipsychotics?
Benztropine | Amantadine: SE hypotension & mild agitation
62
How to treat dystonia as a SE of antipsychotics?
Change to antipsychotics with lower EPS Benztropine Diphenhydramine
63
Tardive Dyskinesia Movements
``` Sucking/smacking lips Choreaoathetoid movement of tongue Facial grimacing Lateral jaw movements/clenching Choreiform or athetoid movements of the body ```
64
Risk Factors for Tardive Dyskinesia
Long use of antipsychotics EPS Elderly Use of other meds
65
Metabolic Effects of Antipsychotics
Weight gain Hyperglycemia Hyperlipidemia NMS: fever, mental status changes, rigidity, autonomic instability
66
Treatment Options in Addition to Medication for Schizophrenia
Family psychoeducational intervention Social skills training for the patient Cognitive behavioral therapy
67
Family Psychoeducational Intervention
Educates family that schizophrenia is a disease, factors about the disease, how to help the person with the disease & fosters optimism Monthly sessions for 6-9 months
68
Social Skills Training for the Patient
Uses behaviorally based instruction, role modeling, rehearsal, corrective feedback, & positive reinforcement Helps with deficits in skills as a result of negative symptoms
69
Cognitive Behavioral Therapy
Used to treat medication-resistant psychosis

Behavioral Health (25 decks)

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