Psychosis Flashcards
Three things needed to define psychosis
delusions, hallucinations, disorganized thinking/speech/behavior
symptoms of schizophrenia
mania, severe depression, substance induced, medical condition, drug induced
person believes “he or she is being tormented, followed, tricked, spied on, or ridiculed”, or that their food is being poisoned
delusions of persecution
individual’s experiencing innocuous events or merecoincidences[1]and believing they have strong personal significance
ideas of reference
False belief that another person, group of people, or external force controls one’s general thoughts, feelings, impulses, or behavior
delusions of control
ixed, false belief that one possesses superior qualities such as genius, fame, omnipotence, or wealth.
delusions of grandeur
person may, for example, believe that he or she has committed some horrible crime and should be punished severely. Another example is a person who is convinced that he or she is responsible for some disaster (such as fire, flood, or earthquake) with which there can be no possible connection.
delusions of guilt
psychotically depressed man believes his internal organs have become infested with and partially consumed by large purple worms.
somatic delusions
Three instances where you may see a patient having visual hallucinations
intoxication, withdrawal, delirium
olfactory hallucinations are associated with an
epileptic aura
what is the main cause of tactile perceptual disturbances
drug induced (cocaine or alcohol)
hallucinating that you are being infested with bugs
Ekboms Syndrome
ideat that something is crawling around your skin
formication
MS, Alzheimers, Parkinson, tertiary syphilis, encephalitis, AIDS, neoplam, cerebrovascular, Huntingtons are all examples of
CNS causes of psychosis
hypo/hypercalcemia, hypopituitarism, hypo/hyperthyroidism, Addison, Cushing are all examples of
endocrinopathies that cause psychosis
B12, folate and niacin are examples of
nutritional/vitamin deficiencies that can cause psychosis
What kind of hallucinations are seen in Lewy Body dementia?
happy hallucinations
At what age do women and men present with schizophrenia?
women → 30
men → 20
If a patient over 55 presents with schizophrenia like symptoms what is the likely diagnosis?
dementia
Schizophrenia is also comorbid with
substance abuse
lower socioeconomic status secondary to impaired social functioning
downward drift
Pathophysiology of schizophrenia is
increased dopamine activity in certain neuronal tracts → disease is most likely due to excess dopamine
what percent of schizophrenia patients smoke?
90%
positive symptoms of schizophrenia
hallucinations, delusions, bizarre behavior, disorganized speech
Negative symptoms of schizophrenia
blunted affect, anhedonia, apathy, alogia, avolition
Psychotic disorders are ____ since they probably have origins in early development but are generally manifested in late adolescence as a result of the developmental trajectory of the brain
neurodevelopmental
1% of ____ is lost per psychotic episode
gray matter
How will gray matter loss look on an MRI or CT?
gray matter atrophy and enlarged ventricles
DSM V criteria for schitophrenia - you need ___ or more symptoms present for at least ____
2 or more
one month
To be diagnosed with schizophrenia you need at least one of your symptoms to be
hallucinations, delusions, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms
For schizophrenia you have to have continuous disturbance for
6 months
patients doesn’t talk, will give very simple answers to what they are asked
poverty of speech
what types of associations may a schizophrenic patient have?
loose → tangential, circumstantial
three phases of schizophrenia
prodromal → psychotics → residual
what is going on in the prodromal stage?
accumulation of cognitive and functional impairment → start to see changes in mood, behavior, academic performance, self care, social withdrawal, sleep patterns, cognitions
what percent of schizophrenic patients remain significantly depressed?
40-50%
Symptoms of schizophrenia that indicate better prognosis
later onset, good social support, positive symptoms, mood symptoms, acute onset, female sex, few relapse, good premorbid function
Symptoms of schizophrenia that indicate worse prognosis
early onset, poor social support, negative symptoms, family history, gradual onset, male sex, many relapses, poor premorbid function, cormorbid substance abuse
which pharmacotherapy has better effect on the positive symptoms of schizophrenia?
FGA
Common side effects of FGA
EPS, tardive dyskinesia, NMS
MOA of FGA
dopamine antagonist
MOST of SGA
5HT2 and D2 antagonists
side effects of SGA
metabolic syndrome, EPS, hypotension, prolonged QTc, hyperprolactinemia
best treatment for negative symptoms of schizophrenia
clozapine
After giving patient antipsychotic they experience back spasms →
dystonia
after giving patient antipsychotic they experience tremor, bradykinesia, and rigidity →
Parkinsonism
After giving patient antipsychotic they experience darting and writhing movements →
tardive dyskinesia
After giving patient antipsychotic they experience AMS, muscle rigidity, autonomic dysregulation (fever, hypertension, tachycardia) →
NMS
“lack of insight” is a symptom of severe mental illness where the person is unable to understand and perceive their illness
anosognosia
why do patients with schizophrenia or bipolar disorder refuse meds and therapy?
anosognosia
What percent of schizophrenia and BPAD patients experience anosognosia?
schizophrenia → 50%
BPAD → 40%
Duration to be considered a Brief Psychotic Disorder
< 30 days
Symptoms of Brief Psychotic Disorder
delusions, hallucinations, disorganized speech (derailment or incoherence), grossly disorganized/catatonic behavior
Onset of Brief Psychotic Disorder is most likely due to
acute stress
Prognosis of Brief Psychotic Disorder
return to premorbid baseline
Duration for schizophreniform disorder
1-6 months
duration for schizophrenia
> 6 months
Schizophrenia + Manic Depression
schizoaffective disorder
Patients with schizoaffective disorder meet the criteria for
major depressive episode, manic episode, or mixed episode when also meeting the criteria for schizophrenia
Schizoaffective disorder a patient must have ____ for 2 weeks in the absence of mood symptoms
positive symptoms
In schizoaffective disorder what must be present for a substantial portion of the psychotic illness
mood symptoms
belief that a person is in love with the affected individual, despite contrary evidence
erotomanic delusion
fantastical beliefs that one is famous,omnipotent, wealthy, or otherwise very powerful. The delusions are generally fantastic and typically have areligious,science fictional, orsupernaturaltheme
grandoise delusion
fixed, false belief that one’s bodily functioning, sensation, or appearance is grossly abnorma
somatic delusion
A person with this type of delusional disorder believes that his or her spouse or sexual partner is unfaithful.
jealous delusion
People with this type of delusional disorder have two or more of the types of delusions listed above.
mixed type delusion
