Psychosis Flashcards
Schizophrenia
At least two of the five symptoms must be present for at least
one month. One of the two symptoms must be delusions, hallucinations, or disorganized speech.
• 1. Delusions.
• 2. Hallucinations.
• 3. Disorganized speech (e.g., frequent derailment or incoherence).
• 4. Grossly disorganized or catatonic behavior.
• 5. Negative symptoms (i.e., diminished emotional expression
or avolition)
Schizophrenia: duration?
- Six-month duration that distinguishes schizophrenia from schizophreniform disorder (one to six months) and brief psychotic disorder (one day to six months).
- Level of functioning… is markedly below the level achieved prior to the onset
- Rule out psychosis due to drugs or a medical condition.
Hallucinations=
Sensory perceptions in absence of external
stimuli
Delusions=
– Firmly held false beliefs
Thought Disorder=
Disruption in form or organization of
thinking – incoherence, difficulty communicating, loose
associations, thought blocking, echolalia, clanging (“he raged at the hypocrisy of the aristocracy democracy” ).
Cognitive symptoms=
• Cognitive symptoms are subtle and are often
detected only when neuropsychological tests are
performed. They include the following:
• Poor “executive functioning” (the ability to
absorb and interpret information and make
decisions based on that information),
• Inability to sustain attention
• Problems with “working memory” (the ability to
keep recently learned information in mind and
use it right away)
Prodromal or Residual Phase=
Social Isolation, Withdrawal • Impairment of Functioning • Peculiar Behavior • Impaired Personal Hygiene • Blunted or Inappropriate Affect • Abnormal Speech • Odd Beliefs • Unusual Perceptual Experiences • Apathy
DDX of Schizophrenia
Mood Disorders:
• Schizoaffective Disorder: Mood issues > Thought Issues when
euthymic
• Bipolar Disorder
• Psychosis is present only during manic or depressive episodes
• Psychotic Depression
• Schizophreniform Disorder – Scz w < 6mo duration
• Brief Reactive Psychosis- Psychotic sx ,1month
• Schizotypal Personality Disorder – Fails to meet active
phase of schizophrenia criteria
• Delusional Disorder – persistent, delusions
• Organic Etiologies
Paranoid Type (DSM IV)
Preoccupation with one or more delusion or frequent auditory hallucinations • None of the following • disorganized speech • disorganized or catatonic behavior • flat or inappropriate affect
Residual Type
Absence of prominent delusions, hallucinations, disorganized
speech or behavior
• Continued evidence of disturbance e.g. negative symptoms
Evaluation of Psychosis
Complete Physical and Neurological Exam
• History – Subst Use, Past Psychosis, FHx, Medical Hx,
Medications.
• Mental Status Exam
• Laboratory Screens:
• Electrolytes, BUN, Cr, CA, Glucose, CBC, Thyroid Pannel, Liver
enzymes, VDRL, B12, Folate, HIV when indicated
• Tox Screen
• Brain Imaging when indicated, or w/ neurological
findings
• EEG when suspicious of absence or partial seizures
Antipsychotic Medications:
-classification
Conventional
• Low Potency – Chlorpromazine (Thorazine), Thioridizine (Mellaril)
• High Potency – Haloperidol (Haldol), Fluphenazine (Prolixin),
Trifluoperazine (Stelazine), Pimozide (Orap)
• Long Acting / Depot – Oil Based Injection
• Prolixin or Haldol Decanoate
Antipsychotic Medications:
-novel or atypical
5HT/DA Antagonists: • Clozapine (Clozaril) • Risperidone (Risperdal) • Olanzapine (Zyprexa) • Quetiapine (Seroquel) • Ziprasidione (Geodon) • Dopamine Partial Agonist/Antagonist • Aripiprazole (Abilify) • D2 Receptor Blockade • Essential for antipsychotic efficacy • 5HT2 Blockade
Side Effects: Key Differentiator for
Antipsychotics
Extrapyramidal Side Effects (EPS)
• Common with Conventional Agents
• High Potency»_space; Low Potency
• Stiffness, shuffling gait, loss of automatic associated movements.
PARKINSONIAN SX
• Occur when > 80% of D2 Receptors are occupied
• Therapeutic Antipsychotic Effects: 65-70% Blocked
• Minimal Effective Dosing - Dose to block for tx of psychosis but
avoid excessive blockaid to minimize EPS
