Psychosis & Schizophrenia Flashcards
Psychosis
Gross impairment of reality testing:
- Hallucinations
- Delusions
- Thought disorder
Symptom of many disorders
Schizophrenia DSM critera
Two or more of the following for > 1 month:
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized or catatonic behavior
- Negative symptoms
Major social or occupational dysfunction
NOT part of mood disorder, substance use, or medical condition
Schizophrenia Prodromal symptoms
Social isolation Impaired functioning Odd behavior Odd beliefs Poor hygiene Blunted or inappropriate affect Abnormal speech Apathy Perceptual disturbances
Schizophreniform Disorder
< 6 months
Positive Symptoms of Schizophrenia
HALLUCINATIONS (auditory & voices most common, all five modalities possible)
DELUSIONS (False beliefs not in keeping with the patient’s culture and background) (most commonly thought broadcasting, withdrawal, insertion)
DISORGANIZATION (Thought or behavior)
Negative Symptoms of Schizophrenia
ALOGIA (poverty of speech)
FLAT AFFECT
ANHEDONIA
AVOLITION
Cognitive Impairment in Schizophrenia
1) Defect of working memory
2) Defect of filtering
3) Mild deterioration throughout illness
4) Best predictor of functional outcome
Neurological signs of Schizophrenia
Eye movement
Balance / proprioception
Stereognosis and graphesthesia abnormalities
Course of Illness for Schizophrenia
1) Prodrome - withdrawl, eccentricity, depression/anxiety
2) Active Phase - active psychotic symptoms, negative symptoms
3) Residual Phase - less intense positive symptoms
4) Exacerbations - throughout lifetime
Schizophrenia Outcome
Generally poor Early intervention is best 20% have "good outcome" - few return to baseline 5% suicide rate Worse medical care
Predictors of Good Outcome in Schizophrenia
Married
Short duration
Mood symptoms
Higher social class
Predictors of Poor Outcome in Schizophrenia
Early onset Poor premorbid functioning Family hx of schizophrenia Enlarged ventricles Cognitive impairment Delayed pharmacotherapy
Subtypes of Schizophrenia
1) Paranoid - delusions / hallucinations, higher premorbid functioning, better outcomes
2) Disorganized - thought disorder, fragmented delusions, negative symptoms
3) Catatonic - less commonly seen in 20th cent.
4) Undifferentiated
Basic Epidemiology
1% lifetime prevalence
46% concordance in monozygotic twins, 14% in dizygotic
Age of onset: Males 18-25, Females 26-45, 10% after age 40
Males = Females
Downward socioeconomic drift
Acute Treatment of Schizophrenia
Containment Reduce stimulation Develop alliance Provide education and support Avoid med side effects (prevent non-compliance)
Long-term Treatment of Schizophrenia
Psychotherapy: problem solving, substance misuse tx, cognitive rehab
Family support and education
Meds
Typical Antipsychotic Medications
More selective D2 blockade
Haloperidol, Thioridazine, chlorpromazine
Side Effects: Greater chance of Parkinsonian symptoms (EPS) Tardive Dyskinsesia QTc prolongation Neuroleptic Malignant Syndrome Hyperprolactemia
Neuroleptic Malignant Syndrome
Fever Elevated liver enzymes Vital signs strange Encephalitis Rigid muscles
Fix with Dantroline - skeletal muscle relaxant
Atypical Antipsychotic Medications
Risperidone, Paliperidone, Olanzapine, Ziprazidone, Clozapine, Aripiprazole, Quetiapine
Less selective for D2
More strongly D1 and D4 blocking
Afinity for 5HT receptor
Lower risk of EPS, TD, and NMS
Increased sedation, weight gain, metabolic syndrome
Clozapine side effects
Agranulcytosis Seizures Myocarditis Sedation Weight gain
