Psychosis & Serotonin Syndrome Flashcards
Delusions
Strongly-held false beliefs not part of culture/religion
Bizarre or not -> persecutory, control, grandiose
Hallucinations
Wakeful experiences of content that isn’t present
All 5 senses - auditory most common, then visual
Schizophrenia DSM-5 Diagnosis
2 or more for significant portion of time w/in a month
-Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms
Or 1 needed with bizarre delusions of hallucinations w/ voice/commentary
Don’t necessarily need delusions or hallucinations for Dx
Positive Symptoms
Delusions
Hallucinations
Predominantly positive symptoms have fairly good response to treatment
Negative Symptoms
Flat affect
Speech poverty - alogia
Blocking
Poor grooming
Lack motivation
Anhedonia
Social withdrawal
Paranoid Schizophrenia
1 or more delusions with frequent auditory hallucinations
No disorganized speech/behavior, flat affect
Disorganized schizophrenia
Disorganized speech and behavior
Flat and inappropriate affect
Catatonic Schizophrenia
Excess purposeless motor activity
Extreme negativism or mutism
Peculiar voluntary movement (posturing)
Echolalia or echopraxia - mimic your movement or what you say
4 components of delusions
False belief
Based on incorrect inference about external reality
Not consistent with intelligence or cultural background
Cannot be corrected by reasoning
Schizoaffective disorder
Both affective and psychotic symptoms - psychosis and depression at same time
Dx: Major depressive/manic episode plus delusions/hallucinations without mood symptoms
Better prognosis than schizophrenia
Brief Psychotic Disorder
Dx: symptoms of delusions/hallucinations, disorganized speech/behavior that persist for more than 1 day but less than 1 month
50-80% never have another psychotic episode
Associated with increased suicide risk
Delusional Disorder
Powerful delusions without other symptoms of psychosis - non-bizarre delusions
Risk to themselves or others - most are refractory to treatment
Schizophreniform Disorder
Schizophrenia-like syndrome for more than a month but less than 6 months
1/3 recover within 6 months, the rest progress to schizophrenia Dx
Antipsychotic side effect management - EPS
Akathisia - smooth, uncontrollable movements
-Treat with benzo, BB, benztropine
Parkinsonian Syndrome - no dopamine
-Treat with benztropine, Amantidine
Dystonia - trouble moving
-Treat with antipsychotic change, benztropine, diphenhydramine
Tardive Dyskinesia
Risk: Long-term use, EPS, elderly, use of other meds
Irreversible, monitor with long-term use
Switch to antipsychotic with lower risk
