Psychotic and Conduct Disorders

Question 1

What is critical to determine when first assessing a patient with a suspected psychosis?

Answer 1

Rule out an organic/medical cause of the mental status change.

Question 2

What S/S help to distinguish and organic cause of psychosis from a functional (psychiatric) cause?

Answer 2

Sudden onset, abnormal vitals, recent memory deficits, psychomotor retardation, emotional lability, occasional periods of lucidity, disorientation, visual/tactile hallucinations (functional cause usually auditory only).

Question 3

Define and describe the diagnostic criteria for delusional disorder.

Answer 3

Persistent, non-bizarre delusion not otherwise explained - fixed, false belief that has a certain level of plausibility. Must be present for 1+ month with no hallucinations nor disorganized speech/behavior.

Question 4

Define and describe paranoid delusions.

Answer 4

Delusions about things that COULD happen. Behavior not obviously odd and functioning not significantly impaired.

Question 5

Define/describe the following types of delusions: erotomatic, somatic, jealous, persecutory, grandiose, reference, control, nihlism.

Answer 5

Erot: famous or powerful person is in love with Pt.
Som: Pt has physical defect or medical condition
Jeal: Pt’s partner having an affair
Pers: Pt or another person is mistreated
Grand: inflated self-worth, power, knowledge
Ref: random events take on personal significance
Cont: some agency controls thoughts, feelings, behaviors
Nihl: exaggerated belief in futility of everything

Question 6

What is the most common type of delusion?

Answer 6

Persecutory

Question 7

Describe delusions of parasitosis.

Answer 7

Firm belief that pruritis is caused by infestation of insects or parasites. Presents with self-inflicted skin manifestations.

Question 8

What are the treatment options for delusiions?

Answer 8

Anti-psychotics 1st line –> aripiprazole (abilify)
SSRIs
Avoid directly challenging the Pt

Question 9

What distinguishes delusions from schizophrenia and other psychotic conditions?

Answer 9

Minimal deterioration in personality or function and the relative absence of other psychopathologic symptoms.

Question 10

Define and describe schizoaffective disorder.

Answer 10

Schizophrenia + a mood disorder (depression, bipolar, etc.). Delusions or hallucinations lasting 2+ weeks without mood disorder symptoms differentiate schizoaffective from mood disorder with psychotic features.

Question 11

What treatment options are available for schizoaffective disorder?

Answer 11

Atypical anti-psychotic is first line. Mood stabilizer or anti-depressant may be added. . Psychosocial support may help as well.

Question 12

Describe the diagnostic criteria for schizophrenia.

Answer 12

6+ month illness with 1+ month acute symptoms along with functional decline. Must have 2+ of the following: hallucinations, delusions, disorganized speech, disorganized/catatonic symptoms, negative symptoms.

Question 13

Differentiate positive from negative symptoms of schizophrenia.

Answer 13

Pos: any change in behavior or thoughts - hallucinations, delusions, etc.
Neg: withdrawal from the outside world - appear emotionless and flat

Question 14

Describe the terms catatonia and residual with regard to schizophrenia.

Answer 14

Cat: silent, no response to external stimuli
Res: socially withdrawn

Question 15

What is the most common type of hallucination associated with schizophrenia.

Answer 15

Auditory

Question 16

Other than the most common, list various types of hallucinations associated with schizophrenia.

Answer 16

Visual, olfactory, tactile, somatic (sensation arising from within the body), gustatory( tasting things that aren’t there - thinking poison is in food, for ex)

Question 17

Define neologisms.

Answer 17

Nonsense words invented by the patient –> common symptom of schizophrenia.

Question 18

Describe the pathophysiology of positive and negative symptoms associated with schizophrenia.

Answer 18

Pos: excess DA receptors in mesolimbic pathway
Neg: low DA in mesocortical pathway
Serotonin hyperactivity and decreased grey matter are also thought to play a role in the disease.

Question 19

What is the main treatment of schizophrenia and describe the subtypes of the medication.

Answer 19

Antipsychotics are 1st line
1st gen/typical: risk of extrapyramidal symptoms (EPS) and treat only positive symptoms
2nd gen/atypical: less risk of EPS and treat both positive and negative symptoms.

Question 20

Define schizophreniform disorder.

Answer 20

Fits criteria for schizophrenia but symptoms last less than 6 months (but greater than 1 month)

Question 21

Describe requirements for a diagnosis of ADHD to be made.

Answer 21

S/S > 6 months present in more than one environment with onset < age 7 and no association with psychosis. S/S –> short attention span, easily distracted, sometimes hyper-focus, hyperactivity, impulsivity.

Question 22

Describe some of the secondary effects/symptoms of ADHD.

Answer 22

emotional lability, poor social skills, motor incoordination, peer rejection and deflated self-image, often don’t comply with parents requests

Question 23

Name two rating scales used to assist in the diagnosis of ADHD.

Answer 23

Conners Comprehensive Behavioral Rating Scale

ADHD Rating Scale IV

Question 24

Describe treatment options available for ADHD.

Answer 24

Pharm: stimulants are first line

Non-pharm: behavior modification (1st line), group therapy, family therapy

Question 25

What stimulants are commonly used most commonly in the management of ADHD?

Answer 25

methylphenidate (Ritalin), dexmethylphenidate (focalin), amphetamine + dextroamphetmine (adderal)

Question 26

If a patient with ADHD has a personal or family history of SUD, what medication is indicated as an alternative to controlled substances (stimulants)?

Answer 26

Atomoxetine - SNRI

Question 27

What medications may be used as adjunctive therapy in the management of ADHD?

Answer 27

Anti-depressants - bupropion, venlafaxine, clonidine, imipramine Guanfenacine - centrally acting anti-HTN

Question 28

What characteristics are consistent with autism spectrum disorders and considered primary signs?

Answer 28

significant emotional discomfort or detachment, communication difficulties (inability to communicate or chooses not to), repetitive behaviors

Question 29

What characteristics are considered secondary signs of autism?

Answer 29

persistent failure to develop social relationships, failure to show preference to parents over other adults, unusual sensitivity to visual, auditory, olfactory stimuli, unusual attachments to ordinary objects.

Question 30

By what age are characteristics of autism typically seen and what S/S will be present at that age?

Answer 30

Age 3-6 months --> aloof, withdrawn, lack facial expression

Question 31

T/F: Autism is more common in males than females.

Answer 31

True: 3-5 times more common in males

Question 32

What diagnostic tool is used at 18 months to aid in the diagnosis of autism?

Answer 32

M-CHAT

Question 33

What treatment options are available in the management of autism?

Answer 33

Behavioral therapy is first line Anti-psychotics (risperidone, aripiprazole, haloperidol) and neuroleptics (carbamazepine) to reduce impulsivity and irritability. SSRIs can help control repetitive behaviors

Question 34

Describe the DSM-V diagnostic criteria for conduct disorder.

Answer 34

Age < 18 and 3+ acts of misconduct in the last 12 months in any of the following categories: - Aggression to people or animals - Destruction of property - Deceitfulness or theft - Serious violations of rules

Question 35

What condition do children with conduct disorder commonly develop in adulthood and what is the percentage risk of developing said condition?

Answer 35

40% diagnosed with conduct disorder have anti-social personality disorder as an adult.

Question 36

T/F: Conduct disorders are more common in males than females.

Answer 36

True

Question 37

What comorbid conditions commonly coexist with conduct disorder?

Answer 37

ADHD, IDD, SUD, mood disorders

Question 38

What differentiates conduct disorder from oppositional defiant disorder?

Answer 38

The presentations are similar. But, conduct disorder typically presents with more physical aggression and other severe forms of antisocial behavior. Conduct disorder would generally be considered a more severe presentation than ODD.

Question 39

What are the treatment options for conduct disorder?

Answer 39

Environmental/behavioral modification, family therapy Stimulants, bupropion, clonidine, lithium, haloperidol, 2nd gen antipsychotics, valproic acid to reduce aggression, SSRIs for mood lability and impulsivity.

Question 40

What is the diagnostic criteria for oppositional defiant disorder?

Answer 40

< 8 y/o with 6+ months of at least four of: - frequent loss of temper - arguments with adults - defying adults’ rules - deliberately annoying others - easily annoyed - anger and resentment - spitefulness - blaming others for mistakes or misbehaviors

Question 41

What percentage of children diagnosed with ODD progress to conduct disorder?

Answer 41

25%

Question 42

What are the treatment options for ODD?

Answer 42

Family therapy, psychotherapy, behavior modification focused on problem solving skills.