Psychotic and Conduct Disorders Flashcards
What is critical to determine when first assessing a patient with a suspected psychosis?
Rule out an organic/medical cause of the mental status change.
What S/S help to distinguish and organic cause of psychosis from a functional (psychiatric) cause?
Sudden onset, abnormal vitals, recent memory deficits, psychomotor retardation, emotional lability, occasional periods of lucidity, disorientation, visual/tactile hallucinations (functional cause usually auditory only).
Define and describe the diagnostic criteria for delusional disorder.
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.
Define and describe paranoid delusions.
Delusions about things that COULD happen. Behavior not obviously odd and functioning not significantly impaired.
Define/describe the following types of delusions: erotomatic, somatic, jealous, persecutory, grandiose, reference, control, nihlism.
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
What is the most common type of delusion?
Persecutory
Describe delusions of parasitosis.
Firm belief that pruritis is caused by infestation of insects or parasites. Presents with self-inflicted skin manifestations.
What are the treatment options for delusiions?
Anti-psychotics 1st line –> aripiprazole (abilify)
SSRIs
Avoid directly challenging the Pt
What distinguishes delusions from schizophrenia and other psychotic conditions?
Minimal deterioration in personality or function and the relative absence of other psychopathologic symptoms.
Define and describe schizoaffective disorder.
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.
What treatment options are available for schizoaffective disorder?
Atypical anti-psychotic is first line. Mood stabilizer or anti-depressant may be added. . Psychosocial support may help as well.
Describe the diagnostic criteria for schizophrenia.
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.
Differentiate positive from negative symptoms of schizophrenia.
Pos: any change in behavior or thoughts - hallucinations, delusions, etc.
Neg: withdrawal from the outside world - appear emotionless and flat
Describe the terms catatonia and residual with regard to schizophrenia.
Cat: silent, no response to external stimuli
Res: socially withdrawn
What is the most common type of hallucination associated with schizophrenia.
Auditory
Other than the most common, list various types of hallucinations associated with schizophrenia.
Visual, olfactory, tactile, somatic (sensation arising from within the body), gustatory( tasting things that aren’t there - thinking poison is in food, for ex)
Define neologisms.
Nonsense words invented by the patient –> common symptom of schizophrenia.
Describe the pathophysiology of positive and negative symptoms associated with schizophrenia.
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.
What is the main treatment of schizophrenia and describe the subtypes of the medication.
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.
Define schizophreniform disorder.
Fits criteria for schizophrenia but symptoms last less than 6 months (but greater than 1 month)
Describe requirements for a diagnosis of ADHD to be made.
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.
Describe some of the secondary effects/symptoms of ADHD.
emotional lability, poor social skills, motor incoordination, peer rejection and deflated self-image, often don’t comply with parents requests
Name two rating scales used to assist in the diagnosis of ADHD.
Conners Comprehensive Behavioral Rating Scale
ADHD Rating Scale IV
Describe treatment options available for ADHD.
Pharm: stimulants are first line
Non-pharm: behavior modification (1st line), group therapy, family therapy
What stimulants are commonly used most commonly in the management of ADHD?
methylphenidate (Ritalin), dexmethylphenidate (focalin), amphetamine + dextroamphetmine (adderal)
If a patient with ADHD has a personal or family history of SUD, what medication is indicated as an alternative to controlled substances (stimulants)?
Atomoxetine - SNRI
What medications may be used as adjunctive therapy in the management of ADHD?
Anti-depressants - bupropion, venlafaxine, clonidine, imipramine
Guanfenacine - centrally acting anti-HTN
What characteristics are consistent with autism spectrum disorders and considered primary signs?
significant emotional discomfort or detachment, communication difficulties (inability to communicate or chooses not to), repetitive behaviors
What characteristics are considered secondary signs of autism?
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.
By what age are characteristics of autism typically seen and what S/S will be present at that age?
Age 3-6 months –> aloof, withdrawn, lack facial expression
T/F: Autism is more common in males than females.
True: 3-5 times more common in males
What diagnostic tool is used at 18 months to aid in the diagnosis of autism?
M-CHAT
What treatment options are available in the management of autism?
Behavioral therapy is first line
Anti-psychotics (risperidone, aripiprazole, haloperidol) and neuroleptics (carbamazepine) to reduce impulsivity and irritability.
SSRIs can help control repetitive behaviors
Describe the DSM-V diagnostic criteria for conduct disorder.
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
What condition do children with conduct disorder commonly develop in adulthood and what is the percentage risk of developing said condition?
40% diagnosed with conduct disorder have anti-social personality disorder as an adult.
T/F: Conduct disorders are more common in males than females.
True
What comorbid conditions commonly coexist with conduct disorder?
ADHD, IDD, SUD, mood disorders
What differentiates conduct disorder from oppositional defiant disorder?
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.
What are the treatment options for conduct disorder?
Environmental/behavioral modification, family therapy
Stimulants, bupropion, clonidine, lithium, haloperidol, 2nd gen antipsychotics, valproic acid to reduce aggression, SSRIs for mood lability and impulsivity.
What is the diagnostic criteria for oppositional defiant disorder?
< 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
What percentage of children diagnosed with ODD progress to conduct disorder?
25%
What are the treatment options for ODD?
Family therapy, psychotherapy, behavior modification focused on problem solving skills.
