Psychotic disorders Flashcards
What are hallucinations?
Perception without external stimuli
Similar quality to real percept
Not under voluntary control
In context of clear sensorium
What are the characteristics of AH?
Heard clearly through ears (vs in mind/heart), in clear consciousness, w/ no one else around
What are delusions?
Usually false beliefs, firmly convicted, held on inadequate grounds, despite evidence to the contrary
What are the positive symptoms of schizophrenia?
Delusion, hallucination, bizarre behavior, disorganized speech
What are the negative symptoms of schizophrenia?
Anhedonia, alogia, apathy, asocial, attention (poor), affect (flat)
What are the cognitive symptoms of schizophrenia?
Impaired attention, executive function, working memory
What are the first rank symptoms of schizophrenia?
AH: running commentary, arguing, thought echo
Passivity: thought, affect, behavior
Thought alienation: insertion, withdrawal, broadcast
Somatic hallucination
Delusional perception
What are the good prognostic factors of schizophrenia?
Female Late onset Acute onset Trigger Good premorbid personality & functioning Few relapses x negative & cognitive symptoms
What is the pathophysiology of schizophrenia?
Dopamine hypothesis
- positive symptoms: hyperactivity of mesolimbic pathway
- negative & cognitive symptoms: underactivity of mesocortical pathway
What is schizoaffective disorder?
Mood episode with psychotic symptoms
AND
Psychotic symptoms for 2w w/o mood symptoms
How to manage schizophrenia?
Antipsychotic
Individual: CBT, metacognitive training, social skill training, vocational rehab, cognitive remediation
Family: psychoeducation, decrease EE
What is brief psychotic disorder?
Psychotic symptoms for 1d-1m
How to dx schizophrenia?
2 symptoms: delusion, hallucination, disorganized speech, disorganized/catatonic behavior, negative symptoms
Duration: 6m of disturbance (1m w/ symptoms)
Impaired functioning
What is delusional disorder?
Non-bizarre delusion x 1m
Functioning x significantly impaired
What medical conditions can cause psychosis?
CNS: vascular, infection (tertiary syphilis), inflammation (MS), neoplasm, degeneration (AD, PD)
Endocrine: thyroid, PTH, Ca, hypopit
Nutritional: B12, folate, niacin, thiamine
What substances can cause psychosis?
Medicine: anti-parkinsonian, steroid, BZD, anticholinergic, antihistamine, NSAID
Drugs: ice, cocaine, meth, cannabis, inhalants/solvents, barbiturates
What is alogia?
Slowing of thought + lack of spontaneous thought -> poverty of speech
How to manage a patient that refuses to comply to treatment & return for follow-up?
CPN for urgent crisis intervention
Risk assessment
What resources are available for patients after discharge?
CPN, ICCMW, hostel or half-way home (if x family)
What etiological factors can cause relapse of psychosis?
Poor compliance Stressor Psychiatric comorbidity Poor social support Underlying dementia / cognitive impairment
What is the onset of hebephrenic schizophrenia?
Prepubertal
What are the RF of schizophrenia?
Advanced paternal age at conception
Late winter early spring births
FH
Live in urban area, immigrant
