Psychotic Disorders

Question 1

Schizophrenia

Answer 1

• Definition:
  
  • major mental disorder with psychotic symptoms marked by a profound withdrawal from interpersonal relationships and cognitive and perceptual disturbances that make dealing with reality difficult.
• Etiology:
  
  • Genetic: runaway synaptic pruning during adolescence
  • Biochemical: dopamine-excess
  • Neuroanatomical: larger ventricles
• Complications:
  
  • suicide risk: 20% of pts attempt suicide
• DSM-V Criteria:
  
  • *2 + of the following present for a significant portion of 1-month:
    
    • -Delusions
    • -Hallucinations
    • -Disorganized speech
    • -Grossly disorganized or catatonic behavior
    • -negative sxs (diminished emotional expression or avolition)
    • *low level of function
    • *continuous signs for 6 months
    • *R/o schizoaffective disorder
    • *not d/t substance or meds
• Sx Categories:
  
  • Positive symptoms: distortion or excess of normal functions (hallucinations, delusions, bizarre behavior)
  • Negative Symptoms: loss of or decrease in normal functions (social withdrawal, flat affect, anhedonia, avolition, alogia)
    
    • *Negative sxs are harder to tx
  • Cognitive sxs: poor executive functioning, ability to pay attention, memory
    
    • *pts with numerous psychotic episodes will have more cognitive dysfunction
• Dx:
  
  • Dx of exclusion
  • CT scan to look for ventricular enlargement
• Tx
  
  • Early aggressive tx decreases long-term problems
  • Typical antipsychotics (first gen antipsychotics):
    
    • dopamine antagonists, target positive sxs; thorazine, mellaril, stelazine, prolixin, haldol; SEs: acute dystonia, EPS, akathisia, tardive dyskinesia
  • Atypical Antipsychotics (Second gen Antipsychotics):
    
    • serotonin-dopamine antagonists, target positive & negative sxs; clozaril, risperdal, zyprexa quetiapine; SE: new-onset DM, weight gain, some extrapyramidal side effects, increased lipids

Question 2

Primary Care Management of Schizophrenia

Answer 2

• -Should be followed by psychiatric prescriber → refer
• Sxs & response to tx exist on a spectrum
• Non-adherence is very high d/t antipsychotic SEs
• Treatment programs in communities are limited
• Pharmacologic tx:
  
  • Early aggressive tx decreases long-term problems
  • Typical antipsychotics (first gen antipsychotics):
    
    • dopamine antagonists target positive sxs; thorazine, mellaril, stelazine, prolixin, haldol; SEs: acute dystonia, EPS, akathisia, tardive dyskinesia
  • Atypical Antipsychotics (Second gen Antipsychotics):
    
    • serotonin-dopamine antagonists, target positive & negative sxs; clozaril, risperdal, zyprexa quetiapine; SE: new-onset DM, weight gain, some extrapyramidal side effects, increased lipids

Question 3

Anhedonia

Answer 3

inability to feel pleasure

Question 4

Avolition

Answer 4

Lack of all motivation, inability to get things done

Question 5

Alogia

Answer 5

“Poverty of speech”, pathologically quiet

Question 6

Delusional Disorder

Answer 6

• Definition:
  
  • at least 1 delusion lasting at least 1 month without other psychotic sxs & no significant impairment in function
• S/sxs:
  
  • delusion
  • no odd or bizarre behavior
• Dx:
  
  • Does not meet criteria for schizophrenia
• Tx:
  
  • Atypical antipsychotics = 1st line
  • Psychotherapy