psychotic disorders

Question 1

Prodromal symptoms

Answer 1

Before first psychotic episode
Changes in cognition/behaviour
Social isolation, lack of motivation, irritability, sleep disturbance etc.
75% of schizophrenic patients experience this
Lasts from weeks → years

Question 2

Active symptoms

Answer 2

Intense hallucinations and or delusions

Question 3

Residual symptoms

Answer 3

Symptoms that remain after full psychotic episode
Lack of motivation, depressed mood, flat affect, disinterest, difficulty concentrating etc.

Question 4

Positive symptoms

Answer 4

Things that are in addition
Hallucinations (sensory events):
- 50-70% of schilophenic individuals experience
- 40% of regular population experience this
- auditory and or visual
Delusions (strong held belief that appear irrational):
- grandeur/grandoise → extreme insight & ability
- erotomatic
- persecutory
- jealous
- somatic
- tactile
- Capgras syndrome

Question 5

Negative symptoms

Answer 5

Things that are removed
- alogia
- anhedonia
- asociality
- apathy/avolition
- affect (negative)

Question 6

Disorganized symptoms

Answer 6

Disorganized speech (off topics/all over the place)
Loose association (spontaneous/off topic but associations can be made)
Innapproriate affect
Catatonia
Grossly disorganized behaviour

Question 7

Schizophrenia: Criteria

Answer 7

• Lasts a month and must experience 2 or more (2 must be including first 3):
  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Negative symptoms
  5. Grossly disorganized symptoms/catatonic
• Active for 1 whole month
• Continuous residual for 6 months
• Functioning is deteriorated before onset
• Equal in men and women

Question 8

Schizoaffective: Criteria

Answer 8

• Lasts a month with overlap of mood disorder (mania/ MDE)
• Mood component has to be independent of hallucinations for 2 weeks
• Higher in women
• Could shift to BPD or MD

Question 9

Schirophreniform: Criteria

Answer 9

• Active psychosis for 1 month
• Deterioration lasts 6 months
• If > 6 months = schizophrenia
• Shorter + lower impairment compared to schizophrenia
• “Provincial diagnosis”
• Equal in men and women
• 50% develop another psychotic disorder

Question 10

Brief psychotic disorder: Criteria

Answer 10

One or more of the following for at least 1 day but <1 month:
1. Delusions
2 hallucinations
3. Disorganized speech
4. Catatonia
- 2x more liken in women
- Retrospective diagnosis
- Most will go on to receive other psychotic diagnosis

Question 11

Delusional disorder: Criteria

Answer 11

• One or more delusions for > 1 month
• Mild hallucinations unrelated to delusions
• Does not impair behaviour
• No negative symptoms but social isolation may develop

Question 12

Conventional antipsychotic medication

Answer 12

1st wave
60-70% effective
Severe side effects:
- extra pyramidal syndrome
- tarvide syndrome

Question 13

Newer antipsychotic medication

Answer 13

Less side effects
Tackles both positive and negative symptoms of psychotic disorder

Question 14

Biological model of psychosis

Answer 14

Genetics:
- identical twins> fraternal twins > siblings
- 10% are carriers
- environment can delay the onset of psychotic disorders in adoptees
Dopamine:
- ↑d2 receptor stimulation (leads to positive symptoms)
- ↓d1 receptor stimulation = responsible for emotions (leads to negative symptoms)
Glutamate:
- ↓ NMDA stimulation
- ketamine/PCP (nmda antagonists) can cause brief psychosis

Question 15

Psychological model of psychosis

Answer 15

Stress:
- stressful events precedes relapse
- drop in socio economic status
- added stressors = more stress
Family:
- could see symptoms as intentional
- family does not cause onset but = relapse
- high expressed emotion = relapse (not in AA families)

Question 16

Treatments to psychosis (non med)

Answer 16

Token economy
Community resources
Clinicians
First episode clinics
Behavional family therapy = psychoeducation
Beck’s CBT = target neg + pos symptoms