Psychotic disorders Flashcards
What is Psychosis?
- Delusions
- Hallucinations
- Disorganized speech
- Grossly Disorganized or catatonic behavior
- Negative symptoms
psychosis
Delusions
Fixed beliefs that one holds despite evidence to the contrary
Think - cognitive distortion
Various themes - see Delusional Disorder specifiers
The distinction between a delusion and a strongly held idea is sometimes difficult - delusions typically cannot be broken
Ex. A patient has delusions that she won a house, she fully believes this despite lack of evidence. She packs her things, tells her family she is moving, etc.
psychosis
Hallucinations
Perception-like experiences that occur without an external stimulus.
Think - sensory based
Vivid, clear, with the full force and impact of normal perceptions, and not under voluntary control
Auditory is most common in psychotic disorders - usually in the form of a voice, not just a noise
Others include: visual, tactile. Olfactory and gustatory typically medical cause involving temporal lobe.
Be sure to distinguish Inner dialogue (intrusive thoughts) vs perceived sounds
Hallucinations while falling asleep or waking up are normal (Hypnagogic Hallucinations)
psychosis
Disorganized Thinking (Speech)
Derailment, thought blocking, tangentially, incoherence, word salad
Disorganized thinking is typically seen in the presentation of disorganized speech
Derailment - switching from topic to topic with no logical connection
Thought blocking- sudden and involuntary interruption
Tangentiality - answers to questions are seem to be unrelated and gradually deviate
Incoherence - unintelligible sounds that may or may not be words
Word salad - mix of seemingly random words strung together in a “sentence”
Symptoms must be severe enough to impair effective communication, but may be mild if in prodromal or residual phases of psychosis
psychosis
Grossly Disorganized Behavior
Behavior that seems bizarre, without purpose or inappropriate.
Ex: childlike silliness, unprovoked agitation, pacing aimlessly, inappropriate giggling, poor hygiene
Included catatonic behavior, which is marked decrease in reactivity to the environment
Can range from….
Resistance to instructions (negativism)
Maintaining a rigid, inappropriate or bizarre posture (waxy flexibility)
Complete lack of verbal and motor response (mutism and stupor)
Purposeless and excessive motor activity without obvious cause (catatonic excitement)
psychosis
Negative Symptoms
Like it sounds - lacking “something”
Diminished emotional expressions - reductions in the expression of emotions in the face, eye contact, intonation of speech and movements of the hand, head, and face that normally give an emotional emphasis to speech
Avolition - decrease in motivated self-initiated purposeful activities
Alogia- diminished speech output
Anhedonia - lack of interest, happiness
Asociality- apparent lack of interest in social interactions
Account for a substantial portion of the morbidity associated with psychotic disorders
Delusional Disorder
general
Time frame
The presence of 1 or more delusions with a duration of 1 months or longer
Criteria A for schizophrenia have never been met
Apart from the impact of the delusions, or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd
If mania or MDD episodes have occurred, these have been brief relative to the duration of delusions
Disturbance is not attributable to the physio effects of a substance or another medical condition and is not better explained by another mental condition (OCD, BDD)
Delusional Disorder
Erotomanic type and Grandiose type
Erotomaniac type: delusion that another person is in love with the individual
Grandiose type - delusional or conviction of having some great or unrecognized talent or insight or having made some important discovery
Delusional disorder
Jealous type and Persecutory type (MC)
Jealous type - delusion that his or her spouse or partner is unfaithful
Persecutory type (MC) - delusion that one is being conspired against, cheated, spied on, followed, poisoning, or drugged, maliciously maligned, harassed, or obstructed in pursuit of long-term goals
delusional disorder
Somatic type
Somatic type - delusions involving bodily functions or sensations
delusional disorder
With bizarre content
Must be clearly implausible, not understandable, and not derived from ordinary life experiences
Ie, belief that an outside source has removed his/her organs and replaced them with someone else’s without leaving any wounds or scars
delusional disorder
prognosis and Tx
Most of these patients DO NOT go on to develop schizophrenia
½ recover fully
⅓ significantly improve significantly
20% maintain the delusion indefinitely
Tx: atypical antipsychotics and therapy
Brief Psychotic Disorder
criteria
Time frame
Sudden onset involving the presence of one or more of the following:
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
*at least 1 of the symptoms must be 1, 2, or 3
Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning
Not better explained by MDD, mania, or another psychotic disorder and is not attributable to effects of substance or medical condition
Brief Psychotic Disorder- Specifier
with marked stressors, with postpartum
With marked stressors
Symptoms occur in response to events that singly, or together, would be stressful to almost anyone in similar circumstance
Without marked stressors
With postpartum onset
If onset is during pregnancy or within 4 weeks postpartum
With catatonia
Brief Psychotic Disorder
Epidemiology and tx
2x more common in females
Pre-existing personality disorder may predispose patients to the development of this disorder
Tx: antipsychotics
Response is usually rapid and complete. If complete resolution is achieved, treat for 1-3 months
Schizophreniform Disorder
criteria
Time frame
2 or more of the following, each present for a significant portion of time during a 1 month period (or less if successfully treated).
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms
**at least 1 of these must be 1, 2, or 3 **
Duration must be at least 1 month but less than 6 months (use provisional specifier while waiting to determine resolution timeframe)
Schizoaffective disorder is ruled out if no major depressive or manic episodes occurring during active-phase symptoms or if mood episodes have occurred and ben present for a minority of total duration of active-phase
Not attributable to the effects of a substance or medical condition, and other psychotic disorders have been ruled out
Schizophreniform Disorder
With good prognostic features
Without good prognostic features
With catatonia
With good prognostic features
Requires the presence of at least 2 of the following:
onset of prominent psychotic symptoms within 4 weeks of the first noticeable change;
confusion/perplexity;
good premorbid social and occupational functioning;
absence of blunted or flat affect
Without good prognostic features
When 2 or more of the above features are not met
With catatonia
About ⅓ of patients will experience a resolution of symptoms before the 6 month mark, and this will be their final diagnosis. The remaining ⅔ usually go on to develop schizophrenia.
Tx: antipsychotics
Schizophrenia Disorder
criteria
A. 2 or more of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated).
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly Disorganized or catatonic behavior
5. Negative symptoms
*At least 1 of these must be 1, 2, or 3
B. Level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset
C. Continuous signs of the disturbance persist for at least 6 months.
This period must include at least 1 month of symptoms (or less if successfully treated), that meets Criteria A and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by 2 or more symptoms listed in Criterion A
D. Schizoaffective disorder is ruled out if no major depressive or manic episodes occurring during active-phase symptoms or if mood episodes have occurred and ben present for a minority of total duration of active-phase
E. Other medical/mental disorders have been ruled out and this is not attributable to effects of a substance
Schizoaffective Disorder
criteria
An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia
Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode during the lifetime duration of the illness
Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness
Disturbance is not attributable to the effects of a substance or another medical condition
Specify: bipolar type, depressive type, first episode vs multiple, remission status
antipsych meds in ppt
Sx of antipsych meds
AIMS
Screening for TD
Provider rates patient
Score of 2 indicates presence of TD
Performed every 6 months
When prescribing think of
Efficacy- similar efficacy among all antipsychotics except for clozapine which is considered clearly more effective than the others
Side effects- similar side effects among all but to different degrees
Cost- there are either cheap or really expensive
Route: PO vs IM
