Psychotic Disorders Flashcards
Positive sx;s
= are an excess or distortion of normal fxns: things that are there that shouldn’t be
- Delusions
- Hallucinations
Negative sx’s
=things that should be there but are not
- blunted affect
- anhedonia
- apathy
- inattentiveness
- less dramatic then positive sx’s
Delusions =
fixed false beliefs that cannot be altered by rational arguments and can’t be accounted for by the cultural background of the pt
-referential, somatic, religious, grandiose, bizarre, paranoid, erotomania, jealousy
Types of delusions
- Paranoid
- ideas of reference (ideas that some event is uniquely related to the individual)
- thought broadcasting (belief that one’s thoughts can be heard by other
- delusions of grandeur
- delusions of guilt
Hallucinations can be:
- auditory (most common)
- visual
- tactile
- olfactory
Delirium features
- short term confusion and changes in cognition
- is associated with fluctuating sensorium, sudden onset, brief fluctuating course and rapid improvement with tx of underlying disorder
- can be treated usually
Etiologies of Delirium
- general medical cndtn
- substance induced
- multiple etiologies
- NOS
schizophrenia =
clinical syndrome of variable but profoundly disruptive psychopathology that involves cognition, emotion, perception and other aspects of behavior
Clinical Dx of Schizophrenia
- at least 2 ax’s present for at least 1 mnth:
- delusions
- hallucinations
- disorganized speech
- disorganized or catatonic behavior
- negative sx’s
- social/occupational dysfxn for at least 6 mnths
Dx exception of schizophrenia
- only 1 sx needed if:
- delusions are bizarre, 2 or more voices converse or voices are commentary
Risk Factors for Schizophrenia
- Medical illness
- Birth season: born in winter or spring
- gestational birth complications
- exposure to flu epidemics
- maternal starvation during pregnancy
- substance abuse
- genetic factors
Schizophrenia Epidemiology
- males = females
- equal worldwide but higher incidence in =urban areas of industrialized nations
- males: age of onset is 18-25
- females: age of onset is bimodal: 25-35 and another peak after 40
Subtypes of Schizophrenia:
- Disorganized
- Catatonic
- Residual
- Undifferentiated
- Paranoid
Disorganized schizo
- disorganized speech/behavior, flat/inappropriate affect
- early onset
- poor prognosis
Residual schizo
- No hallucinations, delusions or disorganized speech
- Negative sx’s are prominent
Catatonic schizo
- rare
- stupor, rigidity
- negativism: motiveless resistance to all instructions or maintenance of rigid posture against attempts to be moved
- waxy flexibility: motoric immobility
- echolalia, echopraxia
Paranoid schizo
- best prognosis
- least severe
- preoccupation with 1 or more delusions or frequent auditory hallucinations
Undifferentiated schizo
does not meet criteria for other types
Diagnostic approach to schizophrenia:
- full set of labs: CBC, BMP, LFTs, B12, folate, TSH, free T4
- urine fox screen and BAC
- neuro exam to r/o seizure disorder
Schizophrenia on PE
- disheveled appearance
- flattened affect
- disorganized thought process
- intact memory and orientation
- auditory halluciantions
- ideas of reference
Management
- typical anti psychs
- atypical antipsychs
Typical Antipsychs
- Dopamine receptor antagonists
- haloperidol, fluphenazine, perhpenazine, thiothixene, chlorpromazine, thioridazine
- tx positive sx’s
- side effects EPS, neuroleptic malignant syndrome and tar dive dyskinesia
Atypical antipsychs
- dopamine and serotonin receptor antagonists
- Clozapine, risperidone, ziprasidone, quetipine, olanzapine, aripiprazole
- More effective against negative sx’s
- side effects: metabolic syndrome, wt gain, hyperlipidemia, some sedation
Schizoaffective disorder =
-Basically have manic and depressive episodes like that of bipolar but they have psychotic sx’s in btwn those episodes
Schizoaffective disorder criteria
- must have an episode of major depression, mania or mixed episode concurrent with schizophrenia sx’s (delusions, hallucinations,)
- must have these psychotic sx’s without mood sx;s for 2 weeks
Management of schizoaffective disorder
- need both mood stabilizer and an antipsychotic because they have both mood disorder and psychotic disorder
- antidepressants or ECT
Dementia=
- severe impairment in memory, judgement, orientation or cognition
- no alteration in LOC
Dementia types:
- Alzheimer’s
- Vascular
- Other medical cndtns: Parkinson’s, Lewy Body, Huntington
- Substance induced
- multiple etiologies
- NOS
