Psychotic disorders

Question 1

Delusion vs illusion vs hallucination

Answer 1

Delusion - false belief

Illusion - misinterpretation of external stimulus

Hallucination - perception in absence of external stimulus

Question 2

Negative sx of schizophrenia

Answer 2

Anhedonia

Affect - flat

Alogia

Apathy

Attention - poor

Question 3

Schizophrenia dx criteria

Answer 3

Need >= 2 of the following for at least 1 mo:

• Delusions (only need 1 if this is bizarre)
• Hallucinations (only need 1 if voice is commentary on persons life or if hear 2 voices talking to each other)
• Disorganized speech
• Disorganized or catatonic behavior
• Negative sx

Duration of illness 6 months or more (including prodromal and residual periods, may not only need psychotic for 6mo)

Sx not secondary to meds, drugs, or Neuro dz

Question 4

Subtypes of schizophrenia

Answer 4

Paranoid type
Disorganized type
Catatonic type
Undifferentiated type
Residual type

Question 5

Schizophrenia - paranoid type

Answer 5

Usually higher functioning
Older onset

Must satisfy:
1) Delusions or auditory hallucinations

2) Not predominant disorganized speech, disorganized or catatonic behavior or inappropriate affect

Question 6

Schizophrenia - disorganized type

Answer 6

Poor functioning type
Early onset

Must satisfy:

1) Disorganized speech
2) Disorganized behavior
3) flat or inappropriate affect

Question 7

Schizophrenia - catatonic type

Answer 7

Rare

Must satisfy 2 of:

1) Motor immobility
2) Excessive purposeless motor activity
3) Extreme negativism or mutism
4) Peculiar voluntary mvmts or posturing
5) Echolalia or echopraxia

Question 8

Schizophrenia - undifferentiated type

Answer 8

has 1 or more of the other subtypes or none of the subtypes

Question 9

Schizophrenia - residual type

Answer 9

Mostly NEGATIVE sx (flattened affect, social w/d) with minimal positive sx

Question 10

Rare ages for schizophrenia presentation

Answer 10

< 15

> 55

Question 11

Postpsychotic depression

Answer 11

Phenomenon of schizo pts

- develop MDD after resolution of psychotic sx

Question 12

Does schizophrenia have a genetic component?

Answer 12

YES! very strong

Question 13

Neurotransmitter abnormalities in schizophrenia

Answer 13

Increased serotonin

Increased norepi

Decreased GABA

Decreased glutamate
- NMDA antagonists (like ketamine) can cause psychosis!

Question 14

CT of schizo pts

Answer 14

Can show enlargement of ventricles and cortical atrophy

Question 15

What antihypertensives exacerbate psychosis in predisposed pts?

Answer 15

Beta blockers

digoxin

Question 16

Schizophreniform disorder

Answer 16

Same as schizo but sx only lasted 1-6 months

Question 17

Tx schizophreniform disorder

Answer 17

Hospitalization

3-6 mo antipsychotics

Supportive psychotherapy

Question 18

Schizoaffective disorder

Answer 18

Meet criteria for MDD, manic, or mixed episodes

Uninterrupted period during which there is a MDD or manic episode w/ schizophrenia

Delusions or hallucinatinos for >=2 wks w/o mood d/o sx (vs have mood sx with hallucinations in mood d/o w/ psychotic features)

+ Mood sx for substaintial portion of psychotic illness

Sx not related to GMC or drugs

Question 19

How many schizoaffectives progress to schizophrenia

Answer 19

60-80%

Question 20

Brief psychotic disorder

Answer 20

+ sx of schizophrenia for 1day - 1 month

Can be seen in response to extreme sress

50-80% recovery rate

Pts w/ borderline personality d/o may have transient stress-related psychotic experiences. This is part of their axis II disorder and IS NOT dx as brief psychotic disorder

Question 21

Quick and easy ways to remember
Brief psychotic disorder
Schizophrenia
Schizopheniform
Schizoaffective
Schizotypal
Schizoid
Delusional disorder

Answer 21

Brief psychotic DO - 1day-1month, sudden onset, full return to function

Schizophreniform - schizo 1- 6mo

Schizophrenia - >6 mo (including 1 mo of active sx) + functional decline

Schizoaffective - schizo + mood d/o
- need to have 2 wk hx of delusions or hallucinations WITHOUT mood sx

Schizotypal - paranoid, odd or magical beliefs, does not need true criteria for schizo

Schizoid - personality disorder, withdrawan, lack of enjoyment from socializing

Delusional DO - >=1 delusions for > 1 mo, no other psychotic sx, normal functioning

Question 22

Genetics of schizophrenia

Answer 22

1% of population

46% monozygotic twins

10-15% dizygotic twins

50% if both parents are

Question 23

Possible causes of schizophrenia

Answer 23

Environment

Brain injury perinatal

Heavy marajuana use

Greater paternal age

Question 24

Fregoli’s Syndrome

Answer 24

a person holds a delusional belief that different people are in fact a single person who changes appearance or is in disguise.

The syndrome may be related to a brain lesion

Question 25

Cotard Syndrome

Answer 25

complaints of having lost possessions and status

Loss of heart, blood, and intestines

Question 26

Capgrass Syndrome

Answer 26

disorder in which a person holds a delusion that a friend, spouse, parent, or other close family member has been replaced by an identical-looking impostor.

Question 27

Good prognostic factors in schizophrenia

Answer 27

Late onset dz

Obvious precipitating stressors

Acute onset

Good premorbid functioning

Presence of mood DO sx

Pt married

Family hx mood DO

Goor support

Presence of + sx

Question 28

Autoscopic psychosis

Answer 28

Visual hallucination of a transparent phantom of one’s own body