Psychotic disorders Flashcards
Delusion vs illusion vs hallucination
Delusion - false belief
Illusion - misinterpretation of external stimulus
Hallucination - perception in absence of external stimulus
Negative sx of schizophrenia
Anhedonia
Affect - flat
Alogia
Apathy
Attention - poor
Schizophrenia dx criteria
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
Subtypes of schizophrenia
Paranoid type Disorganized type Catatonic type Undifferentiated type Residual type
Schizophrenia - paranoid type
Usually higher functioning
Older onset
Must satisfy:
1) Delusions or auditory hallucinations
2) Not predominant disorganized speech, disorganized or catatonic behavior or inappropriate affect
Schizophrenia - disorganized type
Poor functioning type
Early onset
Must satisfy:
1) Disorganized speech
2) Disorganized behavior
3) flat or inappropriate affect
Schizophrenia - catatonic type
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
Schizophrenia - undifferentiated type
has 1 or more of the other subtypes or none of the subtypes
Schizophrenia - residual type
Mostly NEGATIVE sx (flattened affect, social w/d) with minimal positive sx
Rare ages for schizophrenia presentation
< 15
> 55
Postpsychotic depression
Phenomenon of schizo pts
- develop MDD after resolution of psychotic sx
Does schizophrenia have a genetic component?
YES! very strong
Neurotransmitter abnormalities in schizophrenia
Increased serotonin
Increased norepi
Decreased GABA
Decreased glutamate
- NMDA antagonists (like ketamine) can cause psychosis!
CT of schizo pts
Can show enlargement of ventricles and cortical atrophy
What antihypertensives exacerbate psychosis in predisposed pts?
Beta blockers
digoxin
Schizophreniform disorder
Same as schizo but sx only lasted 1-6 months
Tx schizophreniform disorder
Hospitalization
3-6 mo antipsychotics
Supportive psychotherapy
Schizoaffective disorder
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
How many schizoaffectives progress to schizophrenia
60-80%
Brief psychotic disorder
+ 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
Quick and easy ways to remember Brief psychotic disorder Schizophrenia Schizopheniform Schizoaffective Schizotypal Schizoid Delusional disorder
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
Genetics of schizophrenia
1% of population
46% monozygotic twins
10-15% dizygotic twins
50% if both parents are
Possible causes of schizophrenia
Environment
Brain injury perinatal
Heavy marajuana use
Greater paternal age
Fregoli’s Syndrome
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
Cotard Syndrome
complaints of having lost possessions and status
Loss of heart, blood, and intestines
Capgrass Syndrome
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.
Good prognostic factors in schizophrenia
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
Autoscopic psychosis
Visual hallucination of a transparent phantom of one’s own body
