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Psychiatry > Psychotic Disorders > Flashcards

Psychotic Disorders Flashcards

1
Q

What are psychotic disorders characterized by?

A 
Impaired reality testing 
Reality testing = how a person perceives and reacts to people, objects and situations. if it is impaired, they will have:
1. hallucinations
2. impaired thought content
3. disturbed thought process.
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2
Q

What is a hallucination?
What are the 2 most common types?
What are rarely seen except due to other conditions besides psychosis?

A

Hallucination is a false sensory perception without external stimuli.

  1. auditory- most common and can present as commands, threats, conversations, commentary
  2. visual- psychotic disorders

Tactile, olfactory and gustatory are NOT common with psychotic disorders, but are clues to drugs, substance withdraw and seizures.
[olfactory–> seizure]
[tactile–> substance intoxication]

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3
Q

What is a delusion?

What are the classifications?

A

Delusions are fixed, false beliefs that are NOT culturally sanctioned.

  1. persecutory
  2. grandiose
  3. religious
  4. somatic
  5. delusions of control
  6. ideas of reference
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4
Q

A person believes that there is a physical abnormality in the functioning or appearance of his/her body.
What type of delusion is this?

A

somatic

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5
Q

A person believes that external forces are controlling him.

What type of delusion is this?

A

delusions of control

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6
Q

A person believes that certain things are specifically referring to her. She says the commercials talk directly to her. What does she have?

A

ideas of reference – a form of delusion

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7
Q

What are the 4 common manifestations of disturbed thought process?

A
  1. looseness of association- thought shifting from one topic to the next in an unrelated way
  2. incoherence, thought blocking - stopping mid thought without attempting to resume
  3. perseveration - same answer for all questions.
  4. verbigeration- meaningless repetition of a word or phrase
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8
Q

A patient presents to you and you ask where he is from. He says “montana”. You has how long has he lived in Dallas and he says “montana”. You ask if he lives alone and he say “montana.”
What does this demonstrate?

A

It is perseveration and demonstrates disturbed thought process

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9
Q

A woman presents and is telling you her story she says, “I am from Houston, kangaroo, and moved kangaroo to Dallas kangaroo in 2000.”
What does this demonstrate?

A

Verbigeration – disturbed thought process

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10
Q

What are the 4A’s of Bleuler’s description of schizophrenia?

A
  1. Associations [loose]- quick thought transitions with no connections
  2. Ambivalence- opposing feelings at the same time [laughing while frowning]
  3. Autism- unusual behavior and lack of connectedness
  4. affect abnormalities - flat, frowning, laughing inappropriately.
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11
Q

What is the DSM5 criteria for schizophrenia?

A
  1. One month with at least 2 symptoms
    * delusions
    * hallucinations
    - disorganized speech [loose association, thought block, verbigeration, perseveration]
    - disorganized or catatonic behavior
    - negative symptoms
  2. causes social and occupational dysfunction
  3. total disease lasts 6 months [prodrome, residual symptoms]
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12
Q

What are the prodromal/residual symptoms of schizophrenia?

A

Similar but less acute than schizo symptoms.

  1. suspicious but not yet paranoid
  2. illusions but not yet hallucinations [in illusions, the object is still there but it is interpreted wrong ie leaf blowing looks like rat running]
  3. preoccupations and superstitions but not yet delusions
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13
Q

What are the positive symptoms of schizophrenia?

A
  1. hallucinations
  2. delusions
  3. bizarre behavior [inappropriate/agitated]
  4. disordered thought process
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14
Q

What are the negative symptoms of schizophrenia?

A
  1. flat affect
  2. alogia [ poverty of speech–not offering a lot to the convo]
  3. apathy- indifference
  4. avolition- lack of motivation
  5. anhedonia - loss of pleasure/interest
  6. impaired attention

[6 A’s]

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15
Q

What is catatonia?

A

motoric immobility or excessive purposeless movement.

  1. negativism- physical resistance for no reason
  2. mutism - no speaking
  3. posturing - get into uncomfortable positions and stay for hours
  4. catalepsy - waxy flexibility where you can move them and then they will stay
  5. echolalia- repetition of words/phrases spoken by examiner
  6. Echopraxia- basically simon says
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16
Q

What % of the population is affected by schizophrenia ?

How does the prevalence differ for males and females?

A

1% of the population

Males and females have an equal incidence but males will present younger [15-25] than females [25-35]

17
Q

What is the “downward drift hypothesis” for schizophrenia?

A

People are not able to live up to their biological potential and will drift to lower socioeconomic positions than those into which they were born.
1/3-2/3 of homeless are schizophrenic and the DISEASE came first

18
Q

What is the Stress-Diathesis model of schizophrenia?

A

Illness requires 2 conditions:

  1. diathesis- biological or environmental predisposition and vulnerability
  2. stressor- [can also be biologic or environmental] that leads to symptom manifestation

ex. first time leaving home
This is why a lot of times it is first noticed in college

19
Q

What is the relationship between glutamate, the hippocampus and psychosis?

A

Ketamine and PCP have been shown to induce psychotic symptoms and they block NMDAR [thus are anti-glutamatergic] Therefore, glutamate must play a role in inhibiting psychosis.

Hippocampus had areas for:

  1. reviewing past memories
  2. forming associations with the present

This region has abnormal blood perfusion and task-related cell activation in people with psychosis

20
Q

Describe the therapeutic principles of pharmacological treatment of schizophrenia.
What is done in acute episodes?
Between episodes?

A

For acute episodes:

  1. identify and target the symptoms that are most problematic
  2. initiate antipsychotic and titrate with the goal of controlling symptoms
  3. 4-6 weeks is indicated to determine benefit
  4. if not beneficial, switch to a different anti-psychotic. DO NOT ADD

Between episodes:
decrease to the lowest effective dose that adequately controls symptoms [do not completely taper]

21
Q

What is Social Skills Training for a person with schizophrenia?

A

modeling, role play, and videos to focus on:

  1. awareness of grunting, grimaces
  2. practical skills [meals, riding bus, filling out applications]
  3. communication skills
22
Q

What is recovery-oriented treatment for schizophrenia?

A

The gold standard treatment modality for symptom reduction and relapse prevention of schizophrenia.

Helps the consumer [not patient] have a sense of identity, develop personal goals and have a sense of meaning in their lives.

  1. peer support
  2. supported housing
  3. supported employment
23
Q

How does schizophrenia differ from brief psychotic disorder?

A
  1. Involves the positive symptoms of schizophrenia [hallucinations, delusions, speech, etc]
  2. resolves within 1 month

Usually brought on by stress.

24
Q

For brief psychotic disorder, what is the correlation between emotional turmoil and confusion and prognosis?

A

The worse the turmoil, the better the prognosis

25
Q

A patient presents with symptoms of schizophrenia that last more than a month but resolve before six months. What is this ?

A

Schizophreniform disorder

26
Q

What is schizoaffective disorder?

A

The patient has schizophrenia symptoms but also major depression and/or mania.
It can only be differentiated from:
MDD with psychotic features or bipolar I with psychotic features based on history

**prognosis is better than for schizophrenia alone

27
Q

What is delusional disorder?

A

The patient only has delusions about a particular situation at least once a month.

  • jealousy
  • partner is unfaithful
  • persecutory = cheated, followed, drugged
  • grandiose= special knowledge, power, ability
  • erotomanic = loved from afar, by a celeb
  • somatic = infestation, body is disfigured/smelly
28
Q

What neurological medical conditions cause catatonia?

A
  1. neoplasms
  2. head trauma
  3. cerebrovascular disease
  4. encephalitis
29
Q

What metabolic medical conditions cause catatonia?

A
  1. hypercalcemia
  2. hepatic encephalopathy
  3. DKA
  4. Lupus cerebritis

Psychiatry (18 decks)

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