psychotic disorders Flashcards
1
Q
psychosis: defn
A
- distorted perception of reality
- poor reality testing
- delusions
- perceptual disturbances
- disorganized thinking
2
Q
delusions: defn/types
A
- fixed, false beliefs that can’t be altered by rational arguments
- nonbizarre vs bizarre
- types: persecution/paranoia, reference, control (thought broadcasting/insertion), grandeur, guilt, somatic
3
Q
types of hallucinations
A
- auditory: most commonly in SCZ pts
- visual: not common in SCZ, more in drug use/withdrawal, delirium
- olfactory: usually w/epileptic aura
- tactile: 2ary to drug abuse/withdrawal
4
Q
endocrine causes of psychosis
A
- Addison/Cushing
- hyper/hypothyroidism
- hyper/hypocalcemia
- hypopituitarism
5
Q
nutritional causes of psychosis
A
- B12, folate, niacin deficiencies
6
Q
mx that may cause psychosis
A
- steroids
- antiparkinsonian agents
- anticonvulsants
- antihistamines
- anticholinergics
- antihypertensives
- digitalis
- methylphenidate
- fluoroquinolones
7
Q
drugs that may cause psychosis
A
- alcohol
- cocaine
- hallucinogens
- marijuana
- BZOs
- barbiturates
- PCP
8
Q
SCZ sx
A
- positive: hallucinations, delusions, bizarre behavior, disorganized speech
- negative: blunted affect, anhedonia, apathy, alogia, lack of interest in socialization
- cognitive: attention, executive fn, working memory all impaired
9
Q
SCZ phases
A
- prodromal: decline in functioning preceding first psychotic episode
- psychotic
- residual: between psychotic phases, usually negative sx exhibited
10
Q
SCZ diagnosis
A
- sx for at least 1 month (2+ of delusions, hallucinations, disorganized speech, behavior chg, negative sx)
- total duration > 6 mos
- significant social or occupational function deterioration
11
Q
SCZ: paranoid type
A
- higher fn, older age of onset
- preoccupation with delusions/AH
- no predominance of disorganized speech/behavior or inappropriate affect
12
Q
SCZ: disorganized type
A
- poor fn, early onset
- disorganized speech
- disorganized behavior
- flat/inappropriate affect
13
Q
SCZ: catatonic type
A
- rare
- motor immobility
- excessive purposeless motor activity
- extreme negativism or mutism
- peculiar voluntary movements or mutism
- echolalia/echopraxia
14
Q
SCZ: residual type
A
- prominent negative sx
- minimal evidence of positive sx
15
Q
SCZ: epidemiology
A
- 1%
- men present ~20yo (women ~30yo), more negative sx, more impaired social fn
- rare before 15yo or after 55yo
- genetic predisposition (MZ twins 50% concordance)
- comorbid substance abuse common (alcohol>MJ>cocaine)
- higher incidence if born in winter/early spring, lower socioec groups
16
Q
SCZ pathophys
A
DOPA
- mesolimbic: excess dopa activity –> positive sx
- prefrontal cortical: inadequate dopa activity –> negative sx
- tuberoinfundibular: hyperprolactinemia from antipsychotics
- nigrostriatal: EPS from antipsychotics
17
Q
other NTs in SCZ
A
- increased 5HT
- increased NE
- decreased GABA
- decreased NMDA rcptrs
18
Q
SCZ and brain chgs
A
- enlargement of ventricles
- diffuse cortical atrophy
19
Q
SCZ: prognosis
A
- significant improvement in 70% on medications
- 40-50% remain significantly impaired
- 50% attempt suicide
- better prognosis: later onset, social support, positive/mood sx, acute onset, female, few relapses, good premorbid fn
20
Q
SCZ: tx
A
- first gen antipsychotics (D2 antag): work better with pos sx, more EPS/NMS/tardive dyskinesia SEs
- high potency 1st gen: more EPS; low potency 1st gen: more anticholinergic
- second gen (D2 and 5HT2 antag): positive and some negative sx, decreased EPS SEs, increased risk metabolic syndrome
21
Q
tardive dyskinesia
A
- darting/writhing mvmt of face/tongue/head
- up to 20% of long-term hospitalized pts on antipsychotics
- tx: d/c offending agent; BZOs/betaBs/cholinomimetics short term
- more common in older women, after >6 mos mx
- 50% pts achieve spontaneous remission
22
Q
schizophreniform
A
- same criteria as SCZ but lasts b/w 1-6 mos
- 1/3 recover completely
- 2/3 progress to SAD or SCZ
- tx: hospitalization, 3-6 mos antipsychotics, psychotherapy
23
Q
SAD: diagnosis
A
- criteria for MDE, manic episode, or mixed episode PLUS criteria for SCZ
- delusions/hallucinations for 2 wks in absence of mood sx (to differentiate from mood d/o with psychotic features)
- mood sx present for substantial portion of psychosis
24
Q
SAD: prognosis/tx
A
- 60-80% will progress to SCZ
- hosp and psychotherapy
- antipsychotics and mood stabilizers
- antidepressants or ECT for mood sx
25
brief psychotic d/o
- SCZ sx for 1d to 1 mo
- RARE; may be in rxn to stress/trauma
- 50-80% recovery
- tx: hosp, psychotherapy, antipsychotics, BZOs if agitation
26
delusional d/o
- more often in older pts, immigrants, hearing impaired
- nonbizarre fixed delusions >1mo
- not SCZ criteria, not impairing fn
- types of delusions: erotomanic, grandiose, somatic, persecutory (esp in deaf), jealous, mixed
- 50% full recovery, 20% decreased sx, 30% no chg
- difficult to treat; try course of antipsychotic mx
27
shared psychotic d/o
- pt develops same delusional sx as someone else in close relationship (usually family members)
- 20-40% recover upon removal of person
- psychotx and antipsychotic mx if sx do not improve w/in 1-2 wks of separation
28
Koro
- Asia
| - penis shrinking and will disappear --> death
29
Amok
- Malaysia, SE Asia
- sudden unprovoked outbursts of violence w/o recollection
- often commit suicide afterward
30
brain fag
- Africa
| - H/A, fatigue, visual disturbance in male students
31
comparative prognoses of psychotic d/os
best --> worst:
| mood > brief psychotic d/o > SAD > schizophreniform > SCZ
