Psychotic disorders Flashcards
A distorted perception of reality
Psychosis
can be a symptom of schizophrenia, mania, severe depression or substance induced
psychosis
fixed, false beliefs that cannot be altered by rational arguments and cannot be accounted for by the cultural background of the individual
Delusions
a belief that could be true but just isn’t (eg the neighbors are reading my mail and my wife is having an affair)
nonbizarre delusions
a false belief that is impossible (eg a martian fathered my baby and inserted a microchip in my brain)
bizarre delusions
Name the category of delusion:
- “The CIA is after me and tapped my phone”
- “Jesus is speaking to me through TV characters”
- “You can hear my thoughts”
- “You are placing your thoughts in my head”
- ” I am the all powerful son of God and I shall bring down my wrath on you if I don’t get my way”
- “I am responsible for all the world’s wars
- ” I am infected with HIV” ( ALL PAST TESTS HAVE BEEN NEGATIVE)
- Delusion of Persecution/ paranoid delusions
- Ideas of reference
- Thought broadcasting (delusions of control)
- Thought insertion (delusions of control)
- Delusion of grandeur
- Delusions of Guilt
- Somatic delusion
misinterpretation of an existing sensory stimulus (eg mistaking a shadow for a cat)
illusion
a hallucination most commonly exhibited by schizophrenic patients
auditory
a hallucination usually an aura associated with epilepsy
olfactory
a hallucination usually secondary to drug abuse or alcohol withdrawl
tactile
Elderly, medically ill patients who present with psychotic symptoms such as hallucinations, confusion, or paranoia should be carefully evaluated for ? which is a far more common finding in this population
Delirium
What is the DSM-IV Criteria for diagnosing psychosis secondary to general medical condition?
Prominent hallucinations or delusions, symptoms do not occur only during episode of delirium and evidence to support the medical cause from lab data, history or physical
The main class of antibiotics that is known to cause psychosis
Flouroquinolones
What are some prescription meds that may cause psychosis? (name 7 general classes of drugs)
Corticosteroids, antiparkinsonian agents, anticonvulsants, antihistamines, anticholinergics, and some anti hypertensive meds, digitalis, methylphenidate and fluoroquinolones
a psychiatric disorder characterized by a constellation of abnormalities in thinking, emotion and behavior with no single symptom that is pathognomonic and a diverse clinical presentation. It is usually chronic with significant psychosocial and medical consequences to the patient
Schizophrenia
in order to make a dx of schizophrenia, a patient must have symptoms for how long?
at least 6 months
What are the three phases of schizophrenia
Prodromal, Psychotic, Residual
What are the characteristics of the prodromal phase of schizophrenia?
decline in functioning, socially withdrawn and irritable, may have physical complaints and or newfound interest in religion or occult
Char. of the residual phase of schizophrenia?
occur between episodes of psychosis, marked by flat affect, social withdrawal, and odd thinking or behavior, pts can continue to have hallucinations even with treatment.
What is typically considered when a pt. fails both typical and atypical antipsychotics?
Clozapine
DSM-IV criteria to dx schizophrenia
two or more of the following must be present for at least 1 MONTH:
1. Delusions
2. Hallucinations
3. Disorganized speech
4. GROSSLY disorganized or catatonic behavior
5. negative sx (Anhedonia, Affect (flat), Alogia, Avolition (apathy), Attention (poor))
Must cause significant social or occupational functional deterioration
Duration of illness for at least 6 MONTHS (this includes prodromal or residual periods in which above criteria may not be met)
Sx not due to medical, neuro, or substance induced disorder
a subtype of schizophrenia where pt often has higher functioning, older age of onset, and a preoccupation with one or more delusions or frequent auditory hallucinations, no predominance of disorganized speech, or catatonic behavior or inappropriate affect
Paranoid type
subtype of schizophrenia where pts has poor functioning, early onset, disorganized speech, behavior and flat or inappropriate affect
Disorganized type
subtype of schizophrenia where pt meets at least 2 of the following criteria:
motor immobility
excessive purposeless motor activity
extreme negativism or mutism
peculiar voluntary movements or posturing
Echolalia or echopraxia
Catatonic type
subtype of schizophrenia with prominent negative sx with only minimal evidence of positive sx
Residual type
Schizophrenia affects approx. what percentage of people over their lifetime
1% of people
Men tend to have what kind of sx more often then women?
negative sx and more impaired social functioning
People born in which seasons have a higher incidence of schizophrenia ?
Winter and Early spring (unknown why, one theory is exposure to influenza virus in 2nd trimester)
Dopamine pathway responsible for the negative sx in schizophrenia
Prefrontal cortical
Dopamine pathways responsible for the positive sx in schizophrenia
Mesolimbic
CT scans of pts with schizophrenia may show?
enlargement of the ventricles and diffuse cortical atrophy
Side effects seen by neuroleptics that block the tuberoinfundibular pathway?
hyperprolactinemia which may cause gynecomastia, galactorrhea, and menstrual irregularities
Neurotransmitter abnormalities seen in schizophrenia: Dopamine? Serotonin? NE? GABA? Glutamate receptors (NMDA)
Dopamine Increased activity Serotonin elevated NE elevated GABA decreased ( decreased expression of the enzyme needed to create GABA in the hippocampus of schizo pts) Glutamate receptor levels are decreased
Associated with better prognosis for schizophrenic pts?
Later onset, acute onset, good social support, POSITIVE sx, mood sx, FEMALE, few relapses, good premorbid functioning
Associated with poorer prognosis for schizophrenic pts?
Early onset, gradual onset, poor social support, NEGATIVE sx, MALE, family hx, many relapses, poor premorbid functioning (social isolation, etc), comorbid substance abuse
Common side effects of first generation antipsychotics?
Extrapyramidal sx, neuroleptic malignant syndrome, and tardive dyskinesia
Common side effect of 2nd generation antipsychotics?
Increased risk of metabolic syndrome ( due to most drugs in this class causing weight gain)
How long should medications be taken before efficacy is determined?
at least 4 weeks
