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Psychiatry > Psychotic disorders > Flashcards

Psychotic disorders Flashcards

1
Q

difference btwn

1) schizoaffective
2) schizophrenia
3) MDD with psychotic features

in terms of psychotic sx and mood d/o symptoms?

A

schizophrenia: + psychotic sx (delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, negative sx) for >1 month
schizoaffective: + psychotic sx for >2 weeks; criteria for MDE met only during psychotic sx

MDD with psychotic features: mood symptoms for >2 weeks; criteria for psychotic met only during mood sx

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2
Q

Define psychosis

A

distorted perception of reality: delusions, illusions, hallucinations, disorganized thinking

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3
Q

Hallucinations can be olfactory, gustatory, tactile, auditory, or visual. In what disease states would you generally find them in?

A

olfactory, gustatory, tactile = medical conditions

auditory, visual = psychotic disorders

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4
Q

What kinds of delusions are there?

A 
Persecution/Paranoid delusions 
Ideas of reference
Delusions of control
Delusions of grandeur
Delusions of guilt
Somatic delusions
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5
Q

What are 2 delusions of control?

A

thought broadcasting - belief that one’s thoughts can be heard by others

thought insertion - belief that other people thoughts are being placed in one’s head

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6
Q

What is the difference btwn illusions and hallucinations?

A

illusion - misinterpretation of an existing sensory stimulus (mistaking a shadow for a cat)

Hallucinations: sensory perception without an actual external stimulus

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7
Q

most common hallucination experienced by schizophrenics

A

auditory

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8
Q

most common hallucination experienced by an epileptic person

A

olfactory

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9
Q

What are some Rx that can cause psychosis?

A

anything that alters the dopaminergic response:

benzodiazepines (intoxication/withdrawal)
amphetamines
steroids
anticholinergics
anti-parkinsonian agents
anticonvulsants
antihistamines
Anti-HTN (ß blockers)
digitalis
fluroquinolones
barbiturates
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10
Q

What are some recreational drugs that can cause psychosis?

A 
OH withdrawal
hallucinogens (LSD, Ecstasy)
marijuana 
cocaine
phencyclidine
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11
Q

Vitamins deficiencies that can cause psychosis (3)

A

B12
folate
niacin

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12
Q

What should you think of when an medically ill elderly patient presents with psychotic symptoms?

A

delirium

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13
Q

What are + sx of schizophrenia?

What is the biochemical abnormality and pathway that cause this?

A

hallucinations, delusions, bizarre behavior, disorganized speech

excess dopaminergic activity in the mesolimbic pathway (improves with anti-psychotics)

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14
Q

What are - sx of schizophrenia?

What is the biochemical abnormality and pathway that cause this?

A

flat affect, anhedonia, apathy, alogia, lack of interest in socialization

inadequate dopaminergic activity in the prefrontal cortex (worsens with anti-psychotics)

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15
Q

3 phases of schizophrenia

A

1) prodromal - decline in functioning
2) psychotic - perceptual disturbances, delusions, disordered thought process/content
3) residual - btwn episodes of psychosis; flat affect, social withdrawal, odd thinking/behavior

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16
Q

DSM diagnostic criteria (duration of sx) of schizophrenia

A

+/- symptoms for at least ONE month, but symptoms (includes prodrome, psychotic, and residual) have lasted for >6 mo

17
Q

5 types of schizophrenia?

A 
paranoid
disorganized
catatonic
undifferentiated (>1 or none of the subtypes)
residual (- sx)
18
Q

When do men tend to present with schizophrenia? Women?

A

men: 20
women: 30

19
Q

What is highly comorbid with schizophrenia in many patients?

A

substance abuse

20
Q

What is the downward drift hypothesis of schizophrenia?

A

lower socioeconomic groups have higher rates of schizophrenia. Why?
Schizophrenics are unable to function well in society and hence enter lower socioeconomic groups

21
Q

What is the pathophysiology of schizophrenia

A

+ sx = increased dopamine activity in mesolimbic pathways

- sx = decreased dopamine activity in prefrontal cortex

22
Q

why can cocaine and amphetamine cause schizophrenic-like symptoms?

A

because they increase dopamine activity

23
Q

What are two other pathways (other than the mesolimbic/prefrontal cortex pathways) that are affected by neuroleptics

A

tuberoinfundibular - blocked by neuroleptics - causes hyper-PRL -> gynecomastia, galactorrhea, menstrual changes

nigrostriatal - blocked by neuroleptics - causes EPS (tremors, slurred speech, akathisia, dystonia, abnormal movements)

24
Q

What does the brain of a schizophrenic patient look like on a CT? 2

A

enlarged ventricles

diffuse cortical atrophy

25
Q

What are the main mxn and 3 main ADR of 1st generation antipsychotics?

A

D2 (dopamine) antagonist

ADR: EPS, NMS, TD

26
Q

What are the main mxn and main ADR of 2nd generation antipsychotics?

A

Antagonist of 5-HT2 and dopamine receptors

ADR: metabolic syndrome

27
Q

What do you treat EPS sx with?

A

anti-parkinsonian agents: benztropine, diphenhydramine
benzodiazepine
ß blockers

28
Q

If a patient develops metabolic syndrome, what should you do?

A

consider switching to a 1st gen. antipsychotic or a more weight-neutral 2nd gen. antipsychotic such as apiprazole or ziprasidone

29
Q

If a patient develops TD, what should you do?

A

d/c or reduce offending agent and start atypical antipsychotic

benzo, ß blockers, or cholinomimetic may be used short-term

30
Q

If a patient develops NMS, what should you do?

A

d/c all antipsychotics

31
Q

ADR of clozapine

A

agranulocytosis

32
Q

ADR of thioridazine

A

irreversible retinal pigmentation at high doses

33
Q

ADR of chlorpromazine

A

deposits in lens and cornea

34
Q

DSM diagnostic criteria (duration of sx) of schizophreniform

A

sx (including prodrome, psychotic, and residual) that lasted for < 6 mo

35
Q

DSM diagnostic criteria (duration of sx) of schizoaffective d/o

A

meets criteria for MDE, but has had psychotic sx for > 2 weeks without mood d/o sx

36
Q

DSM diagnostic criteria (duration of sx) of brief psychotic d/o

A

sx (including prodrome, psychotic, and residual) that lasted for <1 mo

37
Q

DSM diagnostic criteria (duration of sx) of delusional d/o

A

non-bizzare, fixed delusions for at least 1 mo; functioning in life not significantly impaired

38
Q

type of delusions present in delusional d/o

A 
erotomaniac
grandiose
somatic
persecutory
jealous
mixed (more than one of the above)
39
Q

what is folie a deux?

A

aka “shared psychotic disorder (IPD)” - occurs when a patient develops the same delusional symptoms as someone he/she is in a close relationship with

Psychiatry (12 decks)

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