Psychotic disorders Flashcards
difference btwn
1) schizoaffective
2) schizophrenia
3) MDD with psychotic features
in terms of psychotic sx and mood d/o symptoms?
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
Define psychosis
distorted perception of reality: delusions, illusions, hallucinations, disorganized thinking
Hallucinations can be olfactory, gustatory, tactile, auditory, or visual. In what disease states would you generally find them in?
olfactory, gustatory, tactile = medical conditions
auditory, visual = psychotic disorders
What kinds of delusions are there?
Persecution/Paranoid delusions Ideas of reference Delusions of control Delusions of grandeur Delusions of guilt Somatic delusions
What are 2 delusions of control?
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
What is the difference btwn illusions and hallucinations?
illusion - misinterpretation of an existing sensory stimulus (mistaking a shadow for a cat)
Hallucinations: sensory perception without an actual external stimulus
most common hallucination experienced by schizophrenics
auditory
most common hallucination experienced by an epileptic person
olfactory
What are some Rx that can cause psychosis?
anything that alters the dopaminergic response:
benzodiazepines (intoxication/withdrawal) amphetamines steroids anticholinergics anti-parkinsonian agents anticonvulsants antihistamines Anti-HTN (ß blockers) digitalis fluroquinolones barbiturates
What are some recreational drugs that can cause psychosis?
OH withdrawal hallucinogens (LSD, Ecstasy) marijuana cocaine phencyclidine
Vitamins deficiencies that can cause psychosis (3)
B12
folate
niacin
What should you think of when an medically ill elderly patient presents with psychotic symptoms?
delirium
What are + sx of schizophrenia?
What is the biochemical abnormality and pathway that cause this?
hallucinations, delusions, bizarre behavior, disorganized speech
excess dopaminergic activity in the mesolimbic pathway (improves with anti-psychotics)
What are - sx of schizophrenia?
What is the biochemical abnormality and pathway that cause this?
flat affect, anhedonia, apathy, alogia, lack of interest in socialization
inadequate dopaminergic activity in the prefrontal cortex (worsens with anti-psychotics)
3 phases of schizophrenia
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
DSM diagnostic criteria (duration of sx) of schizophrenia
+/- symptoms for at least ONE month, but symptoms (includes prodrome, psychotic, and residual) have lasted for >6 mo
5 types of schizophrenia?
paranoid disorganized catatonic undifferentiated (>1 or none of the subtypes) residual (- sx)
When do men tend to present with schizophrenia? Women?
men: 20
women: 30
What is highly comorbid with schizophrenia in many patients?
substance abuse
What is the downward drift hypothesis of schizophrenia?
lower socioeconomic groups have higher rates of schizophrenia. Why?
Schizophrenics are unable to function well in society and hence enter lower socioeconomic groups
What is the pathophysiology of schizophrenia
+ sx = increased dopamine activity in mesolimbic pathways
- sx = decreased dopamine activity in prefrontal cortex
why can cocaine and amphetamine cause schizophrenic-like symptoms?
because they increase dopamine activity
What are two other pathways (other than the mesolimbic/prefrontal cortex pathways) that are affected by neuroleptics
tuberoinfundibular - blocked by neuroleptics - causes hyper-PRL -> gynecomastia, galactorrhea, menstrual changes
nigrostriatal - blocked by neuroleptics - causes EPS (tremors, slurred speech, akathisia, dystonia, abnormal movements)
What does the brain of a schizophrenic patient look like on a CT? 2
enlarged ventricles
diffuse cortical atrophy
What are the main mxn and 3 main ADR of 1st generation antipsychotics?
D2 (dopamine) antagonist
ADR: EPS, NMS, TD
What are the main mxn and main ADR of 2nd generation antipsychotics?
Antagonist of 5-HT2 and dopamine receptors
ADR: metabolic syndrome
What do you treat EPS sx with?
anti-parkinsonian agents: benztropine, diphenhydramine
benzodiazepine
ß blockers
If a patient develops metabolic syndrome, what should you do?
consider switching to a 1st gen. antipsychotic or a more weight-neutral 2nd gen. antipsychotic such as apiprazole or ziprasidone
If a patient develops TD, what should you do?
d/c or reduce offending agent and start atypical antipsychotic
benzo, ß blockers, or cholinomimetic may be used short-term
If a patient develops NMS, what should you do?
d/c all antipsychotics
ADR of clozapine
agranulocytosis
ADR of thioridazine
irreversible retinal pigmentation at high doses
ADR of chlorpromazine
deposits in lens and cornea
DSM diagnostic criteria (duration of sx) of schizophreniform
sx (including prodrome, psychotic, and residual) that lasted for < 6 mo
DSM diagnostic criteria (duration of sx) of schizoaffective d/o
meets criteria for MDE, but has had psychotic sx for > 2 weeks without mood d/o sx
DSM diagnostic criteria (duration of sx) of brief psychotic d/o
sx (including prodrome, psychotic, and residual) that lasted for <1 mo
DSM diagnostic criteria (duration of sx) of delusional d/o
non-bizzare, fixed delusions for at least 1 mo; functioning in life not significantly impaired
type of delusions present in delusional d/o
erotomaniac grandiose somatic persecutory jealous mixed (more than one of the above)
what is folie a deux?
aka “shared psychotic disorder (IPD)” - occurs when a patient develops the same delusional symptoms as someone he/she is in a close relationship with
