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Psychiatry > Psychotic disorders > Flashcards

Psychotic disorders Flashcards

1
Q

Paranoid delusion

A

Belief of being persecuted

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2
Q

Ideas of reference

A

Delusion

“Jesus is speaking to me through tv characters” …believing event is uniquely related to you

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3
Q

Thought broadcasting

A

Delusion

Belief that your thoughts can be heard by others

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4
Q

Delusions of guilt

A

Belief that you caused an event

“I caused the flood”

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5
Q

Hallucination vs. illusion?

A

Hallucination is a sensory perception WITHOUT ANY external stimulus.

Illusion is seeing one thing and thinking it’s something else (shadow is a cat)

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6
Q

Medical causes of psychosis

A

CNS: CVD, MS, Parkinson’s, Huntington’s chorea, temporal lobe epilepsy, encephalitis, prion dz, neoplastic

Endocrinopathies: Addison’s or Cushings, hyper/hypothyroidism, hyper/hypocalcemia, hypopituitarism

Nutritional/Vitamin deficiency: B12, folate, niacin

Other: Connective tissue dz, porphyria

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7
Q

DSM-IV criteria for psychotic disorder 2/2 general medical condition?

A
  • Prominent hallucinations or delusions
  • Sx do occur outside an episode of delerium
  • Medical reason eg. lab values, etc.
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8
Q

DSM-IV criteria for medication/substance-induced psychosis? Examples?

A

Same as psychotic but pinning down a specific drug(s)

Antidepressants, antiparkinsonians, antiHTN, antihistamines, DIGITALIS, BETA BLOCKERS, anti-TB, corticosteroids
Hallucinogens, amphetamines, opiates, bromide, heavy metal tox, alcohol

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9
Q

The three phases usually present in schizophrenia?

A
  1. Prodromal- decline in functioning BEFORE 1st psychotic episode (eg. socially withdrawn, irritable, physical complaints, super religious)
  2. Psychotic- Perceptual disturb, delusions, disordered thought
  3. Residual- BETWEEN episodes of psychosis. Flat affect, social withdrawal, odd thinking or behavior (negative). Hallucinations can continue EVEN WITH TREATMENT.
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10
Q

DSM-IV schizophrenia

A

TWO OR MORE for AT LEAST 1 MONTH

  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Grossly disorganized or catatonic behavior
  5. Negative sx like flat affect

Must cause significant social or occupational decline

Duration of at least 6 months which can INCLUDE PRODROMAL OR RESIDUAL PERIODS when the criteria are not met…

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11
Q

Criteria for paranoid type?

A

Highest functioning, OLDER ONSET

  • Preoccupation with one or more delusions or frequent auditory hallucinations
  • WITHOUT predominance of disorganized/catatonic sx or inappropriate affect
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12
Q

Criteria for disorganized type?

A

Poor functioning, EARLY ONSET

  • Disorganized speech/behavior
  • Flat OR inappropriate affect
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13
Q

Criteria for catatonic type?

A 
Rare. 
At least 2 of these:
-Motor immobility
-Excessive purposeless motor activity
-Extreme negativism or mutism
-Peculiar voluntary mvts or posturing
-Echolalia or echopraxia
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14
Q

Characteristics of residual type?

A

NEGATIVE SX prominent with minimal evidence of positive

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15
Q

Positive sx of schizophrenia?

A

Hallucinations, delusions, bizarre behavior, thought disorder

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16
Q

Negative sx of schizophrenia?

A

Blunted affect, anhedonia, apathy, inattentiveness.

Considered to be the “core” of the disorder even though more subtle.

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17
Q

A schizophrenic person tries to interpret a proverb…

A

…they show “concrete understanding” of it (eg. grass is greener on the other side…means that.)

ALSO HAVE A LACK OF INSIGHT INTO DZ.

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18
Q

Age of presentation for men vs. women with schizophrenia? Other diffs?

A

Men ~20, Women ~30

Men usually more severe dz, more negative sx, less able to fn in society

19
Q

Schizophrenia age range at onset?

A

15-45

20
Q

Downward drift hypothesis?

A

Schizophrenics function so poorly that maybe that’s why they end up in lowest SES groups

21
Q

Abused drug causes to be considered in someone p/w schizophrenia sx?

A

Cocaine or amphetamines bc they increase dopamine activity

22
Q

Dopamine pathways affected in schizophrenia?

A

Prefrontal cortex- Negatives

Mesolimbic- Positive sx

23
Q

Dopamine pathways blocked by neuroleptics?

A

Tuberoinfundibular (hyperprolactinemia)

Nigrostriatal (extrapyramidal effects)

24
Q

CT scans of patients w/ schizophrenia?

A

Enlargement of ventricles, diffuse cortical aftrophy

25
Q

What other neurotransmitters are implicated in schizophrenia?

A

Elevated serotonin (some of the atypicals antagonize it like risperidone/clozapine), norepi (long term use of antipsychotics dec this activity)

Decreased GABA

26
Q

Better prognosis in schizophrenia?

A
  • Acute onset
  • Later onset
  • Positive sx
  • Mood sx
  • Female sex
  • Few relapses
  • Good premorbid functioning
  • Good social support
27
Q

Poor prognosis in schizophrenia?

A
  • Gradual onset
  • Early onset
  • Negative sx
  • Family history (REALLY??)
  • Male sex
  • Many relapses
  • Poor premorbid functioning
  • Poor social support
28
Q

Typical neuroleptics?

A
  • Mostly D2 antagonists
  • Classically better at treating the positive sx
  • Significant extrapyramidal sx (but lower anticholinergic effects), risk of NMS, tardive dyskinesia

Chlorpromazine, thioridazine, trifluoperazine, haloperidol

29
Q

Atypical neuroleptics?

A
  • Antagonize 5-HT2 receptors AND dopmaine receptors
  • Better at negative sx rx
  • Much lower incidence of extrapyramidal (but HIGHER ANTICHOLINERGIC EFFECTS…opposite of typicals)
30
Q

How long should drug be taken before determining efficacy?

A

At least 4 weeks; if it fails switch to another med in a DIFFERENT CLASS

70% started on meds have significant improvement

31
Q

Extrapyramidal sx? Rx?

A
  • Dystonia of face, neck, tongue
  • Parkinsonism
  • Akathisia

(look up order they show up)

Antiparkinsonian agents (benztropine, amantadine), Benzodiazepines

32
Q

Anticholinergic sx? Rx?

A

Esp low-potency traditional antipsychotics and atypicals

Dry mouth, constipation, blurred vision

Rx: Stool softener, eye drops, etc

33
Q

Tardive dyskinesia sx? Rx?

A

High potency antipsychotics

Most commonly in older women at least 6 months after starting meds. 50% spontaneous remission but DISCONTINUE anyway bc effects CAN BE permanent.

Darting/writhing movements of of face, tongue, and head

Rx: Discontinue and start atypical neuroleptic.
Benzos, beta-blockers, cholinomimetics short term (and usually stuff goes away when drug is stopped anyway)

34
Q

Neuroleptic malignant syndrome?

A

High potency antipsychotics

Most common in men who recently started a med.

Confusion, high fever, elevated BP, tachycardia, “LEAD PIPE” rigidity, sweating, CPK levels highly elevated (from rhabdo)

20% MORTALITY RATE

35
Q

Other side effects of antipsychotics aka. neuroleptics?

A 
Weight gain
Sedation
Orthostatic hypotension
EKG changes
Hyperprolactinemia (dec libido, impotence, amenorrhea, galactorrhea)
Hematologic eg. agranulocytosis with clozapine so get weekly CBC
Opthalmologic eg. thioridazine
Derm rashes, photosensitivity
Hyperlipemia
Glucose intolerance
36
Q

Thioridazine optho?

A

Irreversible retinal pigmentation (at high doses)

37
Q

Chlorpromazine optho?

A

Deposits in lens and cornea

38
Q

Schizophreniform disorder? Prognosis? Rx?

A

Just like schizophrenia but from 1-6 months

1/3 complete recovery
2/3 schizoaffective or schizophrenia

Hospitalize; 3-6months antipsychotics; supportive psychotherapy

39
Q

DSM-IV criteria of schizoaffective disorder? Rx?

A
  • Meet criteria for either major depressive episode, manic episode, or mixed (DURING which criteria for schizophrenia area ALSO met)
  • Have delusions or hallucinations for 2 weeks WITH NO MOOD DISORDER SX
  • Have mood sx present for a substantial portion of psychotic illness
  • Sx not from drugs or dz

“Better than schizophrenia, worse than mood disorder”

Hospitalize/therapy; antipsychotics for short-term ctl of psychosis; mood stabilizers, antidepressants, or ECT prn for mania or depression

40
Q

Brief psychotic disorder? Prognosis? Treatment?

A

1 day-1month schizophrenia sx. RARE. (Trigger could be death of child, car accident, etc)

50-80% recovery
20-50% eventual schizophrenia or mood disorder dx

Hospitaliz/therapy
Antipsychotics for psychosis and/or BENZOS for agitation

41
Q

Prognosis from best to worst?

A

Mood disorder > Brief psychotic > schizoaffective > schizophreniform > schizophrenia

Brief psychotic IS better than schizoaffective (short time, full recovery, etc)

42
Q

Delusional disorder? DSM-IV? Prognosis? Rx?

A

MC in older patients (after 40), immigrants, and hearing impaired

  • NONBIZARRE, fixed delusions for at least 1 month
  • Doesn’t meet schizo criteria
  • Life functioning not impaired significantly

50% full recovery
20% dec sx
30% no change

Rx: Therapy… antipsychotics often ineffective but should try a course (typical or atypical)

43
Q

Shared psychotic disorder?

A

Remove the inducing person and 40% recovery; then psychotherapy; if no improvement in 1-2 wks start antipsychotic meds

44
Q

Schizotypal vs. schizoid personality disorders?

A

Schizotypal is paranoid, odd or magical beliefs, eccentric, no friends, social anxiety

Schizoid is WITHDRAWN, not wanting social interactions, emotionally restricted

Psychiatry (5 decks)

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