Psychotic Disorders Flashcards
In general, what is psychosis?
a distorted perception of reality - a general term for delusions, perceptual disturbances (hallucinations or illusions) and/or disorganized thinking
note - it’s a symptom of something bigger! Not a diagnosis!
What is a delusion?
a fixed, false belief that cannot be altered by rational arguments and cannot be accounted for by the cultural background of the individual
What’s the difference between a nonbizarre delusion and a bizarre delusion
a nonbizarre is a false belief that could conceivably be true.
a bizarre delusion is impossible
What does “ideas of reference” mean?
it’s a belief that cues in the external environment are uniquely directed to the individual - like if someone believes the radio is sending him/her secret messages
What are the two types of delusions of control?
thought broadcasting (belief that one’s thoughts can be heard by others)
thought insertion (belief that other people are placing their thoughts in one’s head)
Auditory hallucinations are usually associated with what disease?
schizophrenia
VIsual hallucinations are less commonly associated with schizophrenia and are more common with what?
drug intoxication, withdrawal (especially alcoholic hallucinosis), or delerium
Olfactory hallucinations are usually associated with what?
an aura associated with elipepsy
Tactile hallucinations are usually secondary to what?
drug intoxication or alcohol withdrawal
What’s the differential diagnosis for psychosis?
psychosis 2/2 a medical conditions substance-induced delerium/dementia bipolar disorder, manic/mixed episode major depression with psychotic features brief psychotic disorder schizophrenia schizophreniform disorder schizoaffective disorder delusional disorder
What are some general medical causes of psychosis?
CNS disease (CVA, MS, neoplasm, Alzheimer, Parkinson, Huntington, tertiary syphilis, temporal lobe epilspey, encephalitis, prion disease, neurosarcoidosis, AIDs)
Endocrinopathies (Addisons/Cushings, hyper/hypothyroid, hyper/hypocalcemia, hypopituitarism)
Nutritional/Vitamin deficiencies (B12, folate, niacin)
What classes of medications are commonly associated with psychosis?
corticosteroids antiparkinsonian agents anticonvulsants antihistamines anticholinergics some antihypertensives - beta blockers and digitalis methylphenidate fluoroquinolones barbiturates benzodiazepines
How long does a person need to have symptoms before they get a diagnosis of schizophrenia?
6 months
What are the positive symptoms of schizophrenia?
hallucinations, delusions, bizarre behavior, disorganized speech
What are the negative symptoms of schizophrenia?
blunted affect, anhedonia, apathy, alogia, lack of interest in socialization
What are some of the cognitive symptoms of schizophrenia>
impairment in attention, executive function and working memory, often lead to poor school and work performance
What are the three phases of symptoms in schizophrenia?
prodromal - decline in fucntion preceding the first psychotic episode (withdrawn, irritable, newfound religiosity, etc)
psychotic
residual - occurs between episodes of psychosis (flat affect, withdrawal, odd thinking or behavior)
If the symptoms of schizophrenia are present for less than 1 month, what’s the diagnosis?
brief psychotic disorder
If the symptoms of schizophrenia are present between 1-6 months, what’s the diagnosis?
schizophreniform disorder
What percentage of people will be diagnosed with schizophrenia over their lifetime?
1%
How do men and women present differently with schizophrenia?
men tend to present around age 20, women around 30
men tend to have more negative symptoms and more social impairment than women
Substance abuse is highly comorbid with schizophrenia. What is the most commonly abused substance?
alcohol (in 30-50%)
What neurotransmitter is most involved in the pathogenesis of schizophrenia?
dopamine
What are the two main dopaminergic pathways that are affected in schizophrenia? Which one is associated with the negative and which one is associated with the positive symptoms?
Prefrontal cortical (inadequate DA = negative symptoms) Mesolimbic (excessive DA = positive symptoms)
What dopaminergic pathway is affected by neuroleptics, contributing to the side effects of gynecomastia, galactorrhea, and menstrual irregularieis?
tuberoinfundibular (causes hyperprolactinemia)
What dopaminergic pathway is affected by neuroleptics, contributing to the extrapyramidal side effects like tremor, slurred speech, akathisia, dystonia and other abnormal movements?
nigrostriatal
What are some other neurotransmitters implicated in schizophrenia?
elevated serotonin
elevated norepinephrine
decreased GABA
decreased glutamate receptors
What might a CT of the brain show in schizophrenia?
enlarged ventricles and diffuse cortical atrophy
SIgnificant impirovement is noted in what percentage of schizophrenic patients who take antispychotic meds? BUt what percentage will be able to function fairly well in society with medication?
70% improve significantly, but only 20-30% will be able to function well in society
What percentage of patients with schizophrenia will attempt suicide?
50%
What are the main side effects of the first generation anti=psychotics?
extrapyramidal symptoms, neuroleptic malignant syndome and tardive dyskinesia
What are the main side effects of the second generation antipsychotics?
metabolic syndrome
less likely to cause extrapyramidal side effects
What medication is reserved for patients who have failed multiple antipsychotic trials? Why?
Clozapine - risk for agranulocytosis
What are some examples of extrapyramidal side effects?
dystonia, parkinsonism, akathisia
If someone develops metabolic syndrome, what are the medication options?
you can switch to a first generation antipsychotic, or use a more wight-neutral second generation like aripiprazole or ziprasidone
Describe how neuroleptic malignant syndrome presents.
altered mental status and autonomic changes (high fever, hypertension, tachycardia), lead pipe rigidity, sweating
labs show elevated creatine phosphokinase levels, leukocytosis and metabolic acidosis
What percentage of patients treated with long-term antispychotics will experience tardive dyskinesia?
20%
What percentage of patients wil experience spontaneous remission of TD after stopping the offending agent?
50%
What percentage of patients with schizophreniform disorder will progress to schizophrenia?
63%
If someone meets criteria for either a major depressive episode, manic episode or mixed episode during which the criteria for schizophrenia are also met, what additional criteria must they have to receive the diagnosis of schizoaffective disorder? Why?
must have had delusions or hallucinations for 2 weeks in the absence of mood disorder symptoms
this is to differentiate schizoaffective disorder from mood disorder with psychotic features
What percentage of those with schizoaffective disorder will progress to schizophrenia?
60-80%
What’s the recovery rate with brief psychotic disorder?
50-80%
What are the criteria for a diagnosis of delusional disorder?
- nonbizarre, fixed delusions for at leat 1 month
- not meeting criteria for schizophrenia
- functioning not significantly impaired
What percentage of those with delusional disorder will experience a full recovery?
50%
20% will have a decrease in symptoms
30% will have no change
True or false: antipsychotic medications are often effective for delusional disorder
false - usually ineffective, but should be tried
What is the prognosis for the psychotic disorders from best to worst?
mood disorder with psychotic features > brief psychotic disorder > schizoaffective disorder > schizophreniform > schizophrenia
