Psychotic Disorders Flashcards
What is the definition of psychosis?
- A break from reality involving delusions, perceptual disturbances, and/or disordered thinking.
- Ex: schizophrenia & substance-induced psychosis
Disorders of thought include thought ______ and _____.
content
process
What are disorders of thought content?
- Reflect the patient’s belief’s, ideas and interpretations of his and her surroundings
- Examples
- Paranoid delusions
- Ideas of reference
- Loss of ego boundaries
What are disorders of thought process?
- Involve the manner in which the patient links ideas and words together
- Examples
- Tangentiality
- Circumstantiality
- Loosening of associations
- Thought blocking
- Perseveration
What is the definition of a delusion?
- Fixed, false beliefs that cannot be altered by rational arguments and cannot be accounted for by the cultural background of the individual
What are the 5 types of delusions?
- Paranoid delusion
- Ideas of reference
- Thought broadcasting
- Delusions of grandeur
- Delusions of guilt
Paranoid delusion
- Irrational belief that one is being persecuted
- “The CIA is after me and taps my phone”
Ideas of reference
- Belief that some event is uniquely related to the individual
- “Jesus is speaking to me through TV characters”
Thought broadcasting
- Belief that one’s thoughts can be heard by others
Delusions of grandeur
- Belief that one has special powers beyond those of a normal person
- “I am the all-powerful son of God and I shall bring down my wrath on you if I cannot have a smoke”
Delusions of guilt
- False belief that one is guilty of responsible for something
- “I caused the flood in Mozambique”
What is the definition of a hallucination?
sensory perception without an actual external stimulus
What are the 4 types of hallucinations?
When are they commonly seen?
- Auditory - most commonly exhibited by schizophrenic patients
- Visual - commonly seen with drug intoxication
- Olfactory - usually an aura associated with epilepsy
- Tactile - usually secondary to drug abuse or alcohol withdrawal
What is the definition of an illusion?
- Misinterpretation of an existing sensory stimulus
- Ex: mistaking a shadow for a cat
Loss of ego boundaries
unawareness of where one’s mind and body end and those of others begin
What is the differential diagnosis of psychosis?
- Psychosis secondary to general medical condition
- Substance-induced psychotic disorder
- Delirium/Dementia
- Bipolar disorder
- Major depression with psychotic features
- Brief psychotic disorder
- Schizophrenia
- Schizophreniform disorder
- Schizoaffective disorder
- Delusional disorder
What are 4 medical causes of psychosis?
-
CNS disease
- Cerebrovascular disease, MS, neoplasm, Parkinson’s disease, Huntington’s chorea, temporal lobe epilepsy, encephalitis, prion disease
-
Endocrinopathies
- Addison’s/Cushing’s disease, hyper/hypothyroidism, hyper/hypocalcemia, hypopituitarism
-
Nutritional/Vitamin deficiency status
- B12, folate, niacin
-
Other
- Connective tissue disease (SLE, temporal arteritis), porphyria
What is the DSM IV criteria for psychotic disorder secondary to a general medical condition?
- Prominent hallucinations or delusions
- Symptoms do not occur only during episode of delirium
- Evidence to support medical cause from lab data, history or physical
What are the causes of medication/substance-induced psychosis?
- Anti-depressants
- Anti-parkinsonian agents
- Anti-hypertensives
- Anti-histamines
- Anti-convulsants
- Digitalis
- Beta blockers
- Anti-TB agents
- Corticosteroids
- Hallucinogens
- Amphetamines
- Opiates
- Bromide
- Heavy metal toxicity
- Alcohol
What is the DSM IV criteria for psychosis secondary to medication of substance use?
- Prominent hallucinations or delusions
- Symptoms do not occur only during episode of delirium
- Evidence to support medication or substance-related cause from lab data, history or physical
- Disturbance is not better accounted for by a psychotic disorder that is not substance-induced
What is Schizophrenia?
- Psychiatric disorder characterized by constellation of abnormalities in thinking, emotion and behavior
- No single symptom is pathognomonic
What are the positive symptoms of Schizophrenia?
- Hallucinations
- Delusions
- Bizarre behavior
- Thought disorder
What are the negative symptoms of Schizophrenia?
- Blunted affect
- Anhedonia
- Apathy
- Inattentiveness
What are the 3 phases of schizophrenia?
- Prodromal
- Psychotic
- Residual
Prodromal phase of schizophrenia
- Decline in functioning that precedes the first psychotic episode
- The patient may become social withdrawn and irritable
- He/she may have physical complaints and/or newfound interest in religion or the occult
Psychotic phase of schizophrenia
- Perceptual disturbances
- Delusions
- Disordered thought process/content
Residual phase of schizophrenia
- Occurs btwn episodes of psychosis
- Marked by flat affect, social withdrawal, and odd thinking or behavior (negative symptoms)
- Patients can continue to have hallucinations even with treatment
What is the DSM IV Criteria for Schizophrenia?
-
2 or more of the following must be present for at least 1 month:
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms (flat affect)
- Must cause significant social or occupational functional deterioration
- Duration of illness for at least 6 mo (including prodromal or residual periods in which above crteria may not be met)
- Symptoms not due to medical, neurological, or substance-induced disorder
What are the 5 subtypes of Schizophrenia?
- Paranoid type
- Disorganized type
- Catatonic type
- Undifferentiated type
- Residual type
Paranoid type of schizophrenia
- Highest functioning type, older age of onset
- Must meet the following criteria:
- Preoccupation w/ one or more delusions or frequent auditory hallucinations
- No predominance of disorganized speech, disorganized or catatonic behavior, or inappropriate affect
Disorganized type of schizophrenia
- Poor functioning type, early onset
- Must meet the following criteria:
- Disorganized speech
- Disorganized behavior
- Flat or inappropriate affect
Catatonic type of schizophrenia
- Rare
- Must meet at least 2 of the following criteria:
- Motor immobility
- Excessive purposeless motor activity
- Extreme negativism or mutism
- Peculiar voluntary movements or posturing
- Echolalia (repeats words or phrases) or Echopraxia (mimics behavior)
Undifferentiated type of schizophrenia
- Characteristic of more than one subtype or non of the subtypes