Psychotic disorders

Question 1

What is psychosis

Answer 1

• loss of contact with reality

Question 2

fixed, false beliefs, despite disproving evidence

Answer 2

delusions

Question 3

sensory perceptions in the absence of a stimulus

Answer 3

hallucinations

Question 4

paranoid, grandiose, reference, and somatic are examples of

Answer 4

delusions

Question 5

hallucinations can come in what forms

Answer 5

• auditory
• visual
• tactile
• olfactory
• gustatory

Question 6

List the 4 signs that point to psychosis

Answer 6

1. delusions
2. hallucination
3. disorganized thoughts and speech
4. disorganized or catatonic behavior

Question 7

what is disorganized or catatonic behavior

Answer 7

• activity that is not goal-directed
• inability to complete simple tasks
• immobility
• waxy flexibility

Question 8

Bleuler’s “four As’ of schizophrenia

Answer 8

• loose associations
• affective flattening
• autism
• ambivalence

Question 9

negative symptoms

Answer 9

decrease or absence of function

Question 10

positive symptoms

Answer 10

• delusion
• hallucination

Question 11

Which psychotic disorder is characterized by non-bizarre delusions (plausible but false)

i.e. being followed by police, infestations

Answer 11

Delusional disorder

Question 12

what is the level of psychosocial functioning in Delusional disorder

Answer 12

• NOT markedly impaired
• normal thought process
• poor insight

Question 13

List the diagnostic criteria for Delusional disorder

Answer 13

1. non-bizarre delusions for at least 1 month
2. criterion A for schizoprenia has never been met (but hallucinations related to delusion ok)
3. functioning not markedly impaired
4. mood episodes (if present) are breif relative to delusion

Question 14

erotomanic Delusional disorder

Answer 14

• another person is in love with the patient
• usually person of higher status (celebrity stalkers)

Question 15

grandiose Delusional disorder

Answer 15

• inflated worth, power, knowledge, identity, or special relationship to deity or famous person

Question 16

jealous Delusional disorder

Answer 16

• spouse, significant other, sexual partner is unfaithful

Question 17

persecutory Delusional disorder

Answer 17

• being treated malevolntly
• conspired against, cheated, spied on, followed, poisoned

Question 18

what type of Delusional disorder is this: physical defect or medical condition

Answer 18

somatic

Question 19

patients with a brief psychotic disorder have a high risk of

Answer 19

suicide

Question 20

list diagnostic criteria of brief psychotic disorder

Answer 20

1. presence of 1 or more
   
   1. ​delusion
   2. hallucination
   3. disorganized speech
   4. disorganized or catatonic behavior
2. duration 1 day to 1 month with eventual full return to premorbid level of functioning

Question 21

What percentage of patients with schizopreniform disorder progress to schizophrenia or schizoaffective disorder

Answer 21

• 1/3 recover
• 2/3 progress

Question 22

list diagnostic criteria of schizopreniform disorder

Answer 22

1. presence of 2 or more
   
   1. ​delusions
   2. hallucination
   3. disorganized speech
   4. grossly disorganized or catatonic behavior
2. duration 1 month - 6 months

Question 23

which type of symptoms often appear first in schizophrenia

Answer 23

negative symptoms

Question 24

list the diagnostic criteria for schizophrenia

Answer 24

1. at least 1 month of 2+ of the following
   
   1. delusion
   2. hallucination
   3. disorganized speech
   4. disorganized or catatonic behavior
   5. negative symptoms
2. social/occupation dysfunction
3. duration 6 months

Question 25

schizophrenia with **catatonia** is diagnosed via what criteria

Answer 25

* \> or = **3** of the following 1. stupor 2. catalepsy 3. waxy flexibility 4. mutism 5. negativism 6. posturing 7. mannerism 8. stereotypy 9. agitation 10. grimacing 11. echolalia 12. echopraxia

Question 26

What is schizoaffective disorder? what are the two types

Answer 26

* schizophrenia + mood disorder * types 1. bipolar 2. depressed (more common in women)

Question 27

list the diagnostic criteria for schizoaffective disorder

Answer 27

1. meets first criteria for schizophrenia (characteristic symptoms) and **concurrently** has **major depressive, manic, or mixed episode** 2. must have **2+ weeks** of delusions or hallucinations **without** prominant mood sxs 3. mood symptoms are present for a significant portion of the illness

Question 28

goal of treatment of psychotic disorders (3 things)

Answer 28

1. acute stabilization 2. indications for hospitalization 3. maintenance * includes pharmacotherapy

Question 29

acute stabilization involves

Answer 29

1. start antipsychotic at low doses and titrate as needed * avoid use of 2 antipsychotics * may require hospitalization * agitation is first to improve

Question 30

list the 4 indications for hospitalization

Answer 30

1. danger to self (DTS) 2. danger to others (DTO) 3. command auditory hallucinations 4. unable to care for self

Question 31

goal of maintenance therapy

Answer 31

symptom control and relapse prevention

Question 32

Which two antipsychotics are **first generation** D2 receptor blockades used acutely to stabilize patient

Answer 32

* chlorpromazine * haloperidol

Question 33

List the 2nd generation atypical antipsycotics

Answer 33

* Aripiprazole (abilify) * Clozapine (clozaril) * Olanzapine (zyprexa) * Quetiapine (seroquel) * Risperidone (Risperdal)

Question 34

adverse effect of Clozapine (clozaril)

Answer 34

* agranulocytosis * requires regular CBC monitoring of WBC

Question 35

side effect of Olanzapine

Answer 35

weight gain

Question 36

side effects of Risperidone

Answer 36

* elevates prolactin * extrapyramidal symptoms

Question 37

List the extrapyramidal symptoms

Answer 37

* tardive dyskinesia * neuroleptic malignant syndrome

Question 38

tardive dyskinesia is characterized by

Answer 38

abnormal involuntary movements