Psychotic Disorders Flashcards
Define psychosis
- delusions
- hallucinations
- disorganized though/ behavior
*It is a SYMPTOM of many different conditions
Two types of delusions
bizarre vs nonbizarre
Define somatic delusions
belief that one has a disease/ illness
Visual hallucination causes
- drug intox
- delirium
- drug and alcohol withdraw
- lewey body
Most common causes of tactile hallucinations
-secondary to drug use or alcoholic withdraw
Endocrine related causes of psychosis
- hypo/hyperthyroid
- hyper/hypocalcemia
- hypopituitarism
- cushings
Three vitamin related causes of psychosis
- B12
- folate
- niacin
Three random disease states assc with psychosis
- SLE
- porphyria
- temporal arteritis
Criteria common to psychosis induced by either medical condition or medication
- symptoms do not only occur during delirium
- not better accounted for by a psych disorder
Length of time required for diagnosis of:
- schizophrenia
- schizophreniform
- brief psychotic disorder
schizo six months
schizophreniform 1-6 mos
brief less than month
Important workup when schizophrenia is expected
TSH
RPR
brain imaging
Three categories of schizo symptoms
- positive
- negative
- cognitive
Three phases of schizophrenia
- prodromal
- psychotic
- residual
What are the five A’s/negative symptoms of schizophrenia?
- anhedonia
- affect
- alogia
- avolition
- attention
Symptomatic criteria for schizo
must have 3 symptoms, one of which must be a positive symptom (hallucination, delusion, disorganized speech)
Births in what time of year increase risk of schizophrenia?
-late winter and early spring
Age period during which schizophrenia presents
15-55
Contrast males and females with schizo
men earlier, more negative symptoms, poorer prognosis
Define downward drift
-schizo prevalent in low SES because patients fail to succeed in careers
Two pathways involved in schizophrenia
- mesolimbic: high dopa = positive symptoms
- prefrontal/mesocortical: low dopa= negative symptoms
Lifetime prevalence of schizophrenia
1%
Five NT changes in schizo
-high serotonin and NE
-low GABA, glutamate receptors (NMDA)
(major= high dopa)
How is ketamine related to schizophrenia?
- schizo= low NMDA receptors
- ketamine blocks NMDA receptors
CT changes in schizophrenia
- large ventricles
- cortical atrophy
Good prognostic features in schizophrenia
- late acute onset
- positive symptoms
- female
- few relapses, good premorbid function
MOA first gen antipsychotics
D2 antagonists
MOA atypicals
antagonist 5HT and D4 more than D2 receptors
Contrast ADRs of typical vs atypical antipsychotics
- typical: risk extrapyramidal effects
- atypical: risk metabolic effects
How long until antipsychotics are effective?
1 month
List four typical antipsychotics
- haloperidol
- fluphenazine
- perphenazine
- chlorpromazine
What population most commonly suffers from tardive dyskinesia?
-older women 6 months after beginning treatment
Treatment for extrapyramidal side effects
- anticholinergics
- BDZs
- BBers
Two weight neutral atypicals
- aripiprazole
- ziprasidone
Treatment of tardive dyskinesia
BDZ
Botox
Vitamin E
Two antipsychotics that effect the eye
- thioridazine: retinal pigmentation
- chlorpromazine: deposits in lens and cornea
How many patients recover from schizophreniform disorder?
1/3
Schizoaffective disorder
- Meet criteria for major depressive/ manic episode + schizophrenia symptoms
- delusions/hallucinations present for 2 weeks without mood symptoms
Contrast schizoaffective d/o & mood d/o + psychotic features:
-mood disorder= no psychosis in absence of mood episode
What may trigger brief psychotic disorder
extreme stress
Delusional d/o criteria
- delusions for at least one month do not meet criteria for schizophrenia
- usually nonbizarre and can function in society
Define erotomaniac delusions
another person is in love with them
Treatment for delusional disorder
antipsychotics
Psychotic disorder in southeast asia
Koro (penis will recede into body)
Psychotic disorder in Malaysia
Amok (violence –> suicide)
Describe schizotypal personality disorder
paranoid, odd, magical beliefs
lack of friends
Describe schizoid personality disorder
lack of enjoyment from socialization
