Psychotic Disorders

Question 1

3 key elements for diagnosing schizophrenia

Answer 1

1. at least 2 for 1 month: delusions, hallucinations, disorganized speech or catatonic behavior (remember stupor, wavy flexibility, motoric immobility, won’t obey or talk, unusual posturing movements)
   +
2. clear decrement in social and occupational functioning
   +
3. at least 6 month duration of signs of disorder

Question 2

most common type of hallucination in schizophrenia?

Answer 2

auditory

Question 3

patient comes in with olfactory, gustatory, or somatosensory hallucinations. what is your first differential diagnosis?

Answer 3

most probably substance abuse or some general medical condition

Question 4

what 2 conditions have potential to progress to shizophrenia?

Answer 4

1. shizotypal

2. paranoia

Question 5

3 types of disordered thinking seen in schizophrenia?

Answer 5

1. loose associations
   2 blocking - abrupt cessation of thought, no recollection what i was just talking about
2. neologisms - made up words

Question 6

what are the NEGATIVE symptoms of schizophrenia?

Answer 6

1. emotional expressivity (so they have lack of it)
2. they lack nonverbal communication skills
3. poverty of speech
   .
   * note: these negative symptoms are what most affect their functionality in daily living

Question 7

prevalence of schizophrenia in the population:

prevalence in 1st degree relatives of shizophrenics:

Answer 7

general population: 1%
.
relatives: 8-12%

Question 8

average age of schizophrenia onset in males and females?

Answer 8

males: 15-25 years old
females: 25-35 years old
* age of onset is important for diagnosis. if on a boards question the person is older, it’s prrooobably not schizo)

Question 9

what causes relapse of schizophrenia? besides not taking your meds obvis

Answer 9

1. taking street drugs, especially stimulants

2. STRESS

Question 10

what percent of schizophrenic patients have serious impairment?

Answer 10

40-60%

Question 11

schizophrenic suicide rate?

Answer 11

10%

Question 12

which schizophrenic pts are at higher risk for suicide?

Answer 12

if they greater sense of loss from illness. this happens if they had better functioning before illness, they have intact insight, and if they’re going through post-psychotic depression

Question 13

how to tell schizophrenia from other conditions?

Answer 13

there are NO mood symptoms. they are baseline psychotic. whereas in other things like mdd or bipolar the psychotic comes and goes with their mood episodes

Question 14

what is schizophreniform disorder?

Answer 14

identical to schizophrenia but patient returns to normal within 6 months

Question 15

schizoaffective disorder:

Answer 15

like schizophrenia with baseline psychotic state, but also mood stuff (so you have psychotic stuff even when you’re not in a depressive or manic episode, unlike mood disorders)

Question 16

brief psychotic disorder time requirement?

Answer 16

1 month or less

Question 17

if they have schizophrenic - like symptoms but it’s a lifelong thing, what is the diagnosis?

Answer 17

schizotypal personality disorder

Question 18

brief psychotic disorder can usually develop after a significant life stressor. what population is more at risk? (3)

Answer 18

1. those with personality disorders Class A and borderline
2. teenagers
3. those who underwent recent cultural changes..?

Question 19

how to respond to a delusional patient?

Answer 19

don’t respond to delusion (either agree or disagree)

instead say “this must be hard for you” lolol

Question 20

decreased volume of what brain part/area is linked to increased auditory hallucinations and thought disorders in schizophrenia?

Answer 20

superior temporal gyrus

Question 21

what specific deficiency causes the most functional impairment in schizophrenia? what brain area is this linked to?

Answer 21

deficient working memory from dysfunctional DLPFC (dorsolateral prefrontal cortex) -also remember in general negative symptoms cause more problems than postiive ones

Question 22

if you have a monozygotic twin with schizophrenia, what are the chances that you will get it?

Answer 22

50%

Question 23

no gliosis is found in schizophrenic brains. what does this mean?

Answer 23

damage happened BEFORE birth, during utero

Question 24

what things related to pregnancy or birth or newborns are risk factors/indicators for schizophrenia? (3)

Answer 24

1. birth complications
2. 2nd trimester viral infection
3. fingerprint abnormalities

Question 25

which NTs and their dysfunction (under or overactive) are linked to schizophrenia?

Answer 25

1. low dopamine
2. low glutamate (glu antagonists)
3. low serotonine (serotonine antagonists)

Question 26

treatment of schizophrenia (specific)?

Answer 26

psycotherapy - family therapy and social skills training

antipsychotics

Question 27

which antipsychotic drugs are useful in bipolar disorder?

Answer 27

during manic episodes: 2nd generation antipsychotics
.
to prevent future episodies: Olanzapine (which is also a 2nd generation)

Question 28

true or false: positive symptoms are more responsive to APDs than negative symptoms

Answer 28

trueeee

Question 29

how long to feel/see effects of APDs? (3 things/time frames)

Answer 29

agitation - first few hours
hallucinations and thought disorganization better in few days to a week
full benefit takes 6 months

Question 30

mechanism of first generation APDs?

Answer 30

blocking DA-2 receptors in mesolimbic pathway leads to decreased positive symptoms

Question 31

mechanism of 2nd generation APDs?

Answer 31

block DA-2 receptors AND activate 5HT1 receptors which decreases DA blocking effect on nonmesolimbic areas –> decreased side effects

Question 32

Which drug is the most effective APD, and why it is not used first

Answer 32

CLOZAPINE
.
TERRIBLE SIDE EFFECTS and also dangerous

Question 33

side effects of 1st generation ADPs

Answer 33

1. neuro/motor stuff
2. increased prolactin causes galactorrhea, osteoporosis, and sexual dysfunction
3. antihistamine
4. anticholinergic
5. blocks alpha 1 receptors

Question 34

side effects of 2nd generation ADPs (3)

Answer 34

1. metabolic (clozapine can cause a lot of weight gain
2. diabetes (clozapine, olanzapine)
3. endocrine (risperidone ONLY) (increased prolactin)

Question 35

3 types of motor side effects of ADPs:

Answer 35

1. parkinsonism (pill rolling = tremor, TRAP)
2. dystonia (sustained conctraction)
3. akathisia (motor restlessness)

Question 36

blockage of what pathway in brain causes the extrapyramidal side effects of ADPs?

Answer 36

block nigrostriatal pathway

Question 37

how to treat parkinsonsim and akathisia side effects?

Answer 37

parkinsonism: amantadine (mild DA agonist)
Akathisia: Propanolol

Question 38

specific metabolic side effects with APDs, especially 2nd generation: (3)

Answer 38

1. weight gain
2. insulin resistance
3. elevated serum lipids

Question 39

which 2nd generation meds woud you start out with? (the ones that have least side effects) (2)

Answer 39

1. Aripiprazole

2. Ziprasidone