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BSP Exam II > Psychotic Disorders > Flashcards

Psychotic Disorders Flashcards

1
Q

When is peak onset for schizophrenia?

A

Late adolescence and early adulthood

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2
Q

Precipitating events to schizophrenia may include psychosocial stressors, traumatic events, and/or drug and alcohol abuse. For example, _______ use increases risk of developing schizophrenia by at least 6x

A

Cannabis

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3
Q

Prodromal signs and symptoms may exist before symptoms of schizophrenia. What are some examples?

A

Schizoid or schizotypal personalities

Few close friends as adolescents

Minimal social activities

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4
Q

Genetic association of schizophrenia as evidenced by monozygotic vs. dizygotic twins

A

Monozygotic twins (100% shared genes) concordence rate with schizophrenia = 40-50%

Dizygotic twins (50% shared genes) concordence rate with schizophrenia = 10-15%

[genes don’t play a huge role!]

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5
Q

Meta-analysis of literature have found that _____ ____ _____ increase risk of schizophrenia by 1.5-2x, a greater effect than any common genetic variant

A

Early life complications (ELCs)

[aka potentially adverse events that occur during pregnancy and labor, at delivery, and early in neonatal life]

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6
Q

The interaction between genomic risk and ELCs is mainly driven by the _____ genome, and is relatively independent of gene-environment interactions related to parental genomes per se.

Genes highly and differentially expressed in the ________ drive the interaction between polygenic risk scores and early-life complications on schizophrenia risk

A

Fetal

Placenta

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7
Q

Prenatal exposure to _____ ______ during the first trimester of pregnancy appears to increase the risk of developing schizophrenia, making offsprine 7x more likely to develop it

A

Influenza virus

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8
Q

The Copenhagen perinatal cohort stated that maternal ______ during any time in pregnancy was associated with a 3x increased risk of schizophrenia in offspring by age 47

A

URI

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9
Q

The “revised dopamine hypothesis” proposes hyperactive dopamine transmission in the ______ areas and hypoactive dopamine transmission in the _________ in schizophrenia pts

A

Mesolimbic; prefrontal cortex

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10
Q

In addition to the mesolimbic brain areas in schizophrenic pts, dopamine dysregulation is also observed in brain regions including the _____ and _______, which are important for emotional processing

A

Amygdala; prefrontal cortex

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11
Q

PET-studies have identified differences in dopamine contents in the prefrontal cortex, cingulate cortex, and _________ between schizophrenia pts and neuropsychiatric healthy control subjects.

A

Hippocampus

[“In particular, the dopamine system in the hippocampus is OVERACTIVE in schizophrenia pts”]

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12
Q

In terms of hormonal roles in schizophrenia, there is evidence that people with schizophrenia experience both periods of heightened and decreased _____ secretion

A

Cortisol

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13
Q

One set of symptoms that define psychotic disorders is known as “positive” symptoms, aka those symptoms that indicate a better prognosis.

What are the “positive” symptoms?

A

Delusions

Hallucinations

Disorganized thinking (speech)

Grossly disorganized or abnormal motor behavior (including catatonia)

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14
Q

One set of symptoms that define psychotic disorders is known as “negative” symptoms, aka those symptoms that indicate a worse prognosis.

What are the “negative” symptoms?

A

Diminished emotional expression

Avolition

Alogia

Anhedonia

Asociality

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15
Q

Fixed beliefs that are not amenable to change in light of conflicting evidence

A

Delusions

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16
Q

6 types of delusions

A

Persecutory

Grandiose

Referential

Erotomanic

Nihilistic

Somatic

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17
Q

Perceptions that occur without an external stimulus; may occur in any sensory modality

A

Hallucinations

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18
Q

_____ hallucinations are most common in schizophrenia

A

Auditory

[usually experienced as voices, whether familiar or unfamiliar; are perceived as distinct from individual’s own thoughts]

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19
Q

_______ hallucinations are those that occur while waking up

_______ hallucinations are those that occur while falling asleep

A

Hypnopompic

Hypnagogic

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20
Q

T/F: hypnagogic and/or hypnopompic hallucinations are highly indicative of psychosis

A

False

These types of hallucinations are NOT indicative of psychosis, but may indicate some other psychiatric issue; highly related to seizure activity

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21
Q

Types of disorganized thinking

A

Tangentiality (diverging from previous course)

Derailment or loose associations

Incoherence or “word salad”

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22
Q

Examples of grossly disorganized motor behavior include:

________ behavior = marked decrease in reactivity to the environment

_______ _______ = purposeless and excessive motor activity without obvious cause

A

Catatonic

Catatonic excitement

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23
Q

Types of disorganized motor behavior

A

Negativism (resistance to instructions)

Inappropriate or bizarre posture (waxy flexibility)

Mutism and stupor (a complete lack of verbal and motor responses)

Repeated stereotyped movements (staring, grimacing, mutism, and echoing of speech)

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24
Q

What 2 “negative” symptoms are particularly prominent in schizophrenia?

A

Diminished emotional expression — decreased eye contact, speech intonation (prosody), and movements of the hand, head, and face

Avolition — a decrease in motivated self-initiated purposeful activities

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25
Q

____ is a negative symptom manifested by diminished speech output

A

Alogia

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26
Q

_____ is a negative symptom characterized by decreased ability to experience pleasure; also found in depression, borderline, etc

A

Anhedonia

27
Q

Diagnostic criteria for schizophrenia require _____ or more of the following for most of ______ (time); and at least 1 of the first 3 symptoms from Criterion A:

  1. ____
  2. ____
  3. _____
  4. _____
  5. _____
A

Two; 1 month

  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Grossly disorganized or catatonic behavior
  5. Negative symptoms
28
Q

Differentiate presentation of schizophrenia in adults vs. child or adolescent in terms of functioning as stated in the DSM criteria

A

Adult — level of functioning after symptom onset is far below what it was prior to onset

Child or adolescent — failure to achieve expected level of functioning

29
Q

Diagnostic criteria (C) for schizophrenia require continuous signs of the disturbance persisting for at least _______ (time). This MUST include at least _______ (time) of symptoms from Criterion A [delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms]. This MAY include periods of prodromal or residual symptoms

A

6 months; 1 month

[Note: during prodromal or residual periods there may only be ‘negative’ symptoms, or at least 2 group A symptoms that present in an attenuated form, such as having odd beliefs or unusual perceptual experiences]

30
Q

According to the DSM, if there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if … what?

A

Only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated)

31
Q

The Schizophrenia: Catatonic Type, the clinical picture is dominated by at least ____ of the following:

  1. ____
  2. ___
  3. ___
  4. ____
  5. ____
A
  1. Motoric immobility as evidenced by catalepsy or stupor
  2. Excessive motor activity (apparently purposeless and not influenced by external stimuli)
  3. Extreme negativism or mutism
  4. Peculiarities of voluntary movements such as posturing, stereotyped movements, prominent mannerisms, or prominent grimacing
  5. Echolalia or echopraxia
32
Q

Single leading cause of death in schizophrenia pts

A

Suicide

[attempts occur in 20-50% of pts; risk is greatly increased with substance use, comorbid major depression, and previous high functioning]

33
Q

At what time during the disease process do most schizophrenic pts attempt/commit suicide?

A

Usually near illness onset

34
Q

Diagnosis of schizophrenia is made based on clinical symptoms. Medical screening must be utilized to rule out other possible causes — like what?

A

Seizure disorder

Metabolic disorder

Thyroid dysfunction

Brain tumor

Neurosyphilis

Street drug use

35
Q

Tests ordered in workup for schizophrenia

A 
Labs
Drug screen
Imaging (CT/MRI)
Neuro consult
EEG
36
Q

Schizophrenia treatment for pts experiencing acute psychosis

A

Hospitalization if needed for pt safety, and to get them stabilized

IM injections more commonly used while inpatient — Haloperidol, fluphenazine, lorazepam

37
Q

Schizophrenia treatment during stabilization phase

A

Consider converting to newer, atypical antipsychotics

Examples include: cloazpine, risperidone, olanzapine, quetiapine, ziprasidone, iloperidone, or aripiprazole

38
Q

2nd gen antipsychotic with side effects of agranulocytosis and weight gain

A

Clozapine

39
Q

2nd gen antipsychotic with very common side effect of weight gain and metabolic disorders (i.e., diabetes)

A

Olanzapine

40
Q

2nd gen antipsychotics with side effect of QTc prolongation

A

Ziprasidone

Iloperidone

41
Q

T/F: Schizophrenic pts tend to respond well to insight-oriented group and individual psychotherapy modalities

A

False — insight oriented group and individual psychotherapy modalities have been found to make symptoms worse

[Programs that do work include behavioral medicine clinics, residential living facilities, and care managers. Also: self-help programs and ECT]

42
Q

Pharmacologic treatment for catatonic type schizophrenia

A

Benzodiazepines

43
Q

DSM criteria for delusional disorder

A

Presence of 1 or more delusions with duration of 1 month or longer

Criterion A for schizophrenia has never been met

Apart from impact of delusion, functioning is not impaired, and behavior is not obviously bizarre or odd

If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods

Not caused by direct effects of a substance or a general medical condition

[types include erotomanic, grandiose, jealous, persecutory, somatic, mixed, and unspecified]

44
Q

DSM criteria for Brief Psychotic Disorder

A

A. Presence of 1 or more of the following and at least 1 must be 1, 2, or 3:

  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Grossly disorganized/catatonic behavior

B. Duration of an episode of the disturbance is at least 1 day, but less than 1 month, with eventual full return to premorbid level of functioning

C. The disturbance is not better explained by another disorder or substance abuse

45
Q

DSM criteria for schizophreniform disorder

A

A. 2 or more of the following, each present for a significant portion of a 1 month time period, and at least 1 must be 1, 2, or 3:

  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Grossly disorganized/catatonic behavior
  5. Negative symptoms

B. An episode of the disorder lasts at least 1 month but less than 6 months

C. Schizoaffective disorder or other mood disorder has been ruled out

D. Disturbance not due to substance abuse

46
Q

DSM criteria for schizoaffective disorder

A

A. Uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia

B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode during the lifetime duration of the illness

C. Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness

D. The disturbance is not attributable to substance abuse or other medical condition

47
Q

DSM criteria for substance/medication-induced psychotic disorder

A

A. Presence of delusions and/or hallucinations

B. BOTH of the following: symptoms in criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication AND the involved substance/medication is capable of producing symptoms in criterion A

C. The disturbance is not better explained by a psychotic d/o that is not substance/medication-induced

D. The disturbance does not occur exclusively during the course of a delirium

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other functioning

48
Q

DSM criteria for Psychotic Disorder due to Another Medical Condition

A

A. Prominent hallucinations or delusions

B. Evidence that the disturbance is the direct pathophysiologic consequence of another medical condition

C. The disturbance is not better explained by another mental d/o

D. The disturbance does not occur exclusively during the course of a delirium

E. The disturbance causes clinically significant distress or impairment in functioning

49
Q

In the criteria for Catatonia Associated with Another Mental Disorder, the clinical picture is dominated by 3 or more of what symptoms?

A 
Stupor
Catalepsy
Waxy flexibility
Mutism
Negativism
Posturing
Mannerism
Stereotypy
Agitation
Grimacing
Echolalia
Echopraxia
50
Q

Echolalia vs. echopraxia

A

Echolalia = mimicking another’s speech

Echopraxia = mimicking another’s movement

51
Q

Symptom found in catatonia characterized by repetitive, abnormally frequent, non-goal-directed movements

A

Stereotypy

52
Q

Symptom found in catatonia characterized by odd, circumstantial caricature of normal actions

A

Mannerism

53
Q

Symptom found in catatonia characterized by opposition or no response to instructions or external stimuli

A

Negativism

54
Q

Symptom found in catatonia characterized by spontaneous and active maintenance of a position against gravity

A

Posturing

55
Q

Symptom found in catatonia characterized by slight, even resistance to positioning by examiner

A

Waxy flexibility

56
Q

Symptom found in catatonia characterized by passive induction of a posture held against gravity

A

Catalepsy

57
Q

Symptom found in catatonia characterized by no psychomotor activity; not actively relating to environment

A

Stupor

58
Q

Components of “Other specified Schizophrenia Spectrum and Other Psychotic Disorder”

A

Causes significant distress or impairment but does not meet full criteria for any of the other psychotic disorders

Persistent auditory hallucinations in absence of other features

Delusions with significant overlapping mood episodes

Attenuated psychosis syndrome

Delusional symptoms in partner of individual with delusional disorder

59
Q

What is the difference in timeline for schizophrenia vs. schizophreniform vs. brief psychotic disorder?

A

Schizophrenia think >6 months

Schizophreniform think 1-6 months

Brief psychotic disorder <1 month

60
Q

Which of the following is characterized as schizotypal + psychosis?

A. Schizoid
B. Schizotypal
C. Schizophrenia
D. Schizoaffective
E. None of the above
A

C. Schizophrenia

61
Q

Which of the following is characterized as very introverted and voluntarily withdraws from social interactions?

A. Schizoid
B. Schizotypal
C. Schizophrenia
D. Schizoaffective
E. None of the above
A

A. Schizoid

62
Q

Which of the following is characterized as schizoprenia + mood disorder?

A. Schizoid
B. Schizotypal
C. Schizophrenia
D. Schizoaffective
E. None of the above
A

D. Schizoaffective

63
Q

Which of the following is characterized as schizoid symptoms + magical thinking + odd behavior

A. Schizoid
B. Schizotypal
C. Schizophrenia
D. Schizoaffective
E. None of the above
A

B. Schizotypal

64
Q

Schizophrenic pts are NOT more likely to commit homicide. However, there are risk factors that make these pts more likely to commit acts of violence. What are these risk factors?

A

Personality traits found in antisocial and/or borderline PD

History of violent acts

Paranoid beliefs

Content of auditory hallucinations

Substance abuse

Impulsivity

Talking about violence

BSP Exam II (10 decks)

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