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Psychotic disorders Flashcards

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1
Q

distorted perception of reality

A

psychosis

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2
Q

fixed , false beliefs that remain despite evidence to the contrary and cannot be accounted for by the cultural background of the individual

A

delusions

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3
Q

misinterpretation of an existing sensory stimulus– mistaking a shadow for a cat

A

illusion

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4
Q

sensory perception without an actual external stimulus

A

hallucination

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5
Q

most common hallucination exhibited by schizophrenic patients

A

auditory

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6
Q

olfactory hallucination occurs in

A

aura associated epilepsy

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7
Q

tactile hallucination occurs in

A

secondary to drug use or alcohol withdrawal

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8
Q

visual hallucination occurs in

A

less common in shizophrenia. may accompany drug intoxication, drug and lacohol withdrawal, or delirium

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9
Q

audotry hallucination that directly tell the patient to perform certain acts are called

A

command hallucinations

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10
Q

medical causes of psychosis (4)

A
  1. central nervous system disease such as epilepsy, encephalitis, prion disease, alzheimers…
  2. endocrinopathies such as addison/cushing, hyper/hypo-thyroidism, hyper/hypo-calcemia, hypopituitarism
  3. nutritional/vitamin deficiency states– B12/ folate
  4. other– CT disese, SLE, temporal arteritis
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11
Q

to make a diagnosis of schizophrenia, a patient must have symptoms of the disease for at least

A

6 months

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12
Q

symptoms of schizophrenia are broken up into 3 categories

A
  1. positive symptoms– respond to antipsychotics
  2. negative symptoms– treatment resistent and contrbute significantly to the social isolation of shizophrenic patients
  3. cognitive symptoms- poor work and school performance
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13
Q

symptoms of shizophrenia often present in 3 phases

A
  1. prodromal– decline in functioning preeceding the first psychotic episode
  2. psychotic– perceptual disturbances, delusions and disorderd thought process/content
  3. residual– occurs following an episode of active phsychosis. it is marked by mild hallucinations or delusions, social withdrawal and negative symptoms
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14
Q

to diagnose schizophrenia according to DSM-5 criteria what do you need?

A

I.two or more of the following must be present for at least 1 month:

  1. delusions
  2. hallucinations
  3. disorganized speech
  4. grossly disorganized or catatonic behavior
  5. negative symptoms

II.must cause significant deterioration– social/occupational/self-care

III. duration at least 6 months

IV. not due to medical or substance induced

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15
Q

the 5 A’s of schizophrenia sxs:

A
  1. anhedonia- inability to feel pleasure
  2. affect- flat
  3. alogia– poverty of speech
  4. avolition– apathy
  5. attention– poor
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16
Q

echolalia

A

repeats words or phrases

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17
Q

echopraxia

A

mimics behavior

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18
Q

brief psychotic disorder last for ________. Shizophreniform disorder last between___________. Schizophrenia lasts for ____________.

A

brief psychotic disorder last for < 1 month. Shizophreniform disorder last between 1-6 months. Schizophrenia lasts for 6 months

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19
Q

men and women are equally affected but have differen presentation and outcome for schizophrenia:

  1. Men tend to present
  2. women present
  3. men tend to have more or less? negative sxs and better/poorer? outcomes compared to women
A

men and women are equally affected but have differen presentation and outcome for schizophrenia:

  1. Men tend to present early to mid 20s
  2. women present late 20s
  3. men tend to have more negative sxs and poorer? outcomes compared to women
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20
Q

Schzophrenia rarely presents before age __ and after age ____

A

before 15 and after 55

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21
Q

why do lower groups have higher rates of shizophrenia?

A

donward drift hypothesis

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22
Q

pathophysiology of schizophrenia appears to be due to

A

increased dopamine activity in certain neuronal tracts . evidence to support is that most succesful treatments for schizophrenia are dopamine receptor antagonists

***** coccaine and amphetamines increase dopamine activity can cause schizophrenia-like sxs

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23
Q

what part of the brain is involved in the negative sxs of schizophrenia

A

prefrontal cortical

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24
Q

what part of the brain is involved in the positive sxs of schizophrenia

A

Mesolimbic

25
Q

unpleasant, subjectie sense of restlessness and need to move, often manifested by the inability to sit still

A

akathisia

26
Q

the lifetime prevalance of schizophrenia is

A

0.3-0.7%

27
Q

other important dopamine pathways affected by antipsychotics:

  1. blocked by antipsychotics causing hyperprolactinemaia which may cause gynecomastia, galactorrhea, sexual dysfunction, and menstrual irregularities
  2. blocked by antipsychotics causing parkinosinms/EPS such as tremors, rigidity, slurred speech, akathisia, dystonia
A
  1. tuberofundibular

2. Nigostriatal

28
Q

other neurotransmitters abnormalities implicated in schizophrenia :(4)

A
  1. elevated serotinin– antipsychotics antagonize serotnin
  2. elevated norepinephrine – long term use of antipsychotics decreases acitvity of noradrenergic neurons
  3. decreased GABA– decreased expression of the enzyme necessary to create GABA in the hippocampus in schizophrenic pt.
  4. decreased of glutamate receptors– schizophrenic pt. have fewer NMDA receptors ** corresponds to the psychotic symptoms observed with NMDA antagonists like ketamine
29
Q

schizophrenia has a large genetic component?

A

yep

30
Q

what can CT and MRI show potentially in a schizophrenic pt.?

A

may show enlargment of the ventricles and diffuse corticol atrophy and reduced brain volume

31
Q

what is a neologism?

A

newly coined word or expression that has meaning only to the person who uses it

*** schizophrenic pt. often have this

32
Q

first or second generation:

  1. dopamine (D2) antagonist
  2. treat positive sxs. w/ minimal impact on negative sxs.
  3. SE: EPS, neuroleptic malignant syndrome and tardive dyskenisia
A

first generation– chlorpromazine, fluphenazine, haloperidol, perphenazine

33
Q

first or second generation:

  1. antagonize 5-HT2 and dopamine (D4>D2) receptors
  2. lower incidence of EPS but increased risk of metabolic sydnrome
  3. med. should be taken for at least 4 weeks before efficacy is determined
A

second generation

34
Q

which has better efficacy first or second generation antipsychotics>

A

research has shown no significant difference

35
Q

reserved for patients who have failed multiple antipsychotics trials due to increased risk of agrunolocytosis

A

clozapine

36
Q

treatment for EPS sxs of antipsychotics

A
  1. anticholinergics– benztropine, diphenhydramine

2. benzodiazepines/beta-blockers– specifically for akathisia

37
Q

treatment for tardive dyskinesia

A

discontinue or reduce— may use benzo, botox and vitamine E

38
Q

which drug causes ophtalmologic conditions:

  1. irreversible retinal pigmentation
  2. deposits in lens and cornea
A
  1. irreversible retinal pigmentation– thioridazine

2. deposits in lens and cornea – chlorpromazine

39
Q

the cumulative risk of developing tardive dyskenia from antypsychotics is ___ per year

A

5%

40
Q

prognosis of schizophreniform disorder

A

1/3 of pt. recover completely- 2/3 progress to schizoaffective disorder or schizophrenia

41
Q

treatment of schizophreniform

A

hospitalization, 6-month course of antipsychotics and supportive psychotherapy

42
Q

dx. schizoaffective disorder with DSM-5 crit

A
  1. meet criteria for either major depressive or manic episode during which psychotic sxs consistent w/ schisophrenia are also met
  2. delusions or hallucinations for 2 weeks in the absence of mood disorder sxs
  3. mood sxs present for majority of psychotic illness
  4. sxs not due to substance or medical condition
43
Q

treatment for schizoaffective disorder

A

antipsychotics, mood stabilizers, antidepressents or ECT

44
Q

patients with ___________ may have transient, stress-related psychotic experiences. These are considered part of their underlying personality disorder and not diagnosed as a brief psychotc disorder

A

borderline personality disorder

45
Q

brief psychotic disorder (1) prognosis (2) treatment

A

(1) high rates of relapse but almost all completely recover

(2) biref hosp., supportive therapy, course of antipsychotics for psychosis and/or benzo for agitation

46
Q

to be diagnosed with delusional disorder according to DSM-5 crit.

A
  1. one or more delusions for at least 1 month
  2. does not meet crit. for schizophrenia
  3. functionin in life not significantly impaired and behavior not obviously bizarre
47
Q

delusion that another person is in love with the individual

A

ertomanic

48
Q

delusions of having great talent

A

grandiose

49
Q

physical delusions

A

somatic

50
Q

delusions of being persecuted

A

persecutory

51
Q

Schizophrenia vs delusional disorder:

  1. bizarre or nonbizarre delusions
  2. daily functioning significantly impaired
  3. must have 2 or more of the following:
    i. delusions
    ii. hallucination
    iii. disorganized speech
    iv. disorganized behavior
    v. negative sxs
A

Schizophrenia

52
Q

Schizophrenia vs delusional disorder:

  1. usually nonbizarre delusions
  2. daily functioninc not significantly ipaired
A

delusional disorder

53
Q

delusions of unfaithfulness

A

jealous

54
Q

delusiona disorder (1) prognosis (2) treatment

A

(1) better than schizophrenia
(2) difficult to treat given lack of insight and impairment . antipsychotics recommended but group therapy should be avoided due to patient’s suspiciousness

55
Q

culture-specific psychoses:

intense anxiety that the penis will recede into the body, possibly leading to death

A

Koro– southeast asia

56
Q

culture-specific psychoses:

sudden unprovoked outbursts of violence, often followed by suicide

A

Amok– malaysia

57
Q

culture-specific psychoses:

headache, fatigue, eye pain, cognitive difficulties, and other somatic disturbances in male students

A

Brain fag–Africa

58
Q

personality disorder: paranoid, odd or magical beliefs, eccentric, lack of friends, social anxiety

A

schizotypal

59
Q

personality disorder: solitary activities, lack of enjoyment from social interactions, no psychosis

A

Schizoid

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