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Psychiatry > Psychotic disorders > Flashcards

Psychotic disorders Flashcards

1
Q

Describe the course of schizophrenia

A
  • chronic illness
  • relapsing + remitting pattern
  • sx change with time
  • functional deterioration over time
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2
Q

What defines an episode of schizophrenia?

A
  • observed signs of psychosis

- of unknown etiology

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3
Q

What changes will be observed in a schizophrenic patient? 4 A’s

A
  • associations
  • affect
  • ambivalence
  • asociality / autistic isolation
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4
Q

Describe the age of onset of schizophrenia

A
  • male younger - 10-25yo

- females older - 25-35yo with 2nd peak in middle age

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5
Q

What is meant by late onset schizophrenia?

A

Onset > 45 yo

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6
Q

Which factors contribute to a higher mortality rate?

A
  • Medical illness - SE Rx, comorbidities

- Suicide - risk incr during 1st yr after Dx

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7
Q

Explain the etiology of Schizophrenia

A
  • heterogenous etiology
  • interaction between genes + environment
  • causing neurodevelopmental disorder
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8
Q

List some genetic risk factors for Schizophrenia

A
  • 1st degree fam hx

- no specific genetic marker

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9
Q

List some environmental risk factors for Schizophrenia

A
  • Prenatal - maternal infections
  • Child abuse
  • Migration / urbanization (adversity + discrimination)
  • Cannabis use - more prone to psychosis
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10
Q

What are the 4 stage of Schizophrenia?

A
  1. Risk
  2. Prodrome
  3. Onset of Psychosis
  4. Chronic disability stage
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11
Q

What are the signs of the Risk stage?

How do you mx them?

A
  • early childhood behavioral + cognitive problem (1-10yo)
  • quite, introverted, few friends
  • no intervention at this stage
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12
Q

What characterizes the Prodrome stage?

What interventions are used?

A
  • changes in thought - disordered, paranoia
  • social isolation
  • fxn impairment
  • intervention = Psychotherapy (CBT), polyunsaturated fatty acids
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13
Q

What characterizes the onset of psychosis?

A
  • acute psychotic state
  • positive sx
  • Negative sx (5 A’s)
  • Cognitive sx
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14
Q

Which sx are responsible for long term morbidity + functional outcome?

A
  • Negative sx

- Cognitive sx

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15
Q

What complicates the chronic disability stage?

A
  • incr suicide rate

- incr obesity + smoking

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16
Q

List the DSM-V criteria for Schizophrenia

A
  • 2 or more of the following
  • present for majority of time during 1 month period
  • at least 1 must be (1)/(2)/(3)
  1. Delusions
  2. Hallucinations
  3. Disordered speech (derailment / incoherence)
  4. Disordered / catatonic behavior
  • social + occupation dysfunction
  • Not due to MMS
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17
Q

What is the duration of sx for Schizophrenia?

A
  • continuous disturbances
  • for at least 6 months
  • incl 1 month of sx meeting criteria A
18
Q

What are Positive sx?

A
  • Delusions
  • Hallucinations (auditory)
  • Disorganized speech + behavior
19
Q

What are Negative sx?

5 A’s

A
  • Affective blunting
  • Alogia (pov of speech)
  • Avolition (no drive)
  • Anhedonia
  • Asociality
20
Q

What are Cognitive sx?

A
  • Attention
  • Memory
  • Executive fxn
21
Q

What are some common mood sx seen in schizophrenia?

A
  • Depression
  • Anxiety
  • Suicidality
22
Q

What leads to resistance to acute Rx + involuntary hospitilaztion?

A
  • loss of insight

- poor judgment

23
Q

What percentage of Schizophrenic pts have good outcome?

A

10-20%

24
Q

What percentage of Schizophrenic pts have poor outcome

A

50%

  • repeated hospitalization
  • suicide
25
Q

What percentage can live “normal” lives?

A

20-30%

26
Q

List the GOOD prognostic factors for Schizophrenia

A
  • late onset
  • acute onset
  • obvious ppt factor
  • good premorbid fxn
  • mood d/o sx
  • fam hx mood d/o
  • positive sx
  • married
  • good support systems
27
Q

List the POOR prognostic factors for Schizophrenia

A
  • young onset
  • insidious onset
  • no ppt factor
  • poor premorbid fxn
  • hx of perinatal trauma
  • withdrawn autistic behavior
  • negative sx
  • neurological signs + sx
  • many relapses
  • no remission in 3 years
  • single / divorced / widowed
  • poor support systems
28
Q

What is meant by remission in Schizophrenia?

A
  • Full = no sx present for about 6 mo

- Partial = some sx still present

29
Q

What constitutes Schizophreniform Disorder?

A
  • sx identical to schizophrenia
  • > 1 month but < 6 months all phase
  • rapid onset of prodomal sx
30
Q

What is the outcome of Schizophreniform disorder?

A
  • return to baselines fxn level
  • > 6mo - 2/3 progress to schizophrenia (high suicide risk)
  • 50% repeat psychotic episode
  • negative sx = poorer outcome
31
Q

What defines Brief Psychotic disorder and Acute Transient Disorder?

A
  • hallucinations and/or delusions
    • disorganized thinking, speech, behavior
  • > 1 day but < 1 month
  • with/without preceding severe stressor
  • or post partum onset
32
Q

Describe the Epidemiology of Brief psychotic disorder

A
  • Female > male

- younger pts

33
Q

Define Schizoaffective Disorder

A
  • spectrum between schizophrenia + mood disorder
  • uninterrupted illness
  • schizophrenia criteria A met
  • at least 2 wks delusions + hallucinations WITHOUT mood sx
  • mood episode must be present for majority of dis duration (>50%)
34
Q

What are the subtypes of schizoaffective disorder?

A
  • Bipolar

- Depressive

35
Q

How do you Rx schizoaffective disorder?

A
  • Mood stabilizers

- AP

36
Q

Define Delusional disorder

A
  • non bizarre delusions
  • > 1 months
  • criteria A for schizophrenia not met
  • normal fxn + behavior
37
Q

What is a shared Psychotic disorder

A
  • transfer of delusions from one person (ill) to another

- delusion abandoned when separated

38
Q

What is a Culture Bound Syndrome?

A
  • culturally based signs + sx of mental distress / maladaptive behavior
  • must be in keeping with culture
39
Q

When is a psychotic episode NOT substance induced

A
  • sx precede substance use
  • sx >1 mo after cessation
  • substantially in excess of what is expected
40
Q

What are the clinical features of Schizotypal personality disorder?

A
  • frank psychosis absent
  • eccentric
  • magical thinking
  • ideas of reference, paranoid
  • few friends, social anxiety

Psychiatry (6 decks)

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