Psychotic disorders Flashcards
Describe the course of schizophrenia
- chronic illness
- relapsing + remitting pattern
- sx change with time
- functional deterioration over time
What defines an episode of schizophrenia?
- observed signs of psychosis
- of unknown etiology
What changes will be observed in a schizophrenic patient? 4 A’s
- associations
- affect
- ambivalence
- asociality / autistic isolation
Describe the age of onset of schizophrenia
- male younger - 10-25yo
- females older - 25-35yo with 2nd peak in middle age
What is meant by late onset schizophrenia?
Onset > 45 yo
Which factors contribute to a higher mortality rate?
- Medical illness - SE Rx, comorbidities
- Suicide - risk incr during 1st yr after Dx
Explain the etiology of Schizophrenia
- heterogenous etiology
- interaction between genes + environment
- causing neurodevelopmental disorder
List some genetic risk factors for Schizophrenia
- 1st degree fam hx
- no specific genetic marker
List some environmental risk factors for Schizophrenia
- Prenatal - maternal infections
- Child abuse
- Migration / urbanization (adversity + discrimination)
- Cannabis use - more prone to psychosis
What are the 4 stage of Schizophrenia?
- Risk
- Prodrome
- Onset of Psychosis
- Chronic disability stage
What are the signs of the Risk stage?
How do you mx them?
- early childhood behavioral + cognitive problem (1-10yo)
- quite, introverted, few friends
- no intervention at this stage
What characterizes the Prodrome stage?
What interventions are used?
- changes in thought - disordered, paranoia
- social isolation
- fxn impairment
- intervention = Psychotherapy (CBT), polyunsaturated fatty acids
What characterizes the onset of psychosis?
- acute psychotic state
- positive sx
- Negative sx (5 A’s)
- Cognitive sx
Which sx are responsible for long term morbidity + functional outcome?
- Negative sx
- Cognitive sx
What complicates the chronic disability stage?
- incr suicide rate
- incr obesity + smoking
List the DSM-V criteria for Schizophrenia
- 2 or more of the following
- present for majority of time during 1 month period
- at least 1 must be (1)/(2)/(3)
- Delusions
- Hallucinations
- Disordered speech (derailment / incoherence)
- Disordered / catatonic behavior
- social + occupation dysfunction
- Not due to MMS
What is the duration of sx for Schizophrenia?
- continuous disturbances
- for at least 6 months
- incl 1 month of sx meeting criteria A
What are Positive sx?
- Delusions
- Hallucinations (auditory)
- Disorganized speech + behavior
What are Negative sx?
5 A’s
- Affective blunting
- Alogia (pov of speech)
- Avolition (no drive)
- Anhedonia
- Asociality
What are Cognitive sx?
- Attention
- Memory
- Executive fxn
What are some common mood sx seen in schizophrenia?
- Depression
- Anxiety
- Suicidality
What leads to resistance to acute Rx + involuntary hospitilaztion?
- loss of insight
- poor judgment
What percentage of Schizophrenic pts have good outcome?
10-20%
What percentage of Schizophrenic pts have poor outcome
50%
- repeated hospitalization
- suicide
What percentage can live “normal” lives?
20-30%
List the GOOD prognostic factors for Schizophrenia
- 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
List the POOR prognostic factors for Schizophrenia
- 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
What is meant by remission in Schizophrenia?
- Full = no sx present for about 6 mo
- Partial = some sx still present
What constitutes Schizophreniform Disorder?
- sx identical to schizophrenia
- > 1 month but < 6 months all phase
- rapid onset of prodomal sx
What is the outcome of Schizophreniform disorder?
- return to baselines fxn level
- > 6mo - 2/3 progress to schizophrenia (high suicide risk)
- 50% repeat psychotic episode
- negative sx = poorer outcome
What defines Brief Psychotic disorder and Acute Transient Disorder?
- hallucinations and/or delusions
- disorganized thinking, speech, behavior
- > 1 day but < 1 month
- with/without preceding severe stressor
- or post partum onset
Describe the Epidemiology of Brief psychotic disorder
- Female > male
- younger pts
Define Schizoaffective Disorder
- 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%)
What are the subtypes of schizoaffective disorder?
- Bipolar
- Depressive
How do you Rx schizoaffective disorder?
- Mood stabilizers
- AP
Define Delusional disorder
- non bizarre delusions
- > 1 months
- criteria A for schizophrenia not met
- normal fxn + behavior
What is a shared Psychotic disorder
- transfer of delusions from one person (ill) to another
- delusion abandoned when separated
What is a Culture Bound Syndrome?
- culturally based signs + sx of mental distress / maladaptive behavior
- must be in keeping with culture
When is a psychotic episode NOT substance induced
- sx precede substance use
- sx >1 mo after cessation
- substantially in excess of what is expected
What are the clinical features of Schizotypal personality disorder?
- frank psychosis absent
- eccentric
- magical thinking
- ideas of reference, paranoid
- few friends, social anxiety
