Psychotic Disorders Flashcards
When is the onset of Schizophrenia?
late adolescence and early adulthood
What are some precipitating events of Schizophrenia?
Psychosocial stressors
Traumatic Events
Drug/ETOH abuse (cannabis increases risk 6x)
What are features of Schizophrenia that indicate a better prognosis?
Positive Symptoms
Mood Disorders, like Schizoaffective, Major Depression with Psychotic Features or Bipolar Disorder
What are some features of Schizophrenia that indicate a poor prognosis?
Negative Symptoms
poor cognition
poor supports
younger-onset
poor premorbid functioning, insidious onset
What are some prodromal s/s of Schizophrenia?
Schizoid/Shizotypical personalities
Few close friends in adolescence
Minimal social activities
What are positive symptoms?
These add to the presentation
Typical present in Active Phase
-Delusions
-Hallucinations
-Catatonia
-Agitation
What is Loosening of Associations?
When connections among patient’s ideas are absent or obscure. Listeners may feel as if understanding the patient’s thoughts had been suddenly lost
May have preoccupation with invisible forces
In addition to Loosening of Associations, Shizophrenic patient’s may also exhibit which two other forms of thought?
Poverty of content and speech
Though blocking: internal interruption in their speech/thoughts
Patient’s with Schizophrenia may experience what content of thought?
Delusions of persecution, influence, thought broadcasting, Grandeur, or somatic form
What sorts of perceptual disorders may Schizophrenia present with?
Hallucinations (auditory/visual_
What are negative symptoms and when do they normally present?
Present in the Residual Phase
Affective Flattening
Apathy
Social Withdrawal
Anhedonia
Poverty of Thought
Content of Speech
How long must symptoms of Schizophrenia be present in order for a diagnosis to be made?
6 months
What are some differential diagnosis for Schizophrenia
Organic Mental Disorders
Mood Disorders
Delusional Disorder
OCD
Personality Disorders
“Normal Adolescence”
What is the proposed pathology underlying Schizophrenia?
Increased in patient’s born in winter/spring (could be related to influenza virus)
Likely increased DA in neuronal tracts, increased SE and NE, decreased GABA and Glutamate receptors
What are the dignostic criteria for Schizophrenia according to the DSM V
Two or more of the following for at least most of 1 month; at least one of the first three symptoms:
Delusions
Hallucinations
Disorganized Speech
Grossly disorganized/Catatonic Behavior
Negative Symptoms
Must last for at least 6 months
What are the historically recognized subtypes of Schizophrenia
Paranoid
Disorganized
Catatonic
Undifferentiated
Residual
Are Schizophrenic patients more likely to commit homicide or suicide?
Suicide-single leading cause of death in these patients
Can have a tendency towards violence, esp when coupled with antisocial or borderline personality disorder, paranoid beliefs, impulsivity, substance abuse, etc.
SI may be reduced with Clozapine
What are the features of Catatonic Schizophrenia?
At least two of the following:
Motoric immobility as evidenced by catalepsy or stupor
Excessive motor activity (purposeless, without stimuli)
Extreme negativism or mutism
Peculiarities of voluntary movement such as posturing, grimacing, etc
Echolalia or Echopraxia
What nonpharmacologic therapy is available to treat Schizophrenia?
Hospitalization
Group Therapy
Individual Psychotherapy
Community Treatment
Self-Help Programs
ECT
What pharmacologic therapy can be used to treat Acute Psychosis?
IM injections of Haloperidol, Fluphenazine, Lorazepam
(First-generation antipsychotics)
What drugs can be used to treat in the Stabilization Phase of Schizophrenia?
What is the goal of therapy for the Maintenance phase?
Newer atypical Antipsychotics
Keep patient’s free from symptoms while avoiding side effects, usually long-acting injections
Some patient’s with Schizophrenia may be poor responders. What could this be related to?
Could be related to noncompliance with medications
One concerning side effect of first generation antipsychotics includes Extrapuramidal Syndromes, which includes which signs and symptoms?
Acute Dystonic Reaction: sudden tonic contractures of muscles
Drug-induced Parkinsonism: Looks like Parkinson’s
Akathisia: Motor restlessness
Antipsychotic-Induced Catatonia: Mutism, motor changes
Tardive Dyskinesia: choreoathethotic movement and fasciculations
What is a concerning side effect of Clozapine?
What is the main function?
Agranulocytosis
Functions to block DA receptors and affect SE activity
(2nd generation antipsychotic)
What is a concerning side effect of the 2nd generation antipsychotic, Ziprasidone?
QTc prolongation
What is the criteria for Schizoaffective disorder?
An uninterrupted period of illness with either a major depressive episode or manic episode concurrent with symptoms that meet Criterion A for Schizophrenia
Same period of illness, have been delusions or hallucinations for at least two weeks in the absence of mood symptoms
What is the criteria for Brief Psychotic Disorder?
Presence of at least one of the following:
Delusions
Hallucinations
Disorganized Speech
Grossly Disorganized or Catatonic Behavior
Duration is at least 1 day and no more than 1 month with a return to normal functioning
What is the criteria for Schizophreniform?
Meets criteria A, D and E for Schizophrenia
An episode of the disorder lasts at least 1 month but less than 6 months
What is the criteria for Delusional Disorder?
Delusions of at least 1 month’s duration
Has never met criterion A for schizophrenia (for more than a few hours)
Apart from the delusions, functioning is not impaired and behavior is not odd/bizarre
When comparing/contrasting Shizophrenia, Schizophreniform and Brief Psychotic Disorder, how can timeline help?
Schizophrenia > 6 months
Schizophreniform 1-6 months
Brief Psychotic Disorder <1 month
Which second generation antipsychotics cause weight gain?
Clozapine
Olanzapine
Less weight gain: Ziprasidone
What are some hints for differentiating the disorders of the “Schizo” spectrum?
Schizoid: very introverted, withdrawn
Schizotypical: magical thinking/odd behavior
Schizophrenia: Schizotypical + psychosis
Schizaffective: Schizophrenia + mood disorder
