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Psychotic Disorders Flashcards

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1
Q

How long must sx be present to dx schizophrenia?

A

6 months

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2
Q

Difference between schizophrenia and bipolar with psychotic episodes?

A

bipolar (manic or depressive) can have psychotic episodes that come and go

schizophrenia is insidious onset, chronic, and patients are psychotic all the time

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3
Q

Delirium vs schizophrenia

A

delirium is acute with psychotic sx–> can be resolved

–> often wrongly confused with schizophrenia

schizophrenia is chronic and incurable

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4
Q

What is the leading COD in schizophrenia?

A

suicide

rarely homicidal

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5
Q

What drug can reduce SI in schizophrenia?

A

Clozapine

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6
Q

Earlier the onset of schizophrenia, ……

A

the worse the prognosis

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7
Q

What is tardive dyskinesia?

A

lip smacking

pill rolling fingers

choreoathetotic movements of extremities and trunk

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8
Q

Lifetime prevalence of schizophrenia

A

1%

equal but present earlier in men

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9
Q

Onset of schizophrenia

A

late adolescence, early adulthood (18-22)

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10
Q

Precipitating events for schizophrenia

A

stress
traumatic events
drug and alcohol abuse
–> marijuana 6x increase

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11
Q

Prognostic variables of schizophrenia

A

positive sx–> better prognosis

negative sx–> poor prognosis

mood disorders (schizoaffective, MDD with psychotic features, bipolar)–> better prognosis

poor cognitive performance on testing, poor supports, younger onset–> poor prognosis

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12
Q

Positive sx of schizophrenia

A

sx added to presentation, present in active phase;

delusions
hallucinations
catatonia
agitation

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13
Q

Features of schizophrenia

A

loosening of associations (preoccupation with invisible forces)

poverty of content and speech

thought blocking

delusions (grandiose, somatic, persecution, etc)

a/v hallucinations
illusions

cognitive functioning impaired

blunted, flat, or inappropriate affect

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14
Q

Negative sx of schizophrenia

A

sx that appear missing from the presentation in residual phase:

affective flattening
apathy
social withdrawal
anhedonia
poverty of thought
content of speech
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15
Q

Hypothesis of schizophrenia

A

higher rates when born in winter and early spring months (exposure to influenza)

increased dopamine in neuronal tracts blocks pathways responsible for sx

increased serotonin and norepi

decreased GABA and glutamate receptors

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16
Q

Current research for dx of schizophrenia

A

blood test for gene activity

eye-tracking

brain imaging (enlarged ventricles, reduced volume of cortical structures)

17
Q

DSM5 for schizophrenia

A 
2+ for 1 month, at least one of first 3:
delusions
hallucinations
disorganized speech
grossly disorganized or catatonic behavior
negative sx

social or work dysfunction

6 months at least

rule out schizoaffective and mood disorders

rule out substance abuse and medical conditions that can cause delirium or psychosis

18
Q

RF for homicidal behavior in schizophrenia

A

not more likely than population

antisocial or borderline PD
hx violent acts
paranoid beliefs
content of auditory halluc
substance abuse
impulsivity
talking about violence
19
Q

Schizophrenia tmt

A 
hospitalization
group therapy
individual psychotherapy
community tmt
self-help programs
pharm
ECT
benzos for catatonic subtype
20
Q

First vs second generation antipsychotics

A

first blocks dopamine receptors

second blocks dopamine and affect serotonin activity

21
Q

What to use first generation antipsychotics for

A

acute psychosis (IM haloperidol, lorazepam to calm down)

stabilization phase

maintenance phase (long acting)

poor responders

22
Q

Side effects of first generation antipsychotics

A

extrapyramidal syndromes (EPSs)

  • -> tardive dyskinesia
  • -> catatonia
  • ->akathisia (RLS but whole body)
  • -> parkinsonism
  • -> acute dystonic rxn

neuroleptic malignant syndrome
–> muscle rigidity, F, autonomic instability, altered LOC

23
Q

What second generation antipsychotic can cause QTc prolongation?

A

ziprasidone

24
Q

What second generation antipsychotic can cause agranulocytosis and weight gain?

A

clozapine

25
Q

Why is schizoaffective disorder more treatable than schizophrenia?

A

has a mood component

26
Q

What is schizoaffective disorder?

A

uninterrupted period of psychosis (meets sx criteria for schizophrenia) and accompanies major depressive episode or manic episode (essentially combo of mood disorder and schizophrenia sx)

in same time, delusions or hallucinations for at least 2 weeks without mood sx

bipolar and depressive type

27
Q

What is schizophreniform?

A

meets criteria for schizophrenia but doesn’t last 6 months
–> between 1 and 6 month duration

good prognostic features: good social and work fxn, no flat affect

28
Q

Define brief psychotic disorder

A

sx of schizophrenia for 1 day-1 month

eventual return to normal but can have future episodes

29
Q

Define delusional disorder

A

fixed, false beliefs (don’t try to correct them, wont believe you)

at least 1 month

never met schizophrenia criteria for more than a few hours

function and behavior is not odd or bizarre except for delusions

30
Q

Ddx for delusional disorders

A 
alzheimer's 
huntington
brain tumors
complex partial seizures
strokes

schizophrenia when delusions are bizarre

somatoform disorders

malingering

31
Q

Timelines

A

schizophrenia: more than 6 months
schizophreniform: 1-6 months

brief psychotic disorder: less than 1 month

32
Q

Schizo spectrum

A

schizoid: very introverted, voluntarily withdraws from society
schizotypal: schizoid sx + magical thinking and odd behavior
schizophrenia: schizotypal + psychosis
schizoaffective: schizophrenia + mood disorder

33
Q

What second generation antipsychotics cause weight gain?

A

clozapine

olanzapine (also DM)

34
Q

What second generation antipsychotics cause QT prolongation?

A

ziprasidone

iloperidone

35
Q

What second generation antipsychotic increases prolactin?

A

risperidone

Psych (12 decks)

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