Psychotic Disorders Flashcards
How long must sx be present to dx schizophrenia?
6 months
Difference between schizophrenia and bipolar with psychotic episodes?
bipolar (manic or depressive) can have psychotic episodes that come and go
schizophrenia is insidious onset, chronic, and patients are psychotic all the time
Delirium vs schizophrenia
delirium is acute with psychotic sx–> can be resolved
–> often wrongly confused with schizophrenia
schizophrenia is chronic and incurable
What is the leading COD in schizophrenia?
suicide
rarely homicidal
What drug can reduce SI in schizophrenia?
Clozapine
Earlier the onset of schizophrenia, ……
the worse the prognosis
What is tardive dyskinesia?
lip smacking
pill rolling fingers
choreoathetotic movements of extremities and trunk
Lifetime prevalence of schizophrenia
1%
equal but present earlier in men
Onset of schizophrenia
late adolescence, early adulthood (18-22)
Precipitating events for schizophrenia
stress
traumatic events
drug and alcohol abuse
–> marijuana 6x increase
Prognostic variables of schizophrenia
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
Positive sx of schizophrenia
sx added to presentation, present in active phase;
delusions
hallucinations
catatonia
agitation
Features of schizophrenia
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
Negative sx of schizophrenia
sx that appear missing from the presentation in residual phase:
affective flattening apathy social withdrawal anhedonia poverty of thought content of speech
Hypothesis of schizophrenia
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
Current research for dx of schizophrenia
blood test for gene activity
eye-tracking
brain imaging (enlarged ventricles, reduced volume of cortical structures)
DSM5 for schizophrenia
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
RF for homicidal behavior in schizophrenia
not more likely than population
antisocial or borderline PD hx violent acts paranoid beliefs content of auditory halluc substance abuse impulsivity talking about violence
Schizophrenia tmt
hospitalization group therapy individual psychotherapy community tmt self-help programs pharm ECT benzos for catatonic subtype
First vs second generation antipsychotics
first blocks dopamine receptors
second blocks dopamine and affect serotonin activity
What to use first generation antipsychotics for
acute psychosis (IM haloperidol, lorazepam to calm down)
stabilization phase
maintenance phase (long acting)
poor responders
Side effects of first generation antipsychotics
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
What second generation antipsychotic can cause QTc prolongation?
ziprasidone
What second generation antipsychotic can cause agranulocytosis and weight gain?
clozapine
Why is schizoaffective disorder more treatable than schizophrenia?
has a mood component
What is schizoaffective disorder?
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
What is schizophreniform?
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
Define brief psychotic disorder
sx of schizophrenia for 1 day-1 month
eventual return to normal but can have future episodes
Define delusional disorder
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
Ddx for delusional disorders
alzheimer's huntington brain tumors complex partial seizures strokes
schizophrenia when delusions are bizarre
somatoform disorders
malingering
Timelines
schizophrenia: more than 6 months
schizophreniform: 1-6 months
brief psychotic disorder: less than 1 month
Schizo spectrum
schizoid: very introverted, voluntarily withdraws from society
schizotypal: schizoid sx + magical thinking and odd behavior
schizophrenia: schizotypal + psychosis
schizoaffective: schizophrenia + mood disorder
What second generation antipsychotics cause weight gain?
clozapine
olanzapine (also DM)
What second generation antipsychotics cause QT prolongation?
ziprasidone
iloperidone
What second generation antipsychotic increases prolactin?
risperidone
