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Psychiatry Rotation > Psychotic Disorders and Mood Disorders > Flashcards

Psychotic Disorders and Mood Disorders Flashcards

1
Q

Psychosis

A

Distorted perception of reality. Marked by delusion, impaired perceptions (hallucinations of illusions) and/or disorganized thinking.
Is a SYMPTOM of Schizophrenia, mania and severe depression.

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2
Q

Delusions

A

Fixed, false beliefs that cannot be explained or changed by rational arguments.

Classified as either bizarre or non-bizzare

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3
Q

Delusion Themes

A

Paranoid Delusions: someone is out to get you or persecuting you

Ideas of reference: cues in the external environment are uniquely related to the individual.

Delusions of control: patients thoughts can be read or are broadcast

Grandeur: belief that the person has powers beyond that of a normal human

Delusion of guilt: Unrealistic responsibility for bad occurrences

Somatic delusions: False Belief that they are affected with a disease.

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4
Q

Illusion

A

improper perception of an existing stimulus

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5
Q

Hallucination

A

Perception without a sensory stimulus

AUditory: most common in schizophrenia
Visual: Often seen in DT’s
Olfactory: seen in epilepsy with an aura
Tactile: secondary to drug or alcohol withdrawal.

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6
Q

Endocrinopathies that can cause psychosis

A

Addison/Cushing syndrome, hyper/hypoparathyroidism, hypocalcemia and hypopituitarism

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7
Q

Nturitional deficiencies leading to psychosis

A

B12, Thiamine, Folate, niacin

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8
Q

Psychotic Disorder due to Medical COndition

A

Prominent hallucination of delusions
Symptoms are not explained by delirium
Evidence supported by medical. lab and physical exam

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9
Q

Drugs that induce psychosis

A

Corticosteroids, Parkinson Disease treatments, Anticonvulsants, antihistamines, anti-cholinergics, Alcohol, cocaine, hallucinogens, marijuana.

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10
Q

Positive symptoms of Schizophrenia

A

Hallucination, Delusion, bizarre behavior and disorganized speech

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11
Q

Negative symptoms of schizophrenia

A

Blunted Effect, Anhedonia, apathy, a logia and lack of interest in socialization.

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12
Q

Cognitive symptoms of schizophrenia

A

impairment of attention and executive function and working memory.

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13
Q

3 phases of schizophrenia

A

Prodromal
PSychotic
Residual

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14
Q

DSM Criteria for Schizophrenia

A

Two or more of the following for at least one month with overall duration of disease being over 6 months:

Delusions (if bizarre, you can make diagnosis without anything else)
Hallucinations 
Disorganized speech
Catatonic behavior
Negative symtoms
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15
Q

5 Subtypes of Schizophrenia

A

Paranoid: Delusions and auditory halucinations w/o disorganized speech or catatonia

Disorganized type: Disorganized speech or behavior , flat affect.

Catatonic: Excessive purpoeless motor activity, extreme negativism or mutism, EHOLALIA, ECHOPRAXIA

Undifferentiated: More than one subtype
Residual Type: Prominent negative symptoms

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16
Q

5 A’s of schizophrenia

A 
Anhedonia
Affect is flat
ALogia (poverty of speech)
Avolition: (apathy)
Attention: Poor
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17
Q

Most commonly used substance abuse in schizophrenia ?

A

Alcohol

Cannabis

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18
Q

Affect of Dopamine in prefrontal cortex leading to negative symptoms

A

Too little in this area

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19
Q

Effect of Dopamine in the Mesolimbic system leading to positive symptoms

A

Excessive dopaminergic activity.

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20
Q

What occurs when dopamine is blocked in the nigrostriatal system ?

A

EPS

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21
Q

What occurs when dopamine is blocked in the tuberoinfundibular region ?

A

Hyperprolacinemia

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22
Q

Associated with better prognosis in schizophrenia

A 
Late onset
Good support
Positive symptoms
Mood Symptoms
Acute onset
Female Sex
Few relapse
Good premorbid functioning
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23
Q

First Gen Anti-psychotics

A

Chlorpromazine
Thioridazine
Trifluoperazine
haloperidol

Block D2 receptors

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24
Q

Side Effects of Gen 1 AP’s

A

EPS
Neuroleptic Malignant Syndrome
Tardive Dyskinesia

25
Q

Second Generation anti-psychotics

A 
Risperidone
Clozapine
Olanzapine
Quetiapine
Aripiprazole 
Ziprasidone

ROCQ AZ
Antagonize Serotonin receptors

Lower incidence of EPS but increase risk for metabolic syndrome

26
Q

EPS

A

Major side effect of First Gen AP’s

Dystonia: spasm of fce and neck
Parkinsonism (due to DA antagonism)
Akithesia

27
Q

Treament for EPS

A

Antiparkison Agents ( iNcrease DA) such as…
benztropine
diphenhydramine

Benzodiazepines
Beta BLockers (mainly for akithesia
28
Q

MEtabolic Syndrome (2nd Gen)

A

Switch to more weight neutral 2nd gen like Aripiprazole or ziprazidone
GO to 1st gen (risk of EPS)

29
Q

Tardive Dyskinesia

A

Darting or writhing movements of the face tongue and head.

TAKE OFF OFFENDING MED

Give benzos or beta blockers.

30
Q

Neuroleptic Malignant Syndrome

A

High fever, Lead Pipe rigidity, high bp and tachycardia, increased CPK, leukocytosis and metabolic acidosis.

31
Q

Schizophreniform Disorder

A

Same as schizophrenia in terms of descriptors, however the time frame is different. ( between 1-6 months, no longer)

32
Q

Schizoaffective Disorder

A
  1. MDD or Manic episode

2. Delusions or hallucinations for at least 2 weeks in the ABSENCE of Mood disorder symptoms.

33
Q

Brief Psychotic Disorder

A

Patient with psychotic symptoms that are like schizophrenia except that the symptoms are last less than one month. (longer than one month = Schizophreniform. Add mood disorder and you have Schizoaffective)

34
Q

Dulusional Disorder

A

Non-bizarre fixed delusions for at least on month
DOESNT MEET CRITERIA FOR SCHIZO (aka no negative symptoms, no disorganization, no catatonic states)

Functioning in life not impaired

35
Q

Shared psychotic disorder

A

a patient develops the same delusional symptoms as someone he or she is in a close relationship with.

36
Q

Koro

A

Asians: Believes penis is shrinking and will disappear causing death

37
Q

AMok

A

Malaysia: Sudden outbursts of violence which person has no recollection of

38
Q

Brain Fag

A

Africa: Headache fatigue and visual disturbance in male student .

39
Q

Schizoid (Personality disorder, Axis II)

A

Social withdrawal and emotionally restricted

40
Q

Schizotypal (Personality disorder Axis II)

A

Belief in magical things. Criteria for psychosis not met

41
Q

Mood Episode

A

single event (Depression, Mania, Mixed State, hypomania)

42
Q

Mood disorder

A

pattern of mood episodes

MDD, Bipolar I/II, Dysthymic Disorder and Cyclothymic disorder. May have psychotic features.

43
Q

Major Depressive EPISODE

A

Five of the following and must have #1 or 2 for at least a 2 WEEK PERIOD :

Depressed mood
Anhedonia
Changes in appetite or weight
Insomnia
Decreased Concentration 
Psychomotor agitation
Fatigue
Thoughts of death or suicide

SIGECAPS !!!!!!

44
Q

Manic EPISODE

A

Lasts at least ONE WEEK and must include at least 3 of the following:

Distractibility
Iritability/ Insonmnia (lack of need for sleep)
Grandiosity
Flight of ideas
Activity increased
Speech (pressured)
Thoughtlessness

Manic Episode is an EMERGENCY

45
Q

Hypomania

A

Same criteria as Manic episode except it only lasts 4 days (instead of one week) and it does not disrupt your everyday activities and does not have psychotic features

46
Q

Major Depressive Disorder

A

Marked by multiple depressive episodes without the concurrent finding of manic states.

Remember: Depressive Episode must last for 2 weeks and have Depression or Anhedonia plus 4 others SIGECAPS modifiers.

47
Q

Sleep problems associated with MDD

A

Multiple Awakenings
Insomnia
Hypersomnia
Decreased REM

48
Q

SSRIs

A

More safe and better tolerated than other forms of antidepressants
Major Side Effects: Sexual Dysfunction and Rebound Anxiety

49
Q

Tricyclic ANti-depressants:

A

MOST LETHAL IN OVERDOSE

Side effects: Weight Gain, section, orthostatic hypotension, anticholinergic effect. PROLONGED QTC

50
Q

MAOi

A

useful in treatment of refractory depression
Hypertensive crisis when mixed with tyramine rich foods or sympathomimetics (increased epi)
SEROTONIN SYNDROME if used with SSRI’s

51
Q

5 Stages of Grief

A 
Denial
Anger
Bargaining
Depression
Acceptance
52
Q

Bereavement

A

Reaction to a major loss. Typically up to 2 months duration.

53
Q

Bipolar I

A

Can have Mania and Depressio, however depression is not needed for diagnosis
Onset usually before age 30
Highest genetic link of all psych diseases (first relatives have 8-18x more likely chance)

54
Q

Lithium

A

Mood stabilizer used to treat mania

Side Effects: Weight gain, tremor, GI probs, Fatigue, CARDIAC ARYHTMIAS, Seizures, Leukocytosis, Coma, DIABETES INSIPIDUS (nephrogneic) , Polydypsia

55
Q

Treatments of Bipolar I (besides Lithium)

A

Anticonvulsants (Carbamazepine and Valproic Acid)

Atypical Antipsychotics (Risperidone, Olanzapine, Clozapine, QUetiapine, Aripiprazole, Zaprasidone)

Anti-Depressants: NOT USED AS MONOTHERAPY DUE TO ABILITY TO EXACERBATE MANIA

ECT: Especially pregnant patients (since can’t take lithium.. causes Ebstein Anomaly)

56
Q

Bipolar II

A

Recurrent MDD with Hypomania

57
Q

Dysthymic Disorder

A

Chronic Mild Depression most of the time w/o discrete episodes for at least 2 years (cannot go without symptoms for over 2 months, no true major depressive episode, no manic or hypomanic state)

58
Q

Cyclothymic Disorder

A

ALternating periods of hypomania and mild to moderate depression ( if full on MDD it would be Bipolar II). Numerous periods within prevalence of at least 2 years.
Cannot have been symptom free for more than 2 months
No Hx of MDD of Mania

59
Q

Adjustment Disorder

A

Maladaptive behavioral or emotional symptoms develop after a stressful life event. Begins 3 months after, lasts for 6 months after event.

Psychiatry Rotation (15 decks)

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