Psychotic Disorders & Bipolar Disorders (midterm)

Question 1

Schizophrenia spectrum and other psychotic disorders include….

Answer 1

-schizophrenia
-schizotypal (personality) disorder
-delusional disorder
-schizophreniform
-schizoaffective disorder
-substance and medication induced psychotic disorder
-other

Question 2

Schizophrenia spectrum and other psychotic disorders have 5 signs and symptoms in common. What are they?

Answer 2

1) delusions
2) hallucinations
3) disorganized speech
4) grossly disorganized or catatonic behavior
5) negative symptoms

Question 3

What are delusions?

Answer 3

fixed beliefs that are not amenable to change in light of conflicting evidence

Question 4

What are the 6 types of delusions?

Answer 4

1) persecutory delusions
2) referential delusions
3) grandiose delusions
4) eretomanic delusions
5) nihilistic delusions
6) somatic delusions

Question 5

What are persecutory delusions?

Answer 5

-belief that one is going to be harmed or harassed by an individual, group, or organization
-patient is afraid “they are out to get me”
-closely related to nihilistic delusions which is the belief that a major catastrophe will occur

Question 6

What is the most common type of delusion?

Answer 6

persecutory delusions

Question 7

What are referential delusions?

Answer 7

belief that certain gestures, comments, environmental cues, etc are directed at one self

(this is the 2nd most common delusion, persecutory delusions, people out to get them is 1st)

Question 8

What are grandiose delusions?

Answer 8

when one believes that he/she has exceptional skills, abilities, wealth of fame

Question 9

What are eretomanic delusions?

Answer 9

when one believes falsely that another person is in love with him or her

Question 10

What are nihilistic delusions?

Answer 10

involve the conviction that major catastrophe will occur

Question 11

What are somatic delusions?

Answer 11

focus on the preoccupation regarding health and organ function (pain, but its all in their head)

Question 12

What are hallucinations?

Answer 12

-perception like experiences that occur without an external stimulus
-vivid and clear with full force and impact of normal perceptions, and not under voluntary control
-may occur in any sensory modality but auditory are most common
-auditory hallucinations are voices that may be familiar or unfamiliar and are perceived as distinct from the individual’s own thoughts

Question 13

What is disorganized thinking?

Answer 13

-formal thought disorder
-may switch from topic to topic (derailment or loose associations)
-answers to questions that may be obliquely related or unrelated
-it is hard to follow along to what this person is saying, usually sounds like random words in a sentence

Question 14

What is grossly disorganized or abnormal motor behavior (catatonia)?

Answer 14

-may manifest from childlike silliness to unpredictable agitation
-catatonic behavior is a marked decrease in reactivity to the environment
»movement does not make sense, it looks random
»resistence to instructions (negativism)
»maintaining a rigid, inappropriate or bizarre posture
»complete lack of verbal and motor responses (mutism and stupor)
»purposeless and excessive motor activity without obvious cause (catatonic excitement)
»repeated sterotyped movements, staring, grimacing, mutism, and echoing of speech

Question 15

There are 2 negative symptoms that are particularly prominent in schizophrenia. What are they?

Answer 15

1) diminished emotional expression
-reductions in the expression of emotions in the face
-loss of eye contact
-intonation of speech (prosody)
-reduced movements of the hand, head, or face, that normally give an emotional emphasis in speech

2) avolition
-decrease in motivated self-initiated purposeful activities

Question 16

What are the other negative symptoms associated with schizophrenia besides diminished emotional expression and avolition (decrease in motivation of self-initiated activities)?

Answer 16

alogia
-manifested by diminished speech output
-mute, like they don’t hear you

anhedonia
-decreased ability to experience pleasure from positive stimuli or a degradation in the recollection of pleasure previously experienced

asociality
-apparent lack of interest in social interactions and may be associated with avolition, but can also be the manifestation of limited opportunities for social interactions

Question 17

Which disorder is this?
-pt wants to be alone
-pervasive pattern of social and interpersonal deficits marked by acute discomfort with a reduced capacity for close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts
-constantly suspicious, thinks everyone is against them
-ideas of reference, incorrect interpretations of casual incidents and external events as having a particular and unusual meaning specifically for that person
-odd beliefs of magical thinking like superstitions, telepathy, “6th sense”
-unusual perceptual experiences, including bodily illusions
-odd thinking and speech (vague, metaphorical, stereotyped)
-suspiciousness or paranoid idealization (believing that colleagues are intent on undermining their reputation with the boss)
-behavior or appearance that is odd, eccentric, or peculiar
-lack of close friends other than 1st degree relatives
-excessive social anxiety that does not diminish with familiarity

Answer 17

schizotypal personality disorder

Question 18

Which disorder is this?
-characterized by the presence of 1+ delusions that persist for at least 1 month
-hallucinations are present in the delusional type and are not prominent or related to the delusional theme
-functioning is NOT impaired and behavior is NOT obviously bizarre or odd
-social, marital, or work problems resulting from delusional beliefs
-may be able to factually describe that others view their beliefs as irrational but are unable to accept this themselves
-many develop irritable or dysphoric mood like anger and violent behavior can occur with persecutory, jealous, and erotomanic types
-may engage in litigious or antagonistic behavior like sending hundreds of letters of protest to the government

Answer 18

delusional disorder

Question 19

Which disorder is this?
-disturbance that involves the sudden onset of at least 1 of the 5 common psychotic symptoms
-lasts for 30 days or less and will return to fully normal again
-more common in females than males (2:1)
-can occur:
»with marked stressors, symptoms occurring in response to events that are very stressful
»without marked stressors, symptoms occurring without particularly stressful events
»with postpartum onset, during or after pregnancy (within first 4 weeks)
-individuals experience brief but intense emotional turmoil or overwhelming confusion and severity
-may require supervision to meet nutritional and hygiene needs or protect them from consequences of poor judgement, cognitive impairments, or acting on delusions

Answer 19

brief psychotic disorder

Question 20

Which disorder is this?
-identical to schizophrenia in terms of symptoms, but the difference is duration
-must have 2+ of the 5 common psychosis symptoms for 1-6 months
-will undergo prodromal, active, and residual phases
-lack of a criterion requiring impaired social and occupational functioning

Answer 20

schizophreniform disorder

Question 21

Which disorder is this?
-at least 2 symptoms of the 5 common symptoms occur for over 6 months
-symptoms involve a range of cognitive, behavioral, and emotional dysfunctions
-peak onset is early to mid 20s for males and later 20s for females
-the earlier the onset, the worse the prognosis
-stress, drugs, alcohol, smoking can make it much worse
-more common in urban areas or in later winter/early spring
-presence of inappropriateness (laughing in absence of appropriate stimuli)
-dysphoric mood that takes the form of depression, anxiety, or anger
-disturbed sleep pattern like day sleeping and then night time activity
-depersonalization (don’t wants to associate with themself), derealization (don’t want to associate with environment), and somatic concerns with delusional proportions
-cognitive deficits that are linked vocational and functional impairments- these may include declarative memory, working memory, language function, and slower processing speed
-lack of insight which includes unawareness of symptoms, illness, neurological deficits following brain damage (anosognosia)
-hostility and aggression (common for younger males for those with history of violence or non-adherence with treatments, substance abuse, and impulsivity
-there is no positive radiological, lab, or psychometric test for the disorder
-pt has reduced overall brain volume and the brain volume will continue to decrease as they age
-neurological soft signs which include impairment in motor coordination, sensory integration, and motor sequencing of complex movements, left-right confusion, and dis-inhibition of associated movements
-minor physical abnormalities of the face and limbs may occur, like a high riding palate

Answer 21

schizophrenia

Question 22

What is anosognosis?

Answer 22

-neurological deficits following brain damage
-demyelination in the brain, leads to decreased resolution levels
-it is the most common predictor of non-adherence to treatments and it predicts higher relapse rates, increased number of involuntary treatments, poorer psychosocial functioning, aggression, and poorer course of illness

Question 23

Which disorder is this?
-uninterrupted period of illness during which the individual continues to display active or residual symptoms of psychotic illness
-there is major mood episode (major depressive or manic) and disordered thought processes (psychosis)
-a serious mental illness that has 2 features of 2 different conditions: schizophrenia and an affective (mood disorder), either major depression or bipolar
-the person experiences a combo of symptoms like hallucinations or delusions and mania or depression
-not a well understood disorder or well defined

Answer 23

schizoaffective disorder

Question 24

What are the 3 categories for bipolar and related disorders?

Answer 24

1) bipolar 1
2) bipolar 2
3) cyclothymic disorder

Question 25

Which disorder is this?
-manic episode that is followed by hypomanic or major depressive episodes
-not better explained by any other disorder
-major depressive episodes are common
-the manic episode is a period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity of energy lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization if necessary)
-during manic or hypomanic episode, the person will have inflated self-esteem or grandiosity and has a decreased need for sleep
-during manic or hypomanic, they are more talkative than usual, have ideas and thoughts racing, easily distracted, increase in goal directed activity of psychomotor agitation, excessive involvement in activities that have a high potential for painful consequences like buying sprees, sexual indiscretions or investments
-a hypomanic episode is a period of abnormally or persistently elevated, expansive, or irritable mood and have increased goal directed activity or energy
-hypomanic episode lasts for at least 4 consecutive days and present most of the day nearly every day
-major depressive episode is where 5 or more symptoms presents for same 2 week period and represent a change from previous functioning at least of one of the symptoms is either depressed mood or loss of interest and pleasure
-during depressive episode, the depressed mood is most of the day nearly everyday and feels empty, sad, and hopeless, the pt is markedly diminished in interests or pleasures, and will have weight loss or weight gain, insomnia, or hypersomnia
-during depressive disorder, the muscles are tense, and have psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive or inappropriate guilt nearly everyday, diminished ability to think or concentrate or indecisiveness nearly everyday, recurrent thoughts of death/ suicidal ideation
-child abuse, spouse abuse, or other violent behavior may occur during manic episodes
-some patients actually do commit suicide in 10-15% of cases during depressive episodes
-hyperthyroidism may precipitate or worsen manic symptoms but does not cause them
-onset is age 20 for both males and females
-hard to finish school or work due to episodic antisocial behaviors

Answer 25

bipolar 1

Question 26

Which disorder is this?
-one hypomanic episodes for at least 4 days and then at least one major depressive episode for at least 2 weeks BUT NEVER have a full manic episode
-average onset is mid 20s in both men and women
-has genetic and physiological links, more common amongst relatives
-high suicide rates

Answer 26

bipolar 2

Question 27

Which disorder is this?
-a chronic, fluctuating mood disturbance involving numerous periods of hypomanic symptoms and periods of depressive symptoms that are distinct from one another, but neither episodes peak- as in, no major depression, but there is depressive symptoms, same with hypomania
- occurs for 2+ years (1+ years if diagnosed as a child/teenager), does not meet criteria for major depressive episode
-the hypomanic and depressive periods have been present for more than 2 months at a time
-onset can begin in teen years or young adult life and is sometimes considered to reflect a tempermental predisposition to other disorders

Answer 27

cyclothymic disorder

Question 28

Which disorder is this?
-related to meds, intoxication, or drug abuse
-persistent period of abnormally elevated expansive or irritable mood and abnormally increased activity or energy that is attributed to another condition

Answer 28

substance medication induced bipolar related disorder

Question 29

What medications can be used to treat bipolar/related disorders?

Answer 29

1) mood stabilizers like lithium, valporic acid, carbamazepine
2) atypical antipsychotics like aripiprazole or symbax
3) SSRIs or antidepressants like celexa, prozac, zoloft

Question 30

What are some side effects of bipolar drugs?

Answer 30

-nausea
-tremors
-hair loss
-kidney damage
-thyroid issues