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NMSP Exam 1 > Psychotic Disorders - Cooley > Flashcards

Psychotic Disorders - Cooley Flashcards

1
Q

peak time of onset at late adolescence and early adulthood

precipitating events: psychosocial stressors, traumatic events, drug and alcohol abuse (cannabis use increases risk 6x)

prognostic variables

  • positive symptoms: better prognosis
  • negative symptoms: poor prognosis
A

schizophrenia

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2
Q

what are the prodromal signs and symptoms of schizophrenia?

A
  • may exist before symptoms of disease
  • possible schizoid or schizotypal personalities
  • few close friends as adolescents
  • minimal social activities
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3
Q

what has schizophrenia been associated with?

A

a number of early life complications

  • potentially adverse events that occur during pregnancy and labor, at delivery and early in neonatal life
  • **prenatal exposure to influenza virus during the first trimester of pregnancy appears to increase the risk of developing schizophrenia, making the offspring seven times more likely to develop the illness
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4
Q

PET studies have identified differences in dopamine contents in what areas of the brain?

A
  • prefrontal cortex
  • cingulate cortex
  • hippocampus dopamine systems is overactive
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5
Q

there is evidence that people with schizophrenia experience both periods of heightened and decreased secretion of what hormone?

A

cortisol

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6
Q

what are the POSITIVE symptoms that define psychotic disorders?

A
  • delusions
  • hallucinations
  • disorganized thinking (speech)
  • grossly disorganized or abnormal motor behavior (including catatonia)
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7
Q

what are delusions?

A

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

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8
Q

what are the types of delusions?

A
  • persecutory
  • grandiose
  • referential
  • erotomanic (believing stranger is in love w/them)
  • nihilistic
  • somatic
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9
Q

perceptions that occur without an external stimulus

- may occur in sensory modality

A

hallucinations

  • auditory hallucinations most common
  • usually experienced as voices, whether familiar or not
  • perceived as distinct from the individuals own thoughts
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10
Q

what are hypnagogic hallucinations?

A

those that occur while falling asleep - KNOW this

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11
Q

what are hypnopompic hallucinations?

A

those that occur while waking up -> NOT INDICATIVE OF PSYCHOSIS

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12
Q

what are the types of disorganized thinking?

A
  • tangentiality (don’t fully develop any 1 idea)
  • derailment or loose associations (random thoughts out of blue)
  • incoherence (word salad)
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13
Q

marked decrease in reactivity to the environment

A

catatonic behavior

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14
Q

purposeless and excessive motor activity without obvious cause

A

catatonic excitement

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15
Q

resistance to instructions

A

negativism

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16
Q

inappropriate or bizarre posture

A

waxy flexibility

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17
Q

a complete lack of verbal and motor responses

A

mutism and stupor

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18
Q

staring, grimacing, mutism, and the echoing of speech

A

repeated stereotyped movements

19
Q

what are the NEGATIVE symptoms that define psychotic disorders

A
  • diminished emotional expression
  • avolition
  • alogia (inability to speek)
  • anhedonia (lack of pleasure)
  • associality
20
Q

what two negative symptoms are particularly prominent in schizophrenia? KNOW these

A
  1. diminished emotional expression: decreased eye contact, speech intonation, and movements of the hand/head/face
  2. avolition: a decrease in motivated self-initiated purposeful activities
21
Q

what is the diagnostic criteria for schizophrenia?

A
  1. at least TWO of the following for most of 1 MONTH
    - delusions
    - hallucinations
    - disorganized speech
    - grossly disorganized or catatonic behavior
    - negative symptoms
  2. ADULT: most of the time after onset of symptoms the level of functioning is far below what it was prior to onset
    CHILD: failure to achieve expected level of functioning
  3. continuous signs of the disturbance FOR AT LEAST 6 MONTHS (**must include at least 1 month of symptoms from criterion 1)
22
Q

during prodromal or residual periods of schizophrenia, there may only be what?

A

“negative” symptoms, or at least two group 1 symptoms that present in an attenuated form

NOTE: if hx of autism disorder or communication disorder, additional dx of schizophrenia made only if prominent delusions or hallucinations, in addition to other sx are also present for at least 1 month

23
Q

what type of schizophrenia is dominated by at least TWO of the following:

  • motoric immobility as evidenced by catalepsy or stupor
  • excessive motor activity (purposeless and not influenced by external stimuli)
  • extreme negativism or mutism
  • peculiarities of voluntary movement
  • echolalia or echopraxia (meaningless repetition)
A

catatonic type

24
Q

what is the single leading cause of death in pts with schizophrenia?

A

suicide

25
Q

what needs to be ruled out before diagnosing schizophrenia?

A
  • seizure disorders
  • metabolic disorders
  • thyroid function
  • brain tumor
  • neurosyphillis
  • street drug use
26
Q

what is the full workup for schizophrenia?

A 
CBC w/diff
CMP
TSH
UA
lipids
HgA1C
CT/MRI of brain
neurologic exam
EEG
27
Q

what should be on your ddx of schizophrenia?

A
  • organic mental disorders (neurocognitive disorders: delirium, dementias)
  • neuropsychiatric manifestations of autoimmune disorders
  • mood disorders (bipolar, major depressive, schizoaffective)
28
Q

what is the tx for acute psychosis in schizophrenia?

A

hospitalization if needed for pt safety

- IM injections haloperidol, fluphenazine, lorazepam

29
Q

what is the tx during stabilization and maintenance phase of schizophrenia?

A
  • consider converting to newer antipsychotics

- keep pts free from symptoms while avoiding incapacitating side effects

30
Q 
clozapine
risperidone
olanzapine
quetiapine
ziprasidone
iloperidone
aripiprazole
A

examples of good SGA’s for schizophrenia

31
Q

what is the main side effect of clozapine?

A

agranulocytosis KNOW this

32
Q

what is the main side effect of ziprasidone?

A

QTc prolongation KNOW this

33
Q

what have been found to make sx of schizophrenia worse?

A

insight oriented group and individual psychotherapy modalities

34
Q

A. the presence of 1+ delusions with a duration of 1 month or longer
B. criterion A for schizophrenia has never been met
C. apart from the impact of the delusion, functioning is not impaired and behavior is not obviously bizarre or odd
D. if manic or major depressive episodes have occurred ,have been brief relative to the duration of the delusional periods
E. not caused by direct effects of a substance or general medical condition

A

delusion disorder

35
Q

what is on the ddx for delusional disorder?

A 
alzheimers
huntingtons
brain tumors
complex partial seizures
strokes
36
Q

A. presence of 1+ of the following:
- delusions
- hallucinations
- disorganized speech
- grossly disorganized/catatonic behavior
B. duration of an episode is AT LEAST 1 DAY BUT LESS THAN 1 MONTH, with eventual full return to premorbid level of functioning
C. the disturbance is not better explained by major depressive or bipolar or another psychotic disorder

A

brief psychotic disorder

37
Q

A. 2+ of the following, each present for a significant portion of time during 1-month period
- delusions
- hallucinations
- disorganized speech
- grossly disorganized/catatonic behavior
- negative sx
B. an episode of disorder lasts AT LEAST 1 MONTH BUT LESS THAN 6 MONTHS
C. schizoaffective disorder or mood disorders have been ruled out

A

schizophreniform disorder

38
Q

A. uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with criteria A of schizophrenia
B. delusions of hallucinations for 2+ weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness
C. symptoms that meet criteria for a major mood episode are present for the majority of he total duration of the active and residual portions of the illness

A

schizoaffective disorder

NOTE: treat the depression first, then you will see improvement in psychoses

39
Q

A. presence of 1 or both of the following:
- delusions
- hallucinations
B. evidence of:
- sx in criterion A developed soon after sunstance intoxication or withdrawal, or after exposure to medication
- involved substance/medication is capable of producing the sx in criterion A
C. the disturbance is not better explained by psychotic disorder
- sx precede onset of substance/med
- sx persist for about 1 month after cessation of withdrawal
D. disturbance does not occur exclusively during the course of a delirium

A

substance/medication-induced psychotic disorder

40
Q

what are the important timelines to remember with schizo disorders?

A
  • schizophrenia: >6 months
  • schizophreniform: 1-6 months
  • brief psychotic disorder: <1 month
41
Q

very introverted and voluntarily withdraws from social interactions

A

schizoid

42
Q

schizid symptoms + magical thinking and odd behavior (think Willy Wonka)

A

schizotypal

43
Q

shizotypal + psychosis (paranoid thinking, but NOT a mood disorder)

A

schizophrenia

44
Q

schizophrenia + mood disorder

A

schizoaffective

NMSP Exam 1 (19 decks)

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