psychotic disorders: delusional, schizo

Question 1

psychosis definition

Answer 1

distorted perception of reality
poor reality testing may be accompanied by delusions, perceptual disturbances (illusions or hallucinations) and/or disorganized thinking/behavior

may be sx of schizophrenia, mania, depression, delirium, and dementia
exemplified by delusions, hallucinations, or severe disorganization of thought/behavior

Question 2

delusions

Answer 2

false fixed beliefs that remain despite evidence to the contrary

bizarre: false belief that is impossible
non bizarre: false belief that is plausible but not true

Question 3

delusions of persecution/paranoid

Answer 3

irrational belief that one is being persecuted “CIA is after me and tapped my phone”

Question 4

ideas of reference

Answer 4

belief that cues in external environment are uniquely related to individual “TV characters are speaking to me”

Question 5

delusions of control (thought broadcasting/insertion)

Answer 5

broadcasting: ones thoughts can be heard by others
insertion: other’s thoughts are being placed in ones head

Question 6

delusions of grandeur

Answer 6

one has special powers beyond those of a normal person “I am son of god”

Question 7

delusions of guilt

Answer 7

responsible or guilty of something bigger than them “I am cause of all world wars”

Question 8

somatic delusions

Answer 8

one is infected with a disease or has certain illnuse

Question 9

illusions

Answer 9

misinterpretation of an EXISTING sensory stimulus (mistaking shadow for cat)

Question 10

hallucination

Answer 10

sensory perception without a stimulus
Auditory: MC exhibited by schizos
Visual: may accompany drug and EtOH into/withdrawal or delirium
olfactory: aura with epilepsy
tactile: withdrawal

Question 11

Medical causes of psychosis

Answer 11

CVD, MS, neoplasm, Alz, parkinsons, huntingtons, syphilis, epilepsy, AIDS, addisons/Cushings, thyroid issues, Calcium issues, Vitamin deficiencies, SLE

Question 12

schizophrenia diagnosis

Answer 12

psych disorder characterized by constellation of abnormalities in thinking, emotion, and behavior
6+ mos

Question 13

schizophrenia POSITIVE sx

Answer 13

hallucinations
delusions
bizarre behavior
disorganized speech
respond well to meds

Question 14

schizo NEGATIVE sx

Answer 14

flat/blunted affect
anhedonia
apathy
alogia
lack of interest in socializing
tx resistant --> social isolation

Question 15

5 A s of negative schizo sx

Answer 15

Anhedonia
affect (flat)
alogia (poverty of speech)
avolition (apathy)
attention (poor)

Question 16

schizo cognitive sx

Answer 16

impairments in attention, executive fx, working memory –> poor work/school performance

Question 17

DSM DIAGNOSIS OF SCHIZOPHRENIA

Answer 17

1. need 2+ criteria for 1 month (at least 1 must be delusions/AH/speech)
   - delusions
   - hallucinations
   - disorganized speech
   - grossly disorganized or catatonic behavior
   - negative sx
2. must cause significant social/occupational or self care fx deterioration
3. duration 6+ mos (including prodromal or residual)

Question 18

schizo psych/physical exam

Answer 18

dishelved, flat affect, disorganized thought process, AH, paranoid delusions. ideas of reference, lack f insight
intact procedural memory and orientation

Question 19

biggest ADR of clozapine, which generation

Answer 19

2nd gen, last line

agranulocytosis (WBC and ANC counts)

Question 20

typical antipsychotics

Answer 20

clorpromazine, fluphenazine, haloperidol, perphenazine
D2 antagonists
ADRs: EPS, NMS, tardive dystkinesia

Question 21

atypicals

Answer 21

aripiprazole, asenapine, clozaril, iloperidone, lurasidone, olanzapine, qietapine, risperidone, ziprasadone
D2 + 5HT antagonists
dec EPS but inc metabolic syndrome
clozaril = agranulocytosis

Question 22

EPS

Answer 22

extrapyramidal sx
inc with use of high potency 1st gen
dystonia (spasms), parkinsonism (rigid, tremor), akathisia (restless)
tx: anticholinergics, (benztropine, diphenhydramine), BZDs, BB

Question 23

Anticholinergic sx

Answer 23

low potency 1st gen

dry mouth, constip, blurred vision

Question 24

metabolic syndrome

Answer 24

2nd gens, inc BP, sugars, fat

wt neutral = aripiprazole and ziprasidone

Question 25

tardive dyskinisia

Answer 25

1st gens, tongue/mouth movement

BZD can treat

Question 26

NMS

Answer 26

high potency 1st gen
AMS, fever, BP, tachy, rigid, inc CPK
stop all meds

Question 27

schizophreniform

Answer 27

<6 mos of sx

Question 28

schizoaffective

Answer 28

meet criteria for major depressive or manic episode + schizophrenic sx
delusions for 2 weeks in absence of mood disorder

Question 29

delusional disorder

Answer 29

delusions > 1 month, but no criteria for schizophrenia
functioning not significantly impaired

usu non bizaare

Question 30

schizotypal

Answer 30

personality disorder:
paranoid, odd, magical beliefs, eccentric, lack of friends, social anxiety
no psychosis

Question 31

schizoid

Answer 31

solitary activities, lack of enjoyment from social interactions

Question 32

schizo

phrenia s phreniform vs affective vs typal vs oid

Answer 32

schizophrenia: life long
schizophreniform: 1-6 mos
schizoaffective: schizophrenia + mood disorder
schizotypal: paranoid, odd beliefs, eccentric, lack of friends, social anxiety
schizoid: solitary activities, lack of enjoyment from social interactions