psychotic disorders: delusional, schizo Flashcards
psychosis definition
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
delusions
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
delusions of persecution/paranoid
irrational belief that one is being persecuted “CIA is after me and tapped my phone”
ideas of reference
belief that cues in external environment are uniquely related to individual “TV characters are speaking to me”
delusions of control (thought broadcasting/insertion)
broadcasting: ones thoughts can be heard by others
insertion: other’s thoughts are being placed in ones head
delusions of grandeur
one has special powers beyond those of a normal person “I am son of god”
delusions of guilt
responsible or guilty of something bigger than them “I am cause of all world wars”
somatic delusions
one is infected with a disease or has certain illnuse
illusions
misinterpretation of an EXISTING sensory stimulus (mistaking shadow for cat)
hallucination
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
Medical causes of psychosis
CVD, MS, neoplasm, Alz, parkinsons, huntingtons, syphilis, epilepsy, AIDS, addisons/Cushings, thyroid issues, Calcium issues, Vitamin deficiencies, SLE
schizophrenia diagnosis
psych disorder characterized by constellation of abnormalities in thinking, emotion, and behavior
6+ mos
schizophrenia POSITIVE sx
hallucinations delusions bizarre behavior disorganized speech respond well to meds
schizo NEGATIVE sx
flat/blunted affect anhedonia apathy alogia lack of interest in socializing tx resistant --> social isolation
5 A s of negative schizo sx
Anhedonia affect (flat) alogia (poverty of speech) avolition (apathy) attention (poor)
schizo cognitive sx
impairments in attention, executive fx, working memory –> poor work/school performance
DSM DIAGNOSIS OF SCHIZOPHRENIA
- 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 - must cause significant social/occupational or self care fx deterioration
- duration 6+ mos (including prodromal or residual)
schizo psych/physical exam
dishelved, flat affect, disorganized thought process, AH, paranoid delusions. ideas of reference, lack f insight
intact procedural memory and orientation
biggest ADR of clozapine, which generation
2nd gen, last line
agranulocytosis (WBC and ANC counts)
typical antipsychotics
clorpromazine, fluphenazine, haloperidol, perphenazine
D2 antagonists
ADRs: EPS, NMS, tardive dystkinesia
atypicals
aripiprazole, asenapine, clozaril, iloperidone, lurasidone, olanzapine, qietapine, risperidone, ziprasadone
D2 + 5HT antagonists
dec EPS but inc metabolic syndrome
clozaril = agranulocytosis
EPS
extrapyramidal sx
inc with use of high potency 1st gen
dystonia (spasms), parkinsonism (rigid, tremor), akathisia (restless)
tx: anticholinergics, (benztropine, diphenhydramine), BZDs, BB
Anticholinergic sx
low potency 1st gen
dry mouth, constip, blurred vision
metabolic syndrome
2nd gens, inc BP, sugars, fat
wt neutral = aripiprazole and ziprasidone
