Psychotic Disorders - Hill

Question 1

How to diagnose schizophrenia?

Answer 1

2+ of the following (w/ 1 from the first 3)

• Delusions
• Hallucinations (auditory often)
• Disorganized speech
• Disorganized or catatonic behavior
• Negative symptoms (affect flattening, avolition, anhedonia, asociality, alogia)

Question 2

Define…

• Avolition
• Anhedonia
• Asociality
• Alogia

Answer 2

Avolition = no motivation to perform normal life activities

Anhedonia = no pleasure or motivation from hobbies/music/etc.

Asociality = lack of motivation to engage socially

Alogia = poor speech

Question 3

Distinguish:

• Schizophrenia
• Schizophreniform disorder
• Schizoaffective disorder
• Delusional disorder

Answer 3

Schizophrenia = 6+ months

Schizophreniform = 1-6 months

Schizoaffective = 2+ weeks of hallucinations or delusions WITHOUT major mood episode (depression or mania), plus other periods of major mood episode w/ schizophrenic symptoms

Delusional disorder = 1 or 2 fixed delusions for >1 month, normal functioning otherwise

Question 4

Patient w/ schizophrenia symptoms. Things to rule out w/ labs/imaging/EEG/etc.

Answer 4

DRUG USE
Seizure disorder
Metabolic disorder
Thyroid disorder
Brain tumor
Neurosyphilis

Question 5

Explain types of catatonia in schizophrenia

Answer 5

Catatonic stupor - immobile for long period of time

Catatonic excitement - hypermetabolic, manic state

Catatonic posturing - assume strange positions and hold them for long period of time

Question 6

Positive symptoms in schizophrenia (4)

Negative symptoms in schizophrenia (6)

Answer 6

Delusions, hallucinations, catatonia, agitation

Flattening, apathy, withdrawal, anhedonia, poor thought, poor speech content

Question 7

Treatment for schizophrenic being violent in the ED, etc

Answer 7

Haloperidol, Lorazepam + restraint

Question 8

Leading cause of death in schizophrenia

Prevention?

Answer 8

Suicide

Clozapine

Question 9

Explain schizoaffective episode

Answer 9

Uninterrupted period of delusions/hallucinations WITH a depressive or manic episode, before or after a 2+ week period of delusions or hallucinations WITHOUT any mood symptoms.

Question 10

Brief psychotic disorder

Answer 10

1 day to 1 month – 1+ positive schizophrenic symptoms, followed by return to normal level of functioning. MAY be postpartum, may not be.

Question 11

Better prognostic indicators in schizophrenia

Answer 11

Positive symptoms, concurrent mood disorder

Question 12

Worse prognostic indicators in schizophrenia

Answer 12

Negative symptoms, poor cognitive performance, poor support system, younger onset, poor premorbid functioning, slow onset