Psychotic Disorders (Lauren 🌭) Flashcards
What is psychosis?
Loss of contact with reality 🚀
What are the Positive symptoms of psychosis?
Delusions
Hallucinations
Disorganized thoughts and speech
Disorganized or catatonic behavior
What is this:
“Fixed false beliefs, despite disproving evidence’
Delusions
What is the difference between bizarre and non-bizarre delusions?
Non-bizarre delusions are technically plausible. (But are obviously not true)
Ex: The Chandler Police, the Phoenix Police and the Tucson Police are all trying to catch me
🏃♂️🚓🚓🚓
What are paranoid delusions?
“People are following me”🕶
What are persecutory delusions?
“Everyone is against me” 🕴
Conspired against, cheated, spied on, followed, poisoned, etc
What are grandiose delusions?
I’m gorgeous and super intelligent, that’s why people hate me💅🏻🧖🏻♀️🤳🏻💵
What are Reference Delusions?
“Getting messages in the headlines” 📺📻🗞
Ex: someone is putting secret messages in the soap operas just for me to tell me that the world is going to end
What are somatic delusions?
Feeling things in their body🕷🐍
Ex: “I can feel a snake in my belly and worms in my brain and the doctors just keep missing it, I know it’s there”
What is this:
“Sensory perceptions in absence of a stimulus”
hallucinations🧿
What is important to ask a patient if they have auditory hallucinations?
What do the voices say?🗣
Do they tell you to hurt yourself or others?🔪
Visual hallucinations are usually:
Shadows🕴
People appearing in mirrors or windows 💿
Tactile hallucinations are usually caused by _________
Substance abuse🚬
What is a very important possible cause of olfactory hallucinations?
Brain tumor🧠
If someone says they can taste poison in their food, what kind of hallucination is that?
Gustatory hallucination👅
What are some examples of disorganized speech?
Derailment, tangentiality
Incoherence, word salad
Neologisms
Echolalia
Blocking, paucity
What is tangential speech?
They kind of try to answer the question but they never actually get to it
What kind of speech is this:
Words are not related to each other
Word salad🥗
What is a neologism?
Creating new words
Ex: Brangelina, chillax, metrosexual
What is echolalia?
Repeating part of what you say back to them/
You: How are you doing today, joe?
Joe: how are you doing today joe
What would this be an example of:
The patient hears so many voices that when you talk to him, it takes him a moment to pick out what you said to him and answers you after a long pause
Paucity
What are some examples of disorganized or catatonic behavior?
Activity that is not goal directed (Ex: standing up from chair and reaching for nothing)
Unable to complete simple tasks
Immobility
Waxy flexibility
What is waxy flexibility?
You can move them into whatever position and they will just hold it
true or false:
Negative symptoms alone can be psychotic
False
What are negative symptoms?
Decrease or absence of function
Ex: apathy, anhedonia, asociality, alogia (reduced speech)
Which is more effective against negative symptoms: Typical or atypical antipsychotics
Atypical
But negative symptoms are REALLY hard to treat
When a patient shows up with psychosis, what should be in your differential that you need to rule out before you assume its due to a psychiatric disorder?
Substance intoxication or withdrawal
Medication side effect
Delirium
Dementia
Dementia
Thyroid problem
Neurosyphilis/ CNS infection
Epilepsy (Temporal)
B12 deficiency
Lupus
Huntington’s, Wilsons
What three chemicals in the brain cause the symptoms of schizophrenia?
Dopamine
Glutamate
Serotonin
What drugs can cause increased levels of dopamine and thus, symptoms of schizophrenia?
Cocaine
Meth
Levodopa
What drugs mimic glutamate at the NMDA receptor and thus, cause symptoms of schizophrenia?
Ketamine
PCP
What drugs mimic serotonin and result in symptoms of schizophrenia?
LSD
Mescaline
Ecstasy
What effect does serotonin have on dopamine?
Increased release of serotonin results in decreased release of dopamine
(??) slides 11 and 12 seem to contradict each other on this
What are the 7 psychotic disorders in the DSM5?
- Schizotypal Personality Disorder
- Delusional Disorder
- Brief Psychotic Disorder
- Schizophreniform Disorder
- Schizophrenia
- Schizoaffective
- Substance induced, due to General Medical Condition, or Not Otherwise Specified
What is this:
Non-bizarre delusions (Plausible, but false. Ex: being followed by the police)
Hallucinations related to the delusion (ex: sirens)
Psychosocial functioning NOT impaired
Normal thought process
Poor insight
Does not meet criterion A for schizophrenia
Delusional Disorder
In Delusional Disorder, the delusions are (bizarre/non-bizarre)
Non-bizarre
*******
Can someone with delusional disorder hold down a job?
Yes. Psychosocial functioning not impaired👨🏻🚒
What is the DSM5 criteria for delusional disorder?
A. Non-Bizarre delusions for 1 month
B. Criterion A for schizophrenia has never been met (but hallucinations related to the delusion is ok)
C. Functioning is NOT markedly impaired. Behavior not obviously odd or bizarre
D. Mood episodes (If present) are brief relative to delusion
E. Not due to substance or GMC
What are the subtypes of Delusional Disorder?.
Erotomanic 🥰
Grandiose 🤑
Jealous👺
Persecutory😭
Somatic🏥
Mixed
Unspecified
What is an Erotomanic Delusional Disorder?
Patient believes that someone is in in love with them, usually a celebrity, or someone of high status.
Ex: Lebron James is following me around⛹🏾♂️
What is a Grandiose Delusional Disroder?
Inflated worth, power, knowledge, identity or special relationship to a deity or famous person
Ex: Has a special relationship with God🎙
What is a Jealous Delusional Disorder?
Patient believes their partner is CHEATING🧨
What is a persecutory Delusional Disorder?
Patient believes they are being treated malevolently and that they are being conspired against, cheated, spied on, followed, poisoned, harassed, etc….
What is a Somatic Delusional Disorder?
Patient believes they have some sort of physical defect or medical condition
What is a mixed delusional disorder?
Patient has features of more than one subtype, but none predominate
What is this:
Sudden onset of at least 1 positive symptom
Lasts 1 day to 1 month, which a return to normal premorbid functioning
High risk of suicide
Onset in late 20’s-early 30’s often with a marked stressor or post-partum
Brief psychotic disorder
Ex: Kony 2012 guy
How long does brief psychotic disorder last?
1 day to 1 month
What are the DSM5 criteria for Brief PScyhotic Disorder?
A. Presence of 1 or more: Delusions, hallucinations, disorganized speech, disorganized or catatonic behavior
B. Duration of 1 day to 1 month with FULL return to premorbid (normal) level of functioning
C. Not due to schizophrenia, schizoaffective or mood disorder, substance, or GMC
What is this:
IDENTICAL to schizophrenia except it only lasts 1-6 months
Schizophreniform Disorder
What is the prognosis for Schizophreniform Disorder?
1/3 of patients recover
2/3 progress to schizophrenia or schizoaffective disorder
What is the DSM5 criteria for Schizophreniform Disorder?
A. PResence of 2 or more: Delusions, hallucinations, disorganized speech, disorganized or catatonic behavior
B. Duration 1 month - 6 months
C. Not due to anything else
Is schizophrenia a common diagnosis?
Yes, 1% of the population has it
What age do men vs women develop schizophrenia?
Men 18-25 (younger, in college)👨🏻🎓
Women 25-35 (older, married with kids)👩👦👦
Who gets schizophrenia more often: men or women
Equal
Is there a genetic link for schizophrenia?
Yes, if you have a 1st degree releative with schizophrenia you have a 10x risk
Does having schizophrenia affect your life expectancy?
Yes, people die earlier due to heart disease and cancer.
This is because they were dismissed as other medical conditions or we were just trying to get them out of our office as quick as possible. How does that make you feel
(Also, they have a higher rate of suicide)
Whatis the DSM5 for shchizophrenia?
A. At least 2 of the following for 1 month:
Delusions
Hallucinations
Disorganized speech
Disorganized or catatonic behavior
Negative symptoms
B. Social/occupational dysfunction
C. Duration 6 months (1 month criterion A + prodrome/residual period)
D. Schizoaffective and Mood disorders ruled out
E. Not due to substance/GCM
What are some factors that have a good prognosis for schizophrenia?
Female 💄
Later onset 🗓
Acute onset with precipitating factor
Brief duration, early intervention
Treatment compliance💊
Positive symptoms (easier to treat)
Mood disturbance, family hx of mood disorder
Wealthy 💰
Married 🤵🏻👰🏻
Good support system
Good premorbid functioning
What is Schizoaffective Disorder?
Schizophrenia + a mood disorder
What are the two types of Schizoaffective Disorder?
Bipolar Type
Depressed Type
What are the DSM5 for Schizoaffective Disorder?
A. Meets Criterion A for Schizophrenia and concurrently has major depressive, manic, or mixed episode
B. Must have 2+ weeks of delusions of hallucinations without prominent mood symptoms
C. Mood symptoms are present for a significant portion of the illness
D. Not due to substance/GMC
When Alex drops off a patient who is having a schizophrenic crisis, what steps do you have to do during the “Acute Stabilization” part of treatment?
Start antipsychotic at low dose and titrate up
Safety is the priority, preventing the patient from becoming a danger to self or others
Consider need for hospitalization
When a patient who is having a schizophrenic crisis comes to your facility, how long will it take for the agitation, hallucinations, and negative symptoms to improve?
Agitation= quickly. minutes to hours
Hallucinations= a few days
Negative sx, delusions= much longer or never
What was her rule for using more than one antipsychotic?
Best to avoid, but if you have to, MAXIMIZE the first one before adding a second
What are the indications for hospitalization for someone having a schizophrenic crisis?
Danger to self (DTS)
Danger to others (DTO)
Command auditory hallucinations
Unable to care for self (eat, drink, take meds)
What can you do to help increase medication compliance in schizophrenia?
Simplify med regimen (once a day dosing vs TID. Maybe look into long acting injectables)
Minimize side effects
What are the First Generation (Typical) Antipsychotics that you need to know?
Chlorpromazine (Thorazine)
Haloperidol (Haldol)
What is the MOA of first generation (typical) antipsychotics?
D2 receptor blockers
What is the side effect she mentioned about Chlorpromazine (Thorazine)?
The “Thorazine Shuffle”
Shuffling gait
What can happen if you use Haloperidol (Haldol) long-term?>
EPS and tardive dyskinesia
DONT USE IT LONG TERM
What forms is Haloperidol (Haldol) available in?
PO tablet or elixir
IM
IV
Long-acting injection
Topical
What are the Atypical Antipsychotics you need to know for this course?
Aripiprazole (Abilify)
Clozapine (Clozaril)
Onlazapine (Zyprexa)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Which atypical antipsychotic is a partial D2 agonist and is metabolically neutral?
Aripiprazole (Abilify)
Which atypical antipsychotic is a good choice to start with
Aripiprazole (Abilify)
Its great for negative symptoms
Which atypical antipsychotic is a drug of last choice?
Why?
Clozapine (Clozaril)
Agranulocytosis risk
Which atypical antipsychotic requires weekly CBC w/ diff monitoring?
Clozapine (Clozaril) because it can cause agranulocytosis
***
What is the main side effect of Olanzepine (Zyprexa)?
Weight gain
Which atypical antipsychotic did she say that meth addicts love to use to come down from their high
Quetiapine (Seroquel)
What is the side effect of Risperidone (Risperdal)
Prolactinemia= gynecomastia and galatorrhea
EPS
What is the MOA of atypical antipsychotics?
5HT2A receptor blockers
What is the BLACK BOX WARNING for all atypical antipsychotics?
Increased mortality when treating OLD PEOPLE for dementia-related psychosis
What are Extra Pyramidal Symptoms (EPS)?
Acute dystonic reaction
Parkinsonism
Akathisia
Tardive dyskinesia
Neuroleptic Malignant Syndrome ⚰️
What is an “Acute Dystonic Reaction?”
Torticollis
Jaw spasms, dysphagia, dysarthria, tongue protrusion etc
What does Tardive Dyskinesia look like?
Blinking
Lip smacking
Tongue protrusion
If someone has tardive dyskinesia, which tract in their brain is affected?
Nigrostriatial
HOw long does it take for tardive dyskinesia to show up?
When does it go away?
6 months.
May be irreversible
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