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Psych Final! (🐈,👵🏻,🌭) > Psychotic Disorders (Lauren 🌭) > Flashcards

Psychotic Disorders (Lauren 🌭) Flashcards

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1
Q

What is psychosis?

A

Loss of contact with reality 🚀

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2
Q

What are the Positive symptoms of psychosis?

A

Delusions

Hallucinations

Disorganized thoughts and speech

Disorganized or catatonic behavior

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3
Q

What is this:

“Fixed false beliefs, despite disproving evidence’

A

Delusions

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4
Q

What is the difference between bizarre and non-bizarre delusions?

A

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
🏃‍♂️🚓🚓🚓

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5
Q

What are paranoid delusions?

A

“People are following me”🕶

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6
Q

What are persecutory delusions?

A

“Everyone is against me” 🕴

Conspired against, cheated, spied on, followed, poisoned, etc

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7
Q

What are grandiose delusions?

A

I’m gorgeous and super intelligent, that’s why people hate me💅🏻🧖🏻‍♀️🤳🏻💵

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8
Q

What are Reference Delusions?

A

“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

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9
Q

What are somatic delusions?

A

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”

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10
Q

What is this:

“Sensory perceptions in absence of a stimulus”

A

hallucinations🧿

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11
Q

What is important to ask a patient if they have auditory hallucinations?

A

What do the voices say?🗣

Do they tell you to hurt yourself or others?🔪

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12
Q

Visual hallucinations are usually:

A

Shadows🕴

People appearing in mirrors or windows 💿

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13
Q

Tactile hallucinations are usually caused by _________

A

Substance abuse🚬

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14
Q

What is a very important possible cause of olfactory hallucinations?

A

Brain tumor🧠

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15
Q

If someone says they can taste poison in their food, what kind of hallucination is that?

A

Gustatory hallucination👅

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16
Q

What are some examples of disorganized speech?

A

Derailment, tangentiality

Incoherence, word salad

Neologisms

Echolalia

Blocking, paucity

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17
Q

What is tangential speech?

A

They kind of try to answer the question but they never actually get to it

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18
Q

What kind of speech is this:

Words are not related to each other

A

Word salad🥗

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19
Q

What is a neologism?

A

Creating new words

Ex: Brangelina, chillax, metrosexual

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20
Q

What is echolalia?

A

Repeating part of what you say back to them/

You: How are you doing today, joe?

Joe: how are you doing today joe

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21
Q

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

A

Paucity

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22
Q

What are some examples of disorganized or catatonic behavior?

A

Activity that is not goal directed (Ex: standing up from chair and reaching for nothing)

Unable to complete simple tasks

Immobility

Waxy flexibility

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23
Q

What is waxy flexibility?

A

You can move them into whatever position and they will just hold it

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24
Q

true or false:

Negative symptoms alone can be psychotic

A

False

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25
Q

What are negative symptoms?

A

Decrease or absence of function

Ex: apathy, anhedonia, asociality, alogia (reduced speech)

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26
Q

Which is more effective against negative symptoms: Typical or atypical antipsychotics

A

Atypical

But negative symptoms are REALLY hard to treat

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27
Q

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?

A

Substance intoxication or withdrawal

Medication side effect

Delirium

Dementia

Dementia

Thyroid problem

Neurosyphilis/ CNS infection

Epilepsy (Temporal)

B12 deficiency

Lupus

Huntington’s, Wilsons

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28
Q

What three chemicals in the brain cause the symptoms of schizophrenia?

A

Dopamine

Glutamate

Serotonin

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29
Q

What drugs can cause increased levels of dopamine and thus, symptoms of schizophrenia?

A

Cocaine

Meth

Levodopa

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30
Q

What drugs mimic glutamate at the NMDA receptor and thus, cause symptoms of schizophrenia?

A

Ketamine

PCP

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31
Q

What drugs mimic serotonin and result in symptoms of schizophrenia?

A

LSD

Mescaline

Ecstasy

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32
Q

What effect does serotonin have on dopamine?

A

Increased release of serotonin results in decreased release of dopamine

(??) slides 11 and 12 seem to contradict each other on this

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33
Q

What are the 7 psychotic disorders in the DSM5?

A
  1. Schizotypal Personality Disorder
  2. Delusional Disorder
  3. Brief Psychotic Disorder
  4. Schizophreniform Disorder
  5. Schizophrenia
  6. Schizoaffective
  7. Substance induced, due to General Medical Condition, or Not Otherwise Specified
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34
Q

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

A

Delusional Disorder

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35
Q

In Delusional Disorder, the delusions are (bizarre/non-bizarre)

A

Non-bizarre

*******

36
Q

Can someone with delusional disorder hold down a job?

A

Yes. Psychosocial functioning not impaired👨🏻‍🚒

37
Q

What is the DSM5 criteria for delusional disorder?

A

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

38
Q

What are the subtypes of Delusional Disorder?.

A

Erotomanic 🥰

Grandiose 🤑

Jealous👺

Persecutory😭

Somatic🏥

Mixed

Unspecified

39
Q

What is an Erotomanic Delusional Disorder?

A

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⛹🏾‍♂️

40
Q

What is a Grandiose Delusional Disroder?

A

Inflated worth, power, knowledge, identity or special relationship to a deity or famous person

Ex: Has a special relationship with God🎙

41
Q

What is a Jealous Delusional Disorder?

A

Patient believes their partner is CHEATING🧨

42
Q

What is a persecutory Delusional Disorder?

A

Patient believes they are being treated malevolently and that they are being conspired against, cheated, spied on, followed, poisoned, harassed, etc….

43
Q

What is a Somatic Delusional Disorder?

A

Patient believes they have some sort of physical defect or medical condition

44
Q

What is a mixed delusional disorder?

A

Patient has features of more than one subtype, but none predominate

45
Q

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

A

Brief psychotic disorder

Ex: Kony 2012 guy

46
Q

How long does brief psychotic disorder last?

A

1 day to 1 month

47
Q

What are the DSM5 criteria for Brief PScyhotic Disorder?

A

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

48
Q

What is this:

IDENTICAL to schizophrenia except it only lasts 1-6 months

A

Schizophreniform Disorder

49
Q

What is the prognosis for Schizophreniform Disorder?

A

1/3 of patients recover

2/3 progress to schizophrenia or schizoaffective disorder

50
Q

What is the DSM5 criteria for Schizophreniform Disorder?

A

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

51
Q

Is schizophrenia a common diagnosis?

A

Yes, 1% of the population has it

52
Q

What age do men vs women develop schizophrenia?

A

Men 18-25 (younger, in college)👨🏻‍🎓

Women 25-35 (older, married with kids)👩‍👦‍👦

53
Q

Who gets schizophrenia more often: men or women

A

Equal

54
Q

Is there a genetic link for schizophrenia?

A

Yes, if you have a 1st degree releative with schizophrenia you have a 10x risk

55
Q

Does having schizophrenia affect your life expectancy?

A

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)

56
Q

Whatis the DSM5 for shchizophrenia?

A

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

57
Q

What are some factors that have a good prognosis for schizophrenia?

A

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

58
Q

What is Schizoaffective Disorder?

A

Schizophrenia + a mood disorder

59
Q

What are the two types of Schizoaffective Disorder?

A

Bipolar Type

Depressed Type

60
Q

What are the DSM5 for Schizoaffective Disorder?

A

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

61
Q

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?

A

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

62
Q

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?

A

Agitation= quickly. minutes to hours

Hallucinations= a few days

Negative sx, delusions= much longer or never

63
Q

What was her rule for using more than one antipsychotic?

A

Best to avoid, but if you have to, MAXIMIZE the first one before adding a second

64
Q

What are the indications for hospitalization for someone having a schizophrenic crisis?

A

Danger to self (DTS)

Danger to others (DTO)

Command auditory hallucinations

Unable to care for self (eat, drink, take meds)

65
Q

What can you do to help increase medication compliance in schizophrenia?

A

Simplify med regimen (once a day dosing vs TID. Maybe look into long acting injectables)

Minimize side effects

66
Q

What are the First Generation (Typical) Antipsychotics that you need to know?

A

Chlorpromazine (Thorazine)

Haloperidol (Haldol)

67
Q

What is the MOA of first generation (typical) antipsychotics?

A

D2 receptor blockers

68
Q

What is the side effect she mentioned about Chlorpromazine (Thorazine)?

A

The “Thorazine Shuffle”

Shuffling gait

69
Q

What can happen if you use Haloperidol (Haldol) long-term?>

A

EPS and tardive dyskinesia

DONT USE IT LONG TERM

70
Q

What forms is Haloperidol (Haldol) available in?

A

PO tablet or elixir

IM

IV

Long-acting injection

Topical

71
Q

What are the Atypical Antipsychotics you need to know for this course?

A

Aripiprazole (Abilify)

Clozapine (Clozaril)

Onlazapine (Zyprexa)

Quetiapine (Seroquel)

Risperidone (Risperdal)

72
Q

Which atypical antipsychotic is a partial D2 agonist and is metabolically neutral?

A

Aripiprazole (Abilify)

73
Q

Which atypical antipsychotic is a good choice to start with

A

Aripiprazole (Abilify)

Its great for negative symptoms

74
Q

Which atypical antipsychotic is a drug of last choice?

Why?

A

Clozapine (Clozaril)

Agranulocytosis risk

75
Q

Which atypical antipsychotic requires weekly CBC w/ diff monitoring?

A

Clozapine (Clozaril) because it can cause agranulocytosis

***

76
Q

What is the main side effect of Olanzepine (Zyprexa)?

A

Weight gain

77
Q

Which atypical antipsychotic did she say that meth addicts love to use to come down from their high

A

Quetiapine (Seroquel)

78
Q

What is the side effect of Risperidone (Risperdal)

A

Prolactinemia= gynecomastia and galatorrhea

EPS

79
Q

What is the MOA of atypical antipsychotics?

A

5HT2A receptor blockers

80
Q

What is the BLACK BOX WARNING for all atypical antipsychotics?

A

Increased mortality when treating OLD PEOPLE for dementia-related psychosis

81
Q

What are Extra Pyramidal Symptoms (EPS)?

A

Acute dystonic reaction

Parkinsonism

Akathisia

Tardive dyskinesia

Neuroleptic Malignant Syndrome ⚰️

82
Q

What is an “Acute Dystonic Reaction?”

A

Torticollis

Jaw spasms, dysphagia, dysarthria, tongue protrusion etc

83
Q

What does Tardive Dyskinesia look like?

A

Blinking

Lip smacking

Tongue protrusion

84
Q

If someone has tardive dyskinesia, which tract in their brain is affected?

A

Nigrostriatial

85
Q

HOw long does it take for tardive dyskinesia to show up?

When does it go away?

A

6 months.

May be irreversible

86
Q

HEY YOU,
YA YOU
L👀KIN AT OUR CARDS ALL QUARTER

A

FEEL FREE TO BUY US A DRINK WE KNOW WHO YOU HOES ARE 🍸🥃🍸🍻🍺🥂🍾 YOU’RE WELCOME

Psych Final! (🐈,👵🏻,🌭) (2 decks)

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