Schizo 12% Flashcards
define delusional disorder
Otherwise normally functioning person with a belief in something that does not exist but no other symptoms of schizophrenia
belief > 1 mo
no hallucinations or blunting affect
define schizoaffective disorder
Psychotic disorder featuring symptoms of BOTH schizophrenia and a major mood disorder such as depression or bipolar disorder. Symptoms may occur at the same or different times
Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness.
define schizophrenia
Major psychosis for greater than 6 months + difficulty functioning
Two (or more) during a 1-month period. At least one of these must be (1) (2) or (3)
- Delusions
- Hallucinations - auditory (most common), tactile olfactory visual
- Disorganized speech/thought processes unable to stay on topic (loose associations) unable to provide answer related to questions (tangential response)
- Symptoms impair daily functioning
- Disorganized behavior - unpredictable agitation, inappropriate sexual behavior, child-like silliness, catatonic motor behavior, lacking self-care/hygiene
- Negative symptoms - blunted affect, poor posture, lack of goal-directed activities/initiative
- Impairment inability to hold a job or maintain relationships
define schiophrenoform
Major psychosis for > 1 month but < 6 months and no social or occupational impairment.
tx of delusional disorder
Psychotherapy
atypical antipsychotic agents - olanzapine and risperidone
tx of schizoaffective
Psychotherapy
atypical antipsychotic,
- anticonvulsants, (SSRI)
tx of schizophrenia
Atypical antipsychotics: (risperidone, olanzapine, aripiprazole, ziprasidone, quetiapine, asenapine, paliperidone) for negative symptoms & fewer side effects
- Clozapine is an atypical antipsychotic that is not considered first-line because of the propensity to cause agranulocytosis
Typical antipsychotics - dopamine antagonists (haloperidol, chlorpromazine, thioridazine, loxapine, fluphenazine) best for positive symptoms
Clozapine is an atypical antipsychotic that is not considered first-line in tx schizophrenia because of the propensity to cause______
Clozapine is an atypical antipsychotic that is not considered first-line in tx schizophrenia because of the propensity to cause agranulocytosis
list atypical antipsychotics
- risperidone
- olanzapine
- aripiprazole
- ziprasidone
- quetiapine
- asenapine
- paliperidone
list typical antipsychotics
dopamine antagonists
- haloperidol
- chlorpromazine
- thioridazine
- loxapine
- fluphenazine
Atypical antipsychotics: are best to treat for____ symptoms & fewer side effects
Typical antipsychotics best for_____ symptoms
Atypical antipsychotics: are best to treat for negative symptoms & fewer side effects
Typical antipsychotics - best for positive symptoms
list
positive sx
negative sx
Positive sx: (psychotic sx) – hallucinations, delusions, diorganized speech/behavior
Negative sx - flat affect, apathy, lack of motivation
define schizophrenoform
Major psychosis for > 1 month but < 6 months and no social or occupational impairment.
75-year-old woman has been receiving 24-hour care at home due to a fall risk. She has a history of severe diabetic neuropathy, and as a result, she is unstable on her feet. Two months ago, she began thinking that her daughter was telling her caretakers to steal her money, although both her daughter and the caretakers deny this. She continues to maintain an active social life, and cognitive testing shows no new deficit. She denies auditory and visual hallucinations and feeling like people are “out to get her.”
delusional disorder
Psychotherapy
atypical antipsychotic agents - olanzapine and risperidone
45-year-old truck driver who c/o hearing things that are not there for 2 weeks. He reports that he was severely depressed 5 months ago and was placed on Prozac by his PCP. His depression got better and he was “fine” until 2 weeks ago when he started to “hear things.” His work and social life are not impaired by the hallucinations at this time. His friend was diagnosed with schizophrenia a few years ago and he was afraid that he now has schizophrenia.
schizoaffective
Psychotherapy
atypical antipsychotic agents, anticonvulsants, and (SSRI)
26-year-old male presents with ‘voices in my head.” The patient was well until 8 months ago when he began to hear the voices of two men plotting to kill him. His fear of being killed has resulted in his missing multiple days of work, and he was recently fired. On physical exam, he is disheveled and has incoherent, disorganized speech.
schizophrenia
Atypical antipsychotics: (risperidone, olanzapine, aripiprazole, ziprasidone, quetiapine, asenapine, paliperidone) for negative symptoms & fewer side effects
Typical antipsychotics - dopamine antagonists (haloperidol, chlorpromazine, thioridazine, loxapine, fluphenazine) best for positive symptoms
23-year-old male with c/o visual & auditory hallucinations that have been ongoing for 2 months. He is a graduate student at a local university, and he states that his hallucinations have been getting worse. He is still able to attend classes, but it is becoming more difficult to focus in class. His father was diagnosed with schizophrenia when he was about his age. He is currently taking no medications. His labs and imaging are all within the normal range.
schizophrenoform
atyp +/- mood stabilizer (lithium) or anticonvulsant
define types of disorganized speech
- Tangentiality:
- Circumstantiality:
- Derailment:
- Neologisms:
- Tangentiality: speech begins in a goal-directed manner, but deviates gradually and consistently off-topic such that answers to questions are not reached
- Circumstantiality: speech is goal-directed but full of unneeded detail and gets to the answer in a “roundabout” way
- Derailment: speech begins in a goal-directed manner, but topic shift rapidly between sentences with no logical connection to the topic previously discussed
- Neologisms: creation and use of new, nonsensical words
define types of disorganized speech
Incoherence:
Clanging:
Concrete speech:
Perseveration of ideas:
- Incoherence: incomprehensible speech due to loss of logical (severe-word salad)
- Clanging: words are used on how they sound rather than what they mean (Ex: using words that rhyme)
- Concrete speech: inability to use abstract thinking
- Perseveration of ideas: consistently returning to one topic despite the conversation going in a different direction
Types of Delusions
- Persecutory:
- Reference:
- Control:
- Nihilism:
- Persecutory: person or force is interfering with them, observing them or wishes harm to the patient
- Reference: Random events take on a personal significance (directed at them)
- Control: some agency takes control of patients thoughts, feelings, behaviors
- Nihilism: unrealistic belief in the futility of everything and catastrophic events
Types of Delusions
- Grandiose:
- Erotomanic:
- Jealousy:
- Doubles:
- Grandiose: unrealistic in one’s powers and beliefs
- Erotomanic: believes another person is in love with them
- Jealousy: somebody is suspected of being unfaithful
- Doubles: believes a family member or close person has been replaced by an identical double
pathophysioogy of positive sx
excess DA in the mesolimbic pathway
pathophysioogy of negative sx
DA dysfunction in mesocorticol pathway
schizophrenia causes an INC in ___
DA
