Schizo Flashcards
Psychosis mood disorders
Schizoaffective
Bipolar
Major Depression w/ psychotic
Psychosis 2ndary to Med condition
Brain tumor, tertiary syphilis, HIV
Personality disorders
Schizoid personality
Schizotypal personality
Paranoid Personality
Delusion
Bizarre vs. Non-bizarre
- Bizarre = not at all possible in reality
* Non-bizarre = possible in reality
Hallucination vs. delusion
Hallucination = a false sensation/perception
Delusion = a false belief
Disorders of thought
- Ideas of reference
- loose associations/derailment/flight of ideas = one topic to next, RELATED topics
- Tangientiality= UNRELATED answers to questions
- word salad = nearly incomprehensible
Negative symptoms vs. Positive symptoms
timeline
Negatives usually come first on a timeline, then positives later
Working memory
Immediate conscious perception and linguistic processing
Attention
Mini mental status exam
WORLD backwards
Serial 7s
Congnitive s/s
Working memory
Executive function
Attention
Learning
LACK= fall out of society, worse prognosis
Mesolimbic vs. mesocortical pathway
Mesolimbic = too much Dopa (+ S/S)
Mesocortical = too little dopa
(- S/s)
Nigrostriatal pathway = too little dopa (EPS)
Tuberoinfundibular = too little dopa (release prolactin = breasts)
Glutamate in schizophrenia
Regulates dopamine = releases or starts GABA (inhibit)
NMDA receptor has role (PCP)
what part of brain involved
Many, not localized
Schizophrenia
Dx
Must have 2 + at least 1 starred:
- Delusions*
- Hallucinations*
- Disorganized speech*
- Grossly disorganized/catatonic behavior
- neg symptoms
6 months over all, positive symptom for min 1 month
NO MOOD DISORDER FOR MAJORITY of DURATION
Schizophrenia exclusion
*no major depressive, manic, mixed episode in active-phase symptoms
(If so, brief duration)
*not due to drug/med condition
Must have catatonia
- motor immobility
- excessive activity motor
- extreme negativism
- peculiarities of voluntary movement = posturing
- stereotyped movements
Catalepsy
Muscular rigidity, fixity of posture regardless of stimuli
Echolalia
Mimicking sounds
Echopraxia
Mimicking movements
Treating catatonia
Benzos
Gaba inhibitory effects
In state = info overload
Genetic causative agents
Chromosome 6 (too much C4-A)
Pruning of synapses during brain development
Prefrontal pruning - going on too long
Men get first, women later (time normal pruning stops)
DX + Treating early w/ anti-psychs
- Change course
* Longer brain is under stress, more NT toxicity damaging brain
Schiz Brain abnormality
*hypoperfusion = globus pallidus
*anterior hypothalamus smaller
*ventricles enlarged
*sulci enlarged
BRAIN TISSUE LOSS = degenerative
Brain damage = precipitating factors
Birth trauma
Viral infections
Nutritional issues
Diathesis-stress model
Genes + stressors (life events)
Downward drift vs. social causation
Drift = dz causes you to drop social class
So more seen in lower socioeconomic status
Course
*Prodromal: Negative s/s -males 18-25 -females 25-30 -late >40 (women)
- Acute
- Positive s/s
- Recovery/Residual
- improve/hospital/institution/suicide
Prognosis
Better
Late/sudden onset Female Higher function prior Good compliance Family History Paranoid subtypes
Prognosis
Worse
Early age of Onset Male More Negative s/s Lower functioning prior Substance abuse Disorganized type
EPS effects from Rx
*actue
Higher potency typical anti-psycs effects on
*Strong D2 receptor block
+cut Positive s/s
-EPS, hyperprolactinemia
Low potency binds to
histamine alpha adrenergic or histaminic
EPS
Acute dystonia
Torticollis, opisthotonos, oculygyric crisis,
24-48 HOURS FROM ANTI-PSYC INITIATION
EPS
Akathasia
Restlessness –> movement
Days-weeks after anti-psyc treatment start
EPS
Parkinsonism
Traid, rigidity, tremors
Within DAYS of initiating anti-psyc Rx
EPS
Tardive dyskinesia
Long-term, early as 1 month after antipsyc onset
Lip smacking common
Dystonia
Tx
Benztropine
Parkinsonism
Tx
- reduce anti-psyc
- benztropine
- change to atypical anti-psyc
Akathisia
Tx
- reduce anti-psyc
- beta blocker (propranolol)
- Benzo (valium)
- change to atypical antipsyc
- benztropine
Tardive Dyskinesia
Tx
- regular AIMS to detect early
- cease anti-psyc if possible
- change to atypical anti-psyc
- lowest dose possible
Neuroleptic Malignant Syndrome
- Mental status change
- acute, rapid onset
- autonomic instability
- fever/hyperpyrexia
- tac/HTN
- diaphoresis
- neuromuscular findings
- lead pipe rigidity
- labs
- CPK UP, myoglobinuria - renal failure
- leukocytosis
Atypical anti-psycs
D2 + 5HT2a in mesolymbic circuit
Noncompliance?
Depot drugs
Assertive Community Treatment
Very good,
Personalized care
Not available in many states (“freedom of client to refuse care”)
Brief Psychotic Disorder
1 day to 1 month
Schizophreniform
LESS THAN 6 MONTHS
Schizo s/s, NO Schizoaffective/mood disorder
Delusional Disorder
- women more
- NO FUNCTIONALITY LOSS
- NO DISORGANIZED THOUGHT/BEHAVIOR
- mood congruent beliefs = false beliefs consistent w/ patient mood
- mood non-congruent beliefs =
Schizoaffective Disorder
- PSYCHOTIC SYMPTOMS 2 WEEK PERIOD + W/O MOOD SYMPTOMS
* other schizophrenia s/s
Bipolar/depression
PSYCHOSIS w/in MOOD DISORDER PHASE
Just need 1 manic episode for bipolar
Schizoid
NOT ON TEST
Excessive detachment from social relationships, restricted range of expression of emotions
NO ACUTE PSYCHOTIC S/S
Schizotypal
NOT ON TEST
*acute discomfort with/Reduced capacity for close relationships by cognitive or perceptual distortions + eccentricities of behavior
NO ACUTE PSYCHOTIC SYMPTOMS
Delusional disorder types
- persecutory
- Erotomaniac
- Grandoise
- Jealousy
- Somatic
Disorganization s/s
- speech
- thought
- catatonia
- Stereotypy = repeated, non-goal directed movement (rocking)
- Mannerisms (odd)
- Echopraxia
- Automatic obedience
- Negativism
