Schizophrenia and other Psychotic Disorders

Question 1

Psychotic Symptom Domains

(5)

Answer 1

1. Delusions
2. Hallucinations
3. Disorganized Speech
4. Disorganized or catatonic behavior
5. Negative symptoms (absent)

Bolded are CORE domains

Question 2

What is a delusion?

Answer 2

Fixed belief that is not amenable to change, even with conflicting evidence

Question 3

What is a hallucination?

Answer 3

A sensory perception without an external stimulus (auditory are most common)

Question 4

Disorganized Speech-definition and 3 types

Answer 4

Speech that lacks normal, logical connections
1. Clang associations: words that rhyme but do not “fit” together
2. Peseveration:repeating the same thing over and over
3. Word Salad: random words that do not logically fit

Question 5

Disorganized or catatonic behavior

Answer 5

Non-goal oriented behavior (wandering aimlessly)

Question 6

Negative Symptoms definition and 4 types

Answer 6

Diminished emotional expression
1. Avolition:decrease in motivated self-initiated purposeful activites
2. Alogia:diminished speech output
3. Anhedonia: inability to feel pleasure
4. Asociality: lack of interest in social interactions

Question 7

Schizophrenia Diagnosis

Answer 7

1. Active-Phase Symptoms is 1+ month and 2 psychotic domains
2. Must have 1 CORE domain (Delusion, hallucinations, or disorganized speech)
3. Duration: Signs of disturbance for 6+ months

Question 8

What is the only subtype of Schizophrenia?

Answer 8

Catatonia

Question 9

Schizophrenia Associated Features

Answer 9

1. Nicotine Dependence (self medication)
2. Dual Diagnosis (mental illness & substance use disorder)
3. Increased suicide risk
4. Aggression (may be to protect him/herself)

Question 10

Schizophrenia Epidemiology

(3)

Answer 10

1. 1% of population (no gender bias)
2. Higher prevalence in low socioeconomic status downward drift
3. High number of homeless

Question 11

Schizophrenia Onset

Answer 11

Typical onset: late teens
1. Late onset: 40+
2. Childhood onset: 13+

Question 12

What are the 4 dopamine pathways

Answer 12

1. Mesolimbic Pathway (positive symptoms): reward, reinforcement, motivation, motor function
2. Mesocortical Pathway (negative symptoms): executive functions, emotions & affect
3. Nigrostriatal Pathway (Extrapyramidal Syndrome): caudate and putamen, stimulation of purposeful movement
4. Tuberoinfundibular Pathway (Increased Prolactin Release)-projections from hypothalamus to infundibular region-normally inhibits prolactin release

Question 13

Schizophrenia Treatment

First Line

Answer 13

First Generation (Typical) Antipsychotics:
Examples: Haldol, Thorazine
* Dopamine receptor blockers (Antagonists)
* Alleviates positive symptoms (hallucinations, delusions)
* Side Effects: Extrapyramidal syndrome

Question 14

Extrapyramidal Syndrome

(4) DPAT

Answer 14

1. Dystonia: sustained muscle contraction (head and neck) develops in the first week
2. Parkinsonism: tremor and shuffling-develops in first few months
3. Akathisia: excessive movements due to “inner restlessness”-first few months
4. Tardive Dyskinesia: repetitive, involuntary, purposeless movements of the face and extremities-long term side effect after years of medication

Question 15

Neuroleptic Malignant Syndrome

Answer 15

• Starts within first 2 weeks of starting medication OR increasing dosage
• Tachycardia, HTN, elevated RR, fever, rigidity
• Results from precipitous drop in dopamine that impacts hypothalmic function

Question 16

Schizophrenia Treatment

2nd line

Answer 16

Second Generation (Atypical) Antipsychotics
* Examples are Clozapine, risperidone
* Dopamine receptor blocker AND serotonin antagonist
* Alleviates +ve symptoms and negative (anhedonia) symptoms
* Side effects: Agranulocytosis (clozapine)

Question 17

Schizophrenia Treatment

3rd and 4th line

Answer 17

Psychotherapy: used for secondary effects not primary symptoms
ECT: not usually as effective as meds but may be more useful for catatonic subtype

Question 18

Schizophreniform Diagnosis

Answer 18

Same as schizophrenia except less than 6 total months

Question 19

Brief Psychotic Disorder Diagnosis

Answer 19

• 1 CORE domain symptom
• Episode lasts less than 1 month
• Person returns to full premorbid functioning
• Specify trigger of episode (w/ marked stressor/ without marked stressor)

Question 20

Delusional Disorder Diagnosis

Answer 20

1. Presence of Delusion
2. Symptoms must last 1+month
3. No other psychotic domain symptoms
4. No functional impairement
5. Specify if: *non-bizarre delusion *(could possibly occur in life) or bizzare delusion (not possible)

Question 21

Delusional Disorder Subtypes

(6)

Answer 21

1. Persecutory Type: Belief of malevolent treatment
2. Grandiose Type: belief of having some great talent or insight or having made some important discovery
3. Erotomanic Type: belief that someone else is in love with the individual
4. Jealous Type: belief of infidelity by partner
5. Somatic Type:belief involving bodily functions/sensations
6. Unspecified Type: none of the above types

Question 22

Schizoaffective Disorder Diagnosis

Answer 22

• Active Phase of schizophrenia occurs concurrently with a MDE or manic episode
• Active Phase lasts 2+ weeks without mood symptoms of MDE or manic episode
• Mood symptoms are present for the majority of the total duration

Question 23

Schizoaffective Disorder Diagnosis Subtypes

Answer 23

1. Bipolar Type (if mania)
2. Depressive Type (depression without mania)

Question 24

Delusional & Schizoaffective Disorder Treatment

Answer 24

1. Antipsychotic medications
2. Individual psychotherapy
3. CBT
4. Pscyhosocial therapy
5. Family therapy