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Psych Exam 2 > Schizophrenia and Personality Disorder > Flashcards

Schizophrenia and Personality Disorder Flashcards

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1
Q

What is meant by “positive symptoms” associated with schizophrenia?

A

Presence of symptoms that most people don’t have

ex: hallucinations or delusions; disorganized speech

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2
Q

What is meant by “negative symptoms” associated with schizophrenia?

A

Absence of things present in most people

ex: social withdrawal, affective flattening, lack of motivation

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3
Q

Average age of schizophrenia onset in men

A

early to mid-20s

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4
Q

Schizophrenia is a psychiatric disorder involving ______ and _______ psychosis

A

chronic and recurrent

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5
Q

A diagnosis of schizophrenia is based on the presence of such symptoms, coupled with social and occupational dysfunction for ______ in absence of another diagnosis.

And for active psychosis

A

atleast 6 months

atleast 1 month

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6
Q

How many of the following 5 criteria symptoms must be present for a diagnosis of schizophrenia?

Hallucinations
Delusions
Disorganized thinking
Disorganized behavior
Negative symptoms

A

atleast 2 lasting for atleast 1 month

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7
Q

Brief psychotic disorder is diagnosed with psychosis symptoms lasting how long?

A

Less than 1 month

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8
Q

Schizophreniform disorder is diagnosed with psychosis symptoms lasting how long?

A

1-6 months

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9
Q

Schizophrenia is diagnosed with psychosis symptoms lasting how long?

A

6+ months of persistent disturbance with active psychosis for 1+ months

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10
Q

Worldwide prevalence of schizophrenia

A

0.3%-0.9%

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11
Q

What 2 types of hallucinations are most commonly seen with schizophrenia?

A

Visual & auditory

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12
Q

What aspect of schizophrenia is often most responsive to antipsychotic meds?

A

Auditory hallucinations

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13
Q

What is the most common type of hallucination?

A

Auditory

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14
Q

What percent of patients with schizophrenia report auditory hallucinations?

A

40-80%

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15
Q

Auditory hallucinations often involve what phenomena?

A

Sensations of voices, music, body noises, or machinery

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16
Q

Visual hallucinations often involve what phenomena?

A

Glowing orbs, flashes of color up to people, faces, or body parts

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17
Q

What percent of patients with schizophrenia report delusions?

A

> 80%

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18
Q

Delusions that are clearly implausible & impossible are called

Just no way of being true

A

Bizarre delusions

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19
Q

Include feelings of being touched, of sexual intercourse or of pain

A

somatic hallucinations

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20
Q

Strange taste or smell is associated with what type of hallucination

A

Olfactory and gustatory hallucinations

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21
Q

Delusions that are understandable and theoretically possible but are still untrue are called

A

Non-bizarre delusions

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22
Q

Delusions that random or neutral events are in fact targeted and include the patient specifically are called

A

ideas/delusions of reference

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23
Q

Delusions formed around the belief that the person has special significance or power are called

A

Grandiose delusions

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24
Q

What is the most common type of delusion in schizophrenia?

A

Paranoid delusions

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25
Q

Delusions that one is dead or doesn’t exist are called

A

Nihilistic delusions

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26
Q

Delusions where the patient thinks (s)he has a special or romantic relationship with someone (often a celebrity) are called

A

Erotomanic delusions

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27
Q

The phenomenon where a schizophrenia patient doesn’t talk or move and simply appears entranced is called

A

Catatonic behavior/catatonic state

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28
Q

Does schizophrenia usually start with positive or negative symptoms?

A

negative

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29
Q

Are positive or negative symptoms more responsive to treatment?

A

positive

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30
Q

For what other psychiatric disorder are negative symptoms often mistaken?

A

depression

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31
Q

Negtive symptoms

A

Flat affect
Impairments in cognition
Attention deficits
Loss of excutive functioning
Alogia
Avolition
Anhedonia
Social Withdrawal

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32
Q

A negative symptoms appears to cluster into two components

A

A diminished expression of symptoms cluster

An avolition-apapthy cluster

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33
Q

The negative symptom cluster of “diminished expression” involves what specific negative symptoms?

How may those be manifest?

A

Affective flattening, manifest by:
-Unchanging facies
-Little spontaneous movement
-Little use of expressive gestures
-Poor eye contact
-Poor responsiveness
-Lack of vocal inflection

Alogia, manifest by:
-Poverty of speech
-Thought blocking
-Latency of response

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34
Q

The negative symptom cluster of “avolition-apathy” involves what specific negative symptoms?

How may those be manifest?

A

Apathy, manifest by:
-Poor grooming & hygiene
-Failure of role responsibilities
-Anergy

Asociality/anhedonia, manifest by:
-Failure to engage w/ peers socially
-Low interest in stimulating activities
-Low interest in sex/intimacy

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35
Q

In most patients, the onset of schizophrenia presentation is subtle and evolves in a ________ phase.

In adolescents first presentation is with an acute episode of psychosis without ______

A

prodromal

def: the interval between initial symptoms and full symptoms
(same answer for both)

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36
Q

Specific points to investigate in a patient’s Hx related to schizophrenia suspicion include

A

Drug Hx, including:
Hx of substance use
Any Rx or OTC drugs
Steroids
Antihistamines
Anticholinergics

37
Q

Schizophrenia is a _____ disorder

A

thought

38
Q

Schizoprenia risk factors

A

Genetics!

Older paternal age
Pregnancy or birth complications
Maternal infection, malnutrition, drug use, or DM
Late winter-early spring birth month
Urban childhood
Childhood adversity
Hx of head injury
Cannabis use in adolescence
Immigration Hx

39
Q

Disorganized thought processes in schizophrenia often include

and which are the most severe

A

Derailment (suddenly switching topics)
Neologisms (new words)
Word salad
Tangential speech (getting further off topic)
Circumstantial speech (answering a question roundabout)

most severe: derailment, neologisms, word salad

40
Q

At what age should a medical explanation for psychosis be most strongly considered?

A

50 or older

41
Q

Lab testing to rule out medical conditions masquerading as schizophrenia

A

Serum & urine toxicity
CMP
Glucose
Kidney, liver, thyroid panels
Neurosyphilis
Pregnancy

42
Q

What percent of schizophrenia patients have a good response to antipsychotic meds?

A

30-40%

43
Q

How long will it take for the initial response to antipsychotic meds?
Significant response?
Most expected response?

A

1-2 weeks
2-4 weeks
by 10 weeks

44
Q

Drugs of choice for acute psychosis in ER setting

A

PO olanzapine or risperidone ± lorazepam

OR

IM olanzapine or ziprasidone

OR

Haloperidol + lorazepam

45
Q

Before starting antipsychotic Tx, what all should be assessed?

A

Baseline movement (rule out preexisting EPS)
Baseline labs:
-fasting glucose & HbA1C
-Lipid panel
-Prolactin
Baseline ECG to ensure no QT prolongation

46
Q

What antipsychotics are most likely to cause QT prolongation?

A

Thioridazine
Pimozide
Ziprasidone

47
Q

What drug is not used for initial therpay ; it is reserevd for treatment resistant symptoms ?

A

Clozapine

48
Q

What criteria should be met before giving clozapine?

A

Failure of 2 drugs

Those 2 drugs were dosed adequately

Each drug was tried for 6 weeks

There is evidence of adherence to each drug

49
Q

What is a serious adverse effect with Clozapine ?

A

agranulocytosis and myocarditis

50
Q

What lab should be measured before giving clozapine?

A

CBC

51
Q

EPS of
Feeling restless like you cant sit still.
Urge to tap your fingers, fidget, or kjiggle your legs

A

Akathisia

52
Q

EPS of
Muscle contract involuntarily

A

Dystonia

53
Q

EPS of
symptoms similar to Parkinsons disease. May have tremor difficulty finishing thoughts or speaking and stiff facial muscles

A

Parkinsonism

54
Q

EPS of
facial movements happens involuntairly . May make a sucking or chewing motion with your mouth, stick out tongue, or blink eyes a lot

A

Tardive Dyskinesia

55
Q

Management of akathisia

A

Dose reduction followed by change of antipsychotic drug

May add propranolol if needed

56
Q

Management of dystonia

A

Anticholinergic or antihistamine

57
Q

Management of Parkinsonism

A

Dose reduction/drug change
Benzotropine
Amantidine preferable in older patients to adverse effects of anticholenergic drugs

58
Q

Management of tardive dyskinesia

A

Dose reduction/drug change
Valbenazine
Deutetrabenazine
Ginko

59
Q

Medical monitoring with antipsychotics

A

Monitor and record weight at 4,8,12 weeks and then quaterly
Measure wasit circumference annually

At 12 weeks then annually :
Measure blood pressure
Obtain fasting plasma glucose
Obtain fasting lipid profile

Monitor regularly for tardive dyskinesia
EKG
CBC with diff

60
Q

Which antipsychotics are least likely to cause QT prolongation?

A

Aripiprazole
Lurasidone

61
Q

What drug may be added to antipsychotic therapy to prevent weight gain?

A

Metformin

62
Q

Which antipsychotics are most likely to cause prolactin elevation?

A

FGAs

Risperidone

63
Q

High potency FGAs & risperidone are absolutely contraindicated in

A

Women with breast cancer

64
Q

Which antipsychotic is associated with cataracts?

A

Quetiapine

65
Q

Which antipsychotics carry the highest risk of seizures?

A

FGAs

Clozapine

66
Q

Neuroleptic malignant syndrome risk factors

A

High-potency antipsychotics

Parenteral administration

Rapid dose escalation

Use of aripiprazole, lithium, or BZDs

67
Q

Neuroleptic malignant syndrome management

A

Managment in ICU
Stop antipsychotic Rx
Cooling measures
IV hydration + electrolyte mgmt
Muscle relaxant (dantrolene or bromocryptine)
BZD

68
Q

“An enduring pattern of inner experience/behavior that deviates markedly from cultural expectations, is inflexible, starts in adolescence/early adulthood, is stable over time, & leads to distress or impairment” is called

A

Personality disorder

69
Q

Cluster ___?
Paranoid, schizoid, schizotypal

often appear odd or eccentric

A

Cluster A personality disorder

70
Q

Cluster___?
Antisocial, borderline, histrionic, narcissistic

individuals who appear dramatic, emotional, or erratic

A

Cluster B personality disorder

71
Q

Cluster ___?
Avoidant, dependent, obsessive-compulsive

individuals who appear anxious or fearful

A

Cluster C personality disorder

72
Q

A long-standing pattern of distrust & suspiciousness is the hallmark of what personality disorder?

A

Cluster A Paranoid personality disorder

73
Q

How can paranoid personality disorder be distinguished from schizophrenia?

A

Paranoid personality disorder lacks long term psychotic symptoms

74
Q

Detachment from social relationships & exhibition of a restricted range of emotions, often appearing cold & indifferent, is the hallmark of what personality disorder?

A

Cluster A Schizoid personality disorder

75
Q

Which personality disorder displays extreme anhedonia (they are not interested in pleasure)?

A

Cluster A Schizoid personality disorder

76
Q

“Odd and eccentric” behavior, including magical thinking, odd beliefs, suspicion, paranoia, ideas of reference, or telepathic or clairvoyant experiences is the hallmark of what personality disorder?

A

Schizotypal (cluster A)

77
Q

What is the main difference between schizoid & schizotypal personality disorders?

A

Schizoid does not have paranoia or suspicion

78
Q

Disregard for others, behavior that violates others’ rights, & deceit for personal gain is the hallmark of what personality disorder?

A

Antisocial (cluster B)

79
Q

Antisocial personality disorder can only be diagnosed after what age and requires what prior history?

A

After age 18; requires Hx of conduct disorder

80
Q

Instability in self-image, affect, & relationships, impulsivity, self-destructive behaviors, & intense fear of abandonment is the hallmark of what personality disorder?

A

Borderline (cluster B)

81
Q

Excessive attention-seeking and emotionalism with dramatic shows of feeling and/or sexual provocativeness is the hallmark of what personality disorder?

A

Histrionic (cluster B)

82
Q

Grandiosity, a need for admiration, & exaggerated sense of self-importance & social status is the hallmark of what personality disorder?

A

Narcissistic (cluster B)

83
Q

Excessive anxiety in social situations & intimate relationships and EXTREME hypersensitivity to what others think about them is the hallmark of what personality disorder?

A

Avoidant (cluster C)

84
Q

Pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation is the hallmark of what personality disorder?

A

Dependent (cluster C)

85
Q

Preoccupation with orderliness, perfectionism, & control and a 24/7 “laser-focus” on details & rules is the hallmark of what personality disorder?

A

Obsessive-compulsive (cluster C)

86
Q

Management of cluster A personality disorders

A

Refer; Low-dose antipsychotic may help

87
Q

Management of cluster B personality disorders

A

Refer/evaluate for prominent mood symptoms

88
Q

Management of cluster C personality disorders

A

Refer; SSRIs may help b/c anxiety/fear are usually the most dominant symptoms

Psych Exam 2 (2 decks)

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