Schizophrenia & Psychosis

Question 1

psychosis

Answer 1

*a mental disorder in which the thoughts, feelings, affective response, ability to recognize reality, and ability to communicate and relate to others are sufficiently impaired to interfere grossly with the capacity to deal with reality
*characteristics: impaired reality testing, hallucinations, delusions, and illusions

Question 2

key features of psychosis

Answer 2

*delusions
*hallucinations
*disorganized thinking (speech)
*grossly disorganized/abnormal motor behavior
*negative symptoms

Question 3

positive symptoms of psychosis

Answer 3

“added things”
*hallucinations
*delusions
*bizarre behavior
*disorganized thinking

antipsychotic medications work very well for positive symptoms

Question 4

negative symptoms of psychosis

Answer 4

“subtracted things”
*decreased affect (verbal and nonverbal)
*avolition - decreased motivation
*alogia - decreased speech
*anhedonia - decreased interest
*asociality

atypical antipsychotics may help with negative symptoms but traditional typical (first gen) antipsychotics do not

Question 5

cognitive symptoms of psychosis

Answer 5

*attentional deficit
*executive function deficit
*working memory deficit

atypical antipsychotics may help with negative symptoms but traditional typical (first gen) antipsychotics do not

Question 6

delusions

Answer 6

FIXED false beliefs that are not a part of the patient’s culture and do not change in light of conflicting evidence
*persecution/paranoia
*ideas of reference
*delusions of control
*delusions of grandeur
*delusions of guilt
*somatic delusions

Question 7

illusion

Answer 7

misinterpretation of an actual sensory stimulus

Question 8

hallucination

Answer 8

*perception without stimulus
*auditory: often “command” hallucinations tell the pt to do something; most common hallucination in psychiatric conditions
*visual
*olfactory
*tactile (often with drug use or withdrawal; ex. formication = feeling that insects are crawling on or in skin)

Question 9

disorganized thinking in psychosis

Answer 9

*derailment/loose associations
*tangentiality
*incoherence/word salad

Question 10

disorganized behavior in psychosis

Answer 10

*hebephrenia
*agitation
*catatonia (negativism, mutism, stupor, excitement)

Question 11

psychotic disorder due to another medical condition

Answer 11

*prominent hallucinations or delusions
*evidence from history, physical exam, or lab findings that the disturbance is the direct pathophysiological condition of another medical condition (CNS disorders, vitamin deficiencies, endocrinopathies, etc)

Question 12

substance/medication-induced psychotic disorder

Answer 12

*prominent hallucinations or delusions
*evidence from history, PE, or lab of:
-symptoms developed during or soon after substance intoxication or withdrawal
AND
-involved substance/medication is capable of producing the symptoms

Question 13

delusional disorder

Answer 13

A. presence of 1+ delusions with a duration of 1 month or longer
B. criterion A for schizophrenia has never been met
C. functioning is NOT markedly impaired and behavior is NOT obviously bizarre or odd

Question 14

delusional disorder subtypes

Answer 14

*erotomanic
*grandiose
*jealous
*persecutory
*somatic
*mixed, unspecified, Folie a deux

Question 15

brief psychotic disorder

Answer 15

*presence of one or more of: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior

*duration: 1 day to 1 month

Question 16

schizophreniform disorder

Answer 16

*presence of 2+ of: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms

*duration: 1 month to 6 months

Question 17

schizophrenia

Answer 17

*presence of 2+ of: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms

*level of function in one or more major areas is MARKEDLY BELOW the level achieved prior to onset

*duration: continuous signs of the disturbance persist for at least 6 months

Question 18

schizophrenia - epidemiology

Answer 18

*early to mid-20s for males; late 20s for females
*50% concordance among monozygotic (identical) twins
*40% risk if both parents have it
* >50% have comorbid tobacco use
*downward drift hypothesis: deficits in function lead to lower SES
*more common in winter babies
*violence best predicted by male gender, hx of violence, non-adherence, substance abuse, impulsivity

Question 19

schizophrenia - dopamine hypothesis

Answer 19

*mesocortical: VTA -> prefrontal cortex; dysfunction leads to negative symptoms
*mesolimbic: VTA -> NA; dysfunction leads to positive symptoms
*tuberoinfundibular: normal function in schizophrenia (affected by antipsychotics, leading to hyperprolactinemia)
*nigrostriatal: normal function in schizophrenia (affected by antipsychotics, leading to extrapyramidal symptoms)

Question 20

schizophrenia - pathophysiology

Answer 20

*structural brain changes such as: enlarged ventricles & reduced cortical gray matter
*thought to be a misregulation or malprocessing of information in the brain

Question 21

schizoaffective disorder

Answer 21

*an uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with criteria A of schizophrenia
*delusions or hallucinations for 2+ weeks in the ABSENCE of a major mood episode (depressive or manic)

*overall: underlying psychosis with additional overlapping major mood episode

Question 22

“first break psychosis” workup

Answer 22

*imaging study if focal neurological signs (MRI if possible)
*EKG
*CBC, electrolytes, BUN/Cr, glucose, calcium, phosphorous, UA, UDS
*TSH, LFTs
*ESR, ANA, ceruloplasmin, HIV screening, FTA-Abs, B12 and folate

Question 23

schizotypal personality disorder

Answer 23

*a pervasive pattern of social/interpersonal deficits marked by acute discomfort with personal relationships + cognitive/perceptual disturbances/eccentricities of behavior, marked by 5 or more of:
-ideas of reference, odd beliefs/magical thinking, unusual perceptual experiences, odd thinking and speech, suspiciousness/paranoid ideation, inappropriate/constricted affect, odd behavior/appearance, lack of close friends and confidants, excessive social anxiety

Question 24

“schizophrenia” diagnostic timeline

Answer 24

1. brief psychotic disorder (sx 1 day - 1 month)
2. schizophreniform disorder (sx 1-6 months)
3. schizophrenia (sx > 6 months)