Schizophrenia & Psychosis Flashcards
psychosis
*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
key features of psychosis
*delusions
*hallucinations
*disorganized thinking (speech)
*grossly disorganized/abnormal motor behavior
*negative symptoms
positive symptoms of psychosis
“added things”
*hallucinations
*delusions
*bizarre behavior
*disorganized thinking
antipsychotic medications work very well for positive symptoms
negative symptoms of psychosis
“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
cognitive symptoms of psychosis
*attentional deficit
*executive function deficit
*working memory deficit
atypical antipsychotics may help with negative symptoms but traditional typical (first gen) antipsychotics do not
delusions
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
illusion
misinterpretation of an actual sensory stimulus
hallucination
*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)
disorganized thinking in psychosis
*derailment/loose associations
*tangentiality
*incoherence/word salad
disorganized behavior in psychosis
*hebephrenia
*agitation
*catatonia (negativism, mutism, stupor, excitement)
psychotic disorder due to another medical condition
*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)
substance/medication-induced psychotic disorder
*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
delusional disorder
A. presence of 1+ delusions with a duration of 1 month or longer
B. criterion A for schizophrenia has never been met (no mood disorder or other psychotic symptoms)
C. functioning is NOT markedly impaired and behavior is NOT obviously bizarre or odd
delusional disorder subtypes
*erotomanic
*grandiose
*jealous
*persecutory
*somatic
*mixed, unspecified, Folie a deux
brief psychotic disorder
*presence of one or more of: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior
*schizophrenia sx (hallucinations, delusions, illusions) for a short time; usually stress-related
*duration: 1 day to 1 month
schizophreniform disorder
*presence of 2+ of: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms
*duration: 1 month to 6 months
schizophrenia
*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
schizophrenia - epidemiology
*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
schizophrenia - dopamine hypothesis
*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)
schizophrenia - pathophysiology
*structural brain changes such as: enlarged ventricles & reduced cortical gray matter
*thought to be a misregulation or malprocessing of information in the brain
schizoaffective disorder
*an uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with criteria A of schizophrenia
*to differentiate from mood disorder with psychotic features, 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
“first break psychosis” workup
*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
schizotypal personality disorder
*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
“schizophrenia” diagnostic timeline
- brief psychotic disorder (sx 1 day - 1 month)
- schizophreniform disorder (sx 1-6 months)
- schizophrenia (sx > 6 months)
