Schizophrenia Spectrum Flashcards

1
Q

What is the diagnostic criteria for delusional disorder?

A

presence of ≥ 1 delusion in ≥ 1 month WITHOUT significant functional impairment or bizarre behavior

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2
Q

What is an erotomanic delusion?

A

another person is in love w/ them

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3
Q

What is a grandiose delusion?

A

conviction of having some great (but unrecognized) talent or insight or having made some important discovery

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4
Q

What is a jealous delusion?

A

spouse or lover is unfaithful

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5
Q

What is a persecutory delusion?

A

being conspired against, cheated, spied on, followed, poisoned/drugged, harassed, or obstructed in their long-term goals

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6
Q

What is a somatic delusion?

A

delusion involves bodily functions or sensations

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7
Q

What is a mixed delusion?

A

no one delusional theme predominates

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8
Q

What is an unspecified delusion?

A

dominant delusional belief cannot be clearly determined or is not described in the specific types

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9
Q

How is delusional disorder treated?

A

atypical (2nd gen) antipsychotics → Risperidone or Olanzapine

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10
Q

What is schizophrenia?

A

Brain disorder that affects how people think, feel, & perceive

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11
Q

What is the pathophysiology for schizophrenia?

A

abnormalities in dopamine and serotonin
* Positive sxs: excess dopaime in the mesolimbic pathway
* Negative sxs: dopamine imbalance in the mesocortical pathway

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12
Q

What are positive symptoms of schizophrenia?

A

hallucinations (MC auditory), delusions, disorganied speech & behavior

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13
Q

What are negative symptoms of schizophrenia?

A

6 A’s
* absense of normal cognition
* affect flattening
* alogia
* avolition
* anhedonia
* asociality

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14
Q

What is the diagnostic criteria for schizophrenia?

A

** continuous signs of disturbance for ≥ 6 months with ≥ 1 month of ≥ 2 sxs**
* (A) ≥ 2 sx, but 1 must be: delusions, hallucinations, or disorganized speech
* (B) Significant functional deterioration in 1+ major area (work, social, self-care)
* (C) Continuous signs of the disturbance for ≥6 months & must include ≥1 month of sx

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15
Q

How is schizophrenia acute psychosis treated?

A

Acute Psychosis
* Emergent: risperidone or aripiprazole
* Severly agitated: IM ziprasidone, olanzapine, aripiprazole

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16
Q

How do you treat negative symptoms in schizophrenia?

A

Atypical antipsychotics (Ariprazole)
* 1st line management regardless of sxs presentation

17
Q

How do you treat positive symptoms of schizophrenia?

A

Typical (1st gen) antipsychotics
* Haloperidol, chlorpromazine, thioridazine
* Increased risk of EPS

18
Q

How is treatment-resistent schizophrenia treated?

19
Q

What is schizoaffective disorder?

A

Schizophrenia + mood disorder

20
Q

What is the diagnostic criteria for schizoaffective disorder?

A

major depressive, manic, or hypomanic episode concurrent w/ Criterion A of schizophrenia
* ≥ 2 weeks of delusions or hallucinations in the absence of a major mood episode (depressive or manic)
* Specifiers: bipolar type (if manic episodes), depressive type (if MDD)

21
Q

How is schizoaffective disorder treated?

A

CBT + antipsychotics

22
Q

What is schizophreniform disorder?

A

Similar to schizophrenia BUT shorter duration & does not require a significant decline in social or occupational functioning

23
Q

What is the diagnostic criteria for schizophreniform disorder?

A

Criterion A of schizophrenia lasting ≥ 1 month but ≤ 6 months
* (A) ≥ 2 sx, but 1 must be: delusions, hallucinations, or disorganized speech

24
Q

What are extrapyramidal symptoms (EPS)?

A

Due to dopamine blockade in nigrostrial pathway, esp. w/ the 1st gen (typical) antipsychotics haloperidol & fluphenazine

25
What are examples of EPS?
Acute dystonias, parkinsonism, malignant syndrome, akathisia, tardive dyskinesias
25
What is acute dystonia?
**acute muscle spasms of the face, neck & other muscles**, abnormal movements/postures & difficulty swallowing MC w/in 3-4 hrs-days of use
25
How is acute dystonia treated?
**IV benztropine 1-2mg (anticholinergic)** * IV diphenhydramine 25-50mg (antihistamine) * rapidly reversible
26
What is Parkinsonism?
mask-like facies, resting tremor, cogwheel rigidity, shuffling gait, psychomotor retardation 1-2 weeks after initation
27
How is parkinsonism treated?
↓ dose, lower potency drug, or tx w/ anticholinergic (benztropine, diphenhydramine) or amantadine
28
When is malignant syndrome suspected?
When 2/4 are present: * mental status change * rigidity * fever * dysautonomia
29
How is malignant syndrome treated?
BZDs + dantrolene
30
What is akathisia?
motor restlessness with anxiety and agitation 5-60 days after initation
31
How is akathisia treated?
↓ dose or change to propranolol * Antiparkinson agents & BZDs
32
What is tardive dyskinesias?
mostly orofacial muscles – sucking, lip smacking, tongue movements, grimacing, lateral jaw movement
33
How is tardive dyskinesias treated?
* Prevention best (Clozapine) * Tetrabenazine * Reintroduction of offending drug and slow tapering