Schizophrenia Spectrum Flashcards
What is the diagnostic criteria for delusional disorder?
presence of ≥ 1 delusion in ≥ 1 month WITHOUT significant functional impairment or bizarre behavior
What is an erotomanic delusion?
another person is in love w/ them
What is a grandiose delusion?
conviction of having some great (but unrecognized) talent or insight or having made some important discovery
What is a jealous delusion?
spouse or lover is unfaithful
What is a persecutory delusion?
being conspired against, cheated, spied on, followed, poisoned/drugged, harassed, or obstructed in their long-term goals
What is a somatic delusion?
delusion involves bodily functions or sensations
What is a mixed delusion?
no one delusional theme predominates
What is an unspecified delusion?
dominant delusional belief cannot be clearly determined or is not described in the specific types
How is delusional disorder treated?
atypical (2nd gen) antipsychotics → Risperidone or Olanzapine
What is schizophrenia?
Brain disorder that affects how people think, feel, & perceive
What is the pathophysiology for schizophrenia?
abnormalities in dopamine and serotonin
* Positive sxs: excess dopaime in the mesolimbic pathway
* Negative sxs: dopamine imbalance in the mesocortical pathway
What are positive symptoms of schizophrenia?
hallucinations (MC auditory), delusions, disorganied speech & behavior
What are negative symptoms of schizophrenia?
6 A’s
* absense of normal cognition
* affect flattening
* alogia
* avolition
* anhedonia
* asociality
What is the diagnostic criteria for schizophrenia?
** 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
How is schizophrenia acute psychosis treated?
Acute Psychosis
* Emergent: risperidone or aripiprazole
* Severly agitated: IM ziprasidone, olanzapine, aripiprazole
How do you treat negative symptoms in schizophrenia?
Atypical antipsychotics (Ariprazole)
* 1st line management regardless of sxs presentation
How do you treat positive symptoms of schizophrenia?
Typical (1st gen) antipsychotics
* Haloperidol, chlorpromazine, thioridazine
* Increased risk of EPS
How is treatment-resistent schizophrenia treated?
Clozapine
What is schizoaffective disorder?
Schizophrenia + mood disorder
What is the diagnostic criteria for schizoaffective disorder?
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)
How is schizoaffective disorder treated?
CBT + antipsychotics
What is schizophreniform disorder?
Similar to schizophrenia BUT shorter duration & does not require a significant decline in social or occupational functioning
What is the diagnostic criteria for schizophreniform disorder?
Criterion A of schizophrenia lasting ≥ 1 month but ≤ 6 months
* (A) ≥ 2 sx, but 1 must be: delusions, hallucinations, or disorganized speech
What are extrapyramidal symptoms (EPS)?
Due to dopamine blockade in nigrostrial pathway, esp. w/ the 1st gen (typical) antipsychotics haloperidol & fluphenazine
What are examples of EPS?
Acute dystonias, parkinsonism, malignant syndrome, akathisia, tardive dyskinesias
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
How is acute dystonia treated?
IV benztropine 1-2mg (anticholinergic)
* IV diphenhydramine 25-50mg (antihistamine)
* rapidly reversible
What is Parkinsonism?
mask-like facies, resting tremor, cogwheel rigidity, shuffling gait, psychomotor retardation 1-2 weeks after initation
How is parkinsonism treated?
↓ dose, lower potency drug, or tx w/ anticholinergic (benztropine, diphenhydramine) or amantadine
When is malignant syndrome suspected?
When 2/4 are present:
* mental status change
* rigidity
* fever
* dysautonomia
How is malignant syndrome treated?
BZDs + dantrolene
What is akathisia?
motor restlessness with anxiety and agitation 5-60 days after initation
How is akathisia treated?
↓ dose or change to propranolol
* Antiparkinson agents & BZDs
What is tardive dyskinesias?
mostly orofacial muscles – sucking, lip smacking, tongue movements, grimacing, lateral jaw movement
How is tardive dyskinesias treated?
- Prevention best (Clozapine)
- Tetrabenazine
- Reintroduction of offending drug and slow tapering
