Schizophrenia Spectrum

Question 1

What is the diagnostic criteria for delusional disorder?

Answer 1

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

Question 2

What is an erotomanic delusion?

Answer 2

another person is in love w/ them

Question 3

What is a grandiose delusion?

Answer 3

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

Question 4

What is a jealous delusion?

Answer 4

spouse or lover is unfaithful

Question 5

What is a persecutory delusion?

Answer 5

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

Question 6

What is a somatic delusion?

Answer 6

delusion involves bodily functions or sensations

Question 7

What is a mixed delusion?

Answer 7

no one delusional theme predominates

Question 8

What is an unspecified delusion?

Answer 8

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

Question 9

How is delusional disorder treated?

Answer 9

atypical (2nd gen) antipsychotics → Risperidone or Olanzapine

Question 10

What is schizophrenia?

Answer 10

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

Question 11

What is the pathophysiology for schizophrenia?

Answer 11

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

Question 12

What are positive symptoms of schizophrenia?

Answer 12

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

Question 13

What are negative symptoms of schizophrenia?

Answer 13

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

Question 14

What is the diagnostic criteria for schizophrenia?

Answer 14

** 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

Question 15

How is schizophrenia acute psychosis treated?

Answer 15

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

Question 16

How do you treat negative symptoms in schizophrenia?

Answer 16

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

Question 17

How do you treat positive symptoms of schizophrenia?

Answer 17

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

Question 18

How is treatment-resistent schizophrenia treated?

Answer 18

Clozapine

Question 19

What is schizoaffective disorder?

Answer 19

Schizophrenia + mood disorder

Question 20

What is the diagnostic criteria for schizoaffective disorder?

Answer 20

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)

Question 21

How is schizoaffective disorder treated?

Answer 21

CBT + antipsychotics

Question 22

What is schizophreniform disorder?

Answer 22

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

Question 23

What is the diagnostic criteria for schizophreniform disorder?

Answer 23

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

Question 24

What are extrapyramidal symptoms (EPS)?

Answer 24

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

Question 25

What are examples of EPS?

Answer 25

Acute dystonias, parkinsonism, malignant syndrome, akathisia, tardive dyskinesias

Question 25

What is acute dystonia?

Answer 25

acute muscle spasms of the face, neck & other muscles, abnormal movements/postures & difficulty swallowing MC w/in 3-4 hrs-days of use

Question 25

How is acute dystonia treated?

Answer 25

IV benztropine 1-2mg (anticholinergic)
* IV diphenhydramine 25-50mg (antihistamine)
* rapidly reversible

Question 26

What is Parkinsonism?

Answer 26

mask-like facies, resting tremor, cogwheel rigidity, shuffling gait, psychomotor retardation 1-2 weeks after initation

Question 27

How is parkinsonism treated?

Answer 27

↓ dose, lower potency drug, or tx w/ anticholinergic (benztropine, diphenhydramine) or amantadine

Question 28

When is malignant syndrome suspected?

Answer 28

When 2/4 are present:
* mental status change
* rigidity
* fever
* dysautonomia

Question 29

How is malignant syndrome treated?

Answer 29

BZDs + dantrolene

Question 30

What is akathisia?

Answer 30

motor restlessness with anxiety and agitation 5-60 days after initation

Question 31

How is akathisia treated?

Answer 31

↓ dose or change to propranolol
* Antiparkinson agents & BZDs

Question 32

What is tardive dyskinesias?

Answer 32

mostly orofacial muscles – sucking, lip smacking, tongue movements, grimacing, lateral jaw movement

Question 33

How is tardive dyskinesias treated?

Answer 33

• Prevention best (Clozapine)
• Tetrabenazine
• Reintroduction of offending drug and slow tapering