Schizophrenia Spectrum and Other Psychotic Disorders: - end of exam 1

Question 1

Emil Kraepelin:

Answer 1

Classified the Sx of Schizophrenia based on Physical Etiology. Coined term “Dementia Praecox”, describing long-term deteriorating course of Delusions, Hallucinations and Bizarre Motor Problems.

Question 2

Eugen Bleuler:

Answer 2

Established the 4A’s: Associations (Loosened), Affect (Excited/Withdrawn), Ambivalence, Autism (Living in an Internal World).

Question 3

Kurt Schneider

Answer 3

Characterized 1st and 2nd rank Sx.

Question 4

Etiology and Epidemiology

Answer 4

Children of Schizophrenic parents and Monozygotic Twin Schizophrenics have the greatest incidence. Dopamine Hypothesis: Mesolimbic Pathway – Increased DA results in Hallucinations and Delusions. Mesocortical Pathway – Decreased DA results in Negative Sx. Nigrostriatal Pathway – Decreased DA produces Trembling and loss of Muscle Control, Excess DA results in Tardive Dyskinesia. Tuberoinfundibular Pathway – Decreased DA leads to uninhibited PRL and Lactation. Serotonin Hypotheisis: 5-HT Antagonists have been shown to reduce Positive Sx.

Question 5

delusional disorder

Answer 5

Delusions lasting at least 1 month without marked impairment on functioning or behavior. Delusions may be Erotomanic, Grandiose, Jealous, Persecutory or Somatic.

Question 6

Brief Psychotic Disorder

Answer 6

Presence of one or more of: Delusions, Hallucinations, Disorganized Speech and Grossly Disorganized or Catatonic Behaviors for at least one day but less than 1 month with full return to normal function.

Question 7

Schizophreniform Disorder

Answer 7

Presence of two or more of: Delusions, Hallucinations, Disorganized Speech and Grossly Disorganized or Catatonic Behaviors for at least one month but less than 6 months.

Question 8

Schizophrenia

Answer 8

Presence of two or more of: Delusions, Hallucinations, Disorganized Speech and Grossly Disorganized or Catatonic Behaviors for at least 6 months. Higher rate of Suicide than general population.

Question 9

Positive Sx

Answer 9

Delusions and Hallucinations (Auditory = Most Common). Due to Hyperactive D2 Receptors.

Question 10

Negative Sx

Answer 10

Absence of normal behaviors and emotions and disharmony in emotional tone, speech and ideas. Affect may be constricted, blunted for flat.

Question 11

Schizoaffective Disorder

Answer 11

Schizophrenia + Major Mood Disorder.

Question 12

Catatonia

Answer 12

3 or More of the Following: Stupor, Catalepsy, Waxy Flexibility, Mutism, Negativism (No Reaction to Stimuli), Posturing (Maintains Posture against Gravity), Mannerism (Caricature of Normal Actions), Stereotypy (Repetitive, Non-Goal Directed Movements), Agitation, Grimacing, Echolalia, Echopraxia. Occurs in up to 35% of Schizophrenics.

Question 13

Medication Risks

Answer 13

Neuroleptic Malignant Syndrome – Potentially fatal response to abrupt cessation of DA in response to Neuroleptic Meds, Sx: Hyperthermia, Muscular Rigidity and Autonomic Dysregulation.

Question 14

PNS Impairments

Answer 14

Dry Mouth, Constipation, Urinary Retention, Bowel Obstruction, Dilated Pupils, Blurred Vision, Increased HR, Respiratory Problems and Weight Gain.

Question 15

Tardive Dyskinesia

Answer 15

Involuntary choreoathetoid movements of the face, trunk or extremities in response to prolonged exposure to DA Receptor Antagonists.

Question 16

Metabolic Syndrome

Answer 16

Assoc. w/2nd Gen Atypical Antipsychotics. At least 3 of the following: Abdominal Obesity, High TGs, Low HDL, HTN, Elevated Fasting Blood Glucose.

Question 17

Delayed Ejaculation:

Answer 17

Marked delay or infrequency of ejaculation for at least 6 months despite adequate sexual stimulation and the desire to ejaculate.

Question 18

Erectile Disorder

Answer 18

Marked difficulty in obtaining and maintaining erection during sexual activity for at least 6 months.

Question 19

Female Orgasmic Disorder:

Answer 19

Marked delay, infrequency or absence of Orgasm or reduced intensity of Orgasm for at least 6 months.

Question 20

Female Sexual Interest/Arousal Disorder

Answer 20

Lack of or Significantly Reduced Sexual Interest/Arousal with at least 3 of: Absent/Reduced interest in Sexual Activity, Absent/Reduced Sexual Fantasies, Fails to Initiate or Respond to Partner’s Initiation, Absent Physical Arousal, Absent Mental Arousal.

Question 21

Genito-Pelvic Pain/Penetration Disorder

Answer 21

Persistent difficulties with Vaginal Penetration during intercourse with marked Pain on Penetration, Fear of Pain and Marked Tensing/Tightening of Pelvic Floor Muscles on Attempted Penetration.

Question 22

Male Hypoactive Sexual Desire Disorder

Answer 22

Persistently deficient/absent Sexual thoughts, fantasies and desire for sexual activity.

Question 23

Premature (Early) Ejaculation

Answer 23

Recurrent pattern of ejaculation within 1 minute of vaginal penetration, specifically if it occurs before the individual desires it.

Question 24

Gender Dysphoria in Children

Answer 24

Marked incongruence between experienced gender and assigned gender of at least 6 months duration with at least 6 of the following: Strong desire to be other gender, strong desire to cross-dress, preference for cross-gender roles in play, preference for toys/games/activities of the other gender, preference for playmates of the desired gender, rejection of gender role, dislike of personal sexual anatomy, strong desire for sexual characteristics of preferred gender.

Question 25

Gender Dysphoria in Adolescents and Adults

Answer 25

Marked incongruence between experienced gender and assigned gender of at least 6 months with at least 2 of the following: Marked incongruences between one’s experienced gender and secondary sexual characteristics, strong desire to be rid of or prevent development of assigned secondary sexual characteristics, strong desire for the sexual characteristics of the other gender, strong desire to be of the other gender, strong desire to be treated as the other gender, strong conviction that one has the typical feelings and reactions as the other gender.

Question 26

voyeuristic disorder

Answer 26

Recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing or engaging in sexual activity.

Question 27

Exhibitionistic Disorder

Answer 27

Recurrent and intense sexual arousal from the exposure of one’s genitals to an unsuspecting person.

Question 28

Frotteuristic Disorder

Answer 28

Recurrent and intense sexual arousal from touching or rubbing against a non-consenting person.

Question 29

Sexual Masochism Disorder

Answer 29

Recurrent and intense sexual arousal from the act of being Humiliated, Beaten, Bound or otherwise made to Suffer.

Question 30

Sexual Sadism Disorder

Answer 30

Recurrent and intense sexual arousal from the Physical or Psychological suffering of another

Question 31

Pedophilic Disorder

Answer 31

Recurrent and intense sexually arousing fantasies, urges or behaviors involving sexual activity with a prepubescent child or children <13y/o.

Question 32

Fetishistic Disorder

Answer 32

Recurrent and intense sexual arousal from either the use of Nonliving Objects (Ex: Female Underwear) or a Highly Specific focus on Non-genital body parts (Ex: Feet, Hair)

Question 33

Transvestic Disorder:

Answer 33

Recurrent and intense sexual arousal from Cross-Dressing.

Question 34

Describe concepts, risk factors, epidemiology, and warning signs of suicide:

Answer 34

: There is no definitive method for clinicians to determine who will commit suicide. Risk Factors: Prior Suicide Attempt, Age >45, EtOH Dependence, Irrationality, Rage, Violence, Male Gender, Unwilling to Accept Help, Especially Bad Depressive Episode. Warning Signs in Teens: Talking aboust Suicide/Death/”Going Away”, Feelings of Guilt and Hopelessness, isolating self from friends and family, loss of interest in pleasurable activities, EtOH/Drugs ang Giving things Away. Reduce risk by reaching out, beginning therapy, assessing the level of risk, give the patient options to better their situation, define and impose goals, sign a Safety Contract, remove lethal means, engage social support, provide Suicide Hotline # and/or Voluntary/Involuntary Hospitalization.

Question 35

Be familiar with the essentials of assessment for dangerousness:

Answer 35

Hx of Violent Behavior is the most valid predictive factor for Future Violence. Higher risk is the patients is hostile, has distorted thinking, maladaptive impulse control and access to weapons.

Question 36

Tarasoff Decision

Answer 36

If in the course of therapy, the patient discloses the intent to harm/kill a third party it is the duty of the clinician to protect that third party. Steps to take include: Changing the treatment program, requesting that the patient be committed, warning the potential victim and contacting the police. Always consult with colleagues and document all steps taken.

Question 37

PA Act 143 Sections 302 & 304

Answer 37

302: Involuntary Emergency Exam and Tx <90 Days. It is generally more legal and ethical to admit in cases of doubt.

Question 38

Child Abuse

Answer 38

Physical Injury (Unexplained burns, bites, bruises, broken bones, frightened of adults), Emotional Maltreatment (Mood Swings, Overly Mature or Regressive, Attempts Suicide), Sexual Abuse/Exploitation (Difficulty walking/sitting, VD <14y/o, Refuses to participate in physical activities) and Serious Physical Neglect (Lacks healthcare/glasses, absent from school, dirty/severe BO, lacks warm clothing). Any healthcare provider who has reasonable causes to suspect child abuse must report it.

Question 39

domestic violence

Answer 39

1:4 Women over their lifetime, 20-24y/o at greatest risk. Most cases are never reported. Abuse is committed to establish Power and keep Control. Cycle of Abuse: Tension Building, Abuse Incident, Honeymoon Phase.

Question 40

Elder Abuse

Answer 40

Physical, Emotional, Sexual, Exploitation, Neglect and Abandonment. Up to 10% of the Elderly are victims, but only 1:14 cases are reported. Financial Exploitation is most self-reported.

Question 41

Differentiate normal from abnormal bereavement/grieving

Answer 41

Grief is accompanied by minor loss of appetite, minor sleep disturbances, some survivor guilt and crying/sadness but resolves within 2months and completely after a year, maybe with psychotherapy and short acting BZs for sleep. Abnormal Grief resembles depression w/Significant Weight loss and Sleep disturbance, intense guilt/worthlessness/hopelessness and hallucinations and delusions lasting more than 2 months and persisting beyond a year. Tx includes Antidepressants, Antipsychotics, ECT and Psychotherapy.

Question 42

Kübler-Ross Grief Stages

Answer 42

Denial, Anger, Bargaining, Depression, Acceptance

Question 43

End of Life Issues:

Answer 43

: Patients are concerned with Advanced Directives (Living Will) and detail what kind of end-of-life care they want (Ex: No heroic measures, pain control). Palliative care affirms life and regards dying as a normal process and neither hastens nor postpones death. Goals are to relieve pain, integrate psychological and spiritual care and offer a support system for the family. Hospice is a supportive care home for the terminally ill with a certified diagnosis and <6mos.

Question 44

Impaired Physicians

Answer 44

Types of Impairment – Cognitive Deficits (Dementia, Organic Damage), Disruptive (Anger, Harassment, Abuse Behaviors), Substance Abuse and Inappropriate Workplace Conduct. Approximately 6% of physicians abuse drugs and 14% abuse EtOH. Anesthesiologists and ER physicians are 3x more likely to abuse substances. Suspect impairment when Quality of Care decreases, Absenteeism Increases and Doc becomes irritable or aggressive. Impairment risks legal trouble, financial difficulties and emotional disturbances. If possible, as the Doc first what’s wrong, if not report suspicions to their Supervisor who will take steps and if necessary enroll them in the Physician’s Health Program.

Question 45

Dissociative Identity Disorder

Answer 45

Presence of two or more distinct personalities with unique affect, behavior, memory, perception and cognition. Some cultures refer to this as Possession.

Question 46

Dissociative Amnesia

Answer 46

Inability to recall important autobiographical information related to Traumatic or Stressful Events

Question 47

Depersonalization Disorder

Answer 47

Depersonalization – Experiences of unreality, detachment or being an outside observer with respect to one’s thoughts, feelings, sensations, body or actions.

Question 48

derealization disorder

Answer 48

Derealization – Experiences of unreality or detachment with respect to surroundings (individuals or objects perceived as dream-like, foggy or distorted).