Schizophrenia Spectrum and Other Psychotic Disorders Flashcards
What age are males and females when psychotic disorders start?
males 15-25yr
females 25-35yr
What is the most common psychotic disorder affecting 1% of the population?
Schizophrenic
What is schizophrenic disorder?
a massive disruption of thinking, mood, and overall behavior coupled with poor filtering of stimuli
What percent of pts with schizophrenia require long term hospitalization?
50%
What 3 things causes schizophrenia?
genetic, environmental, neurochemical
Who responds more successfully to medications?
Women than man
What percent of schizophrenics have no affected parent?
80%
What are two environmental influences of schizophrenia?
- born in the winter, with maternal virus infection during the 3rd trimester
- exposure to diuretics for severe maternal HTN
What 3 neuro changes take place in a schizo brain?
- decrease glucose utilization by frontal lobe
- Ventricle enlargement
- Abnormalities in brain density and brain waves
What is the dopamine hypothesis?
Hyperactive dopamine in the mesolimbic tract leads to positive symptoms
Hypoactive dopamine in the mesocortical tract leads to negative symptoms
What creates hallucinations and delusions?
Serotonin agnosits
What can be given to improve hallucinations and delusions?
serotonin antagonists
During a psychotic episode what is intact in the patient?
memory (oriented to person, place, and time)
What characterizes schizophrenia?
at least 1 episode of psychosis and persistent disturbances of behavior, appearance, speech, and affect impairing them
When can a psychotic episode occur?
spontaneous or follow traumatic/ stressful event
What are the 5 positive symptoms?
Hallucinations Delusions Disorganized Speech Agitation Talkativeness
What are 7 negative symptoms?
diminished sociability restricted affect poverty of speech lack of motivation flat affect cognitive disturbances poor grooming
How long must schizophrenic last?
> 6 mo
What is the criteria for schizophrenic?
2 or more symptoms are present for a significant portion of time during a 1 month period
What are the 3 phases of Schizophrenia?
Prodromal
Psychotic
Residual
What 3 things are seen in the Prodromal phase?
- Still functioning in reality
- Increasing social withdrawal
- Increasing interest in religion, the occult, and philosophy
What 1 thing is seen in the Psychotic phase?
“Psychotic break” from reality
What 2 things are seen in the Residual phase?
- Period between psychotic episodes
- Negative symptoms are still present and patient is not back to “normal”
What is Alogia?
Poverty of speech- no informative information
What are delusions?
false beliefs not correctable by logic or reason
What does delusions commonly consist of?
paranoid thinking and preoccupation with the supposedly threatening behavior of others
What are somatic delusions?
delusions that revolve around issues of bodily decay or infestation
What illusions?
distortions of reality creating misperceptions of real external stimuli
What are hallucinations?
creating stimuli where none exists. Sensory perceptions not associated with real external stimuli
What is the most common hallucinations?
auditory
What is thought blocking?
an abrupt stop in the train of thought
What is polydipsia?
excessive water drinking without appropriate physiologic need
What do you have to be careful with in patients that are experiencing schizophrenia?
“Water intoxication”
What are the symptoms of water intoxication?
confusion, lethargy, psychosis, seizure, death all due to cerebral edema
What is emergency detention?
removing the patient’s rights and ability to checkout form care for 48hrs due to potential threat to their own or others safety
In Texas who can place a person on emergency detention?
police officer or judge
What is the treatment of choice for schizophrenia?
antipsychotic meds
What are the 2 common 1st generation antipsychotics used in the txt of schizophrenia?
Haloperidol and Chlorpromazine (Thorazine)
What are two extrapyramidal side effects of 1st gen antipsychotics?
acute dyskinesias and dystonia
How can dyskinesia and dystonia be treated?
Diphenhydramine (Bendryl)
What syndrome can develop due to the extrapyramidal side effects of typical antipsychotics?
Neuroleptic malignant syndrome
A life threatening neurologic emergency characterized mental status change, rigidity, fever, and autonomic dysfunction?
Neuroleptic malignant Syndrome
What are 3 common 2nd generation antipsychotics used in the txt of schizophrenia?
Clozapine, Olanzapine, Risperidone
What is the difference between the typical and atypical antipsychotics?
extrapyramidal side effects- much less severe in 2nd generation
What are sde of atypical antipsychotics?
weight gain, QTC prolongation, Myocarditis, Sexual dysfunction
Which meds are more expensive?
2nd gen antipsych
There is a inverse relationship between what two things?
stability of living situation and amount of antipsychotic meds
In prognosis what symptoms can be treated successfully with meds?
positive symptoms
Which two symptoms contribute more to long term disability
negative symptoms and cognitive
What is delusional disorder?
a psychosis in which the predominant symptom is a persistent delusion for > 1mo
What two things are not affected in delusional disorder?
intellectual and occupational activities
What is the month criteria for delusional disorder?
presence of >1 delusions with a duration of one 1 MONTH
What is a erotomanic type delusion?
the pt believes that another person, who is usually famous or in some kind of higher status, is secretly in love with her or him
What is grandiose type?
pt believes he/she has special prominence or talent, unusual fame, or major achievements
What is jealous type?
pt believes that a spouse or lover is unfaithful and finds “evidence” to support the delusion, accuses them, and relentlessly ties to substantiate the offense
What is persecutory type?
pt is typically preoccupied by a delusion that he or she is being persecuted, conspired against, or potentially harmed
What is somatic type?
pt believes that something awful is wrong w/ his/her body
What is mixed type?
no one delusional theme predominates
What is unspecified type?
dominant delusional belief cannot be clearly determined
What is the 1st Txt for delusional disorder?
2nd gen antipsychoitc
There have been no clinical trials of what two things in delusional disorder?
cognitive behavioral or psychosocial therapy
What are schizoaffective disorders?
cases that fail to fit within either schizophrenic or affective (depressive)
What is the month criteria for schizoaffective disorder?
psychotic symptoms linger for longer than 2wks, but are not permanent
What three meds can be used for schizoaffective disorder?
mood stabilizers, antidepressants, 2nd gen antipsychotics
What is schizophreniform disorder?
similar symptoms to schizophrenia except that the duration of prodromal, acute, and residual symptoms is longer than 1 month but less than 6mo
What is the month requirement for schizophreniform?
symptoms last at least 1 mo but less than 6 mo
What is schizophreniform disorder treated with?
long term therapy and 2nd gen antipsychotics
What is the requirement for brief psychotic disorder?
symptoms lasting less than 1 mo (at least 1 day)
Treatment for brief psychotic disorder?
therapy long term and 2nd generation antipsychotics while symptoms are active
