Schizophrenia Spectrum And Other Psychotic Disorders

Question 1

Delusional disorder

Answer 1

• 1 or more delusion lasting at least 1 month without other psychotic symptoms
• +/ nonbizarre= possible but highly unlikely (ex. Being poisoned)
• apart from delusion, behavior is not obviously odd or bizarre and no significant impairment of function
• not explained by another disorder

Question 2

Schizoaffective disorder

Answer 2

-schizophrenia + mood disturbance (MDD or manic episode)

Question 3

Schizophrenia

Answer 3

->6 months duration of illness with 1 month of acute symptoms along with functional decline*

• 1% of population
• MC in males
• onset:
  
  • men= early 20s
  • women= late 20s

Question 4

Schizophrenia- RF

Answer 4

• family history

- 10% incidence with first degree relative

Question 5

Schizophrenia- brain changes

Answer 5

• decreased CNS gray matter
• increased size of ventricles
• increased CNS dopamine receptors

Question 6

Schizophrenia- criteria

Answer 6

• 2 or more
• at least 1 must be hallucination, delusion, or disorganized speech
• positive symptoms:
  
  • hallucinations
  • delusions
  • disorganized speech and thinking
  • abnormal behavior
• negative symptoms:
  
  • flat emotional affect
  • emotional withdrawal
  • lack of emotional expression
  • avolition- lack of self-motivation
  • lack of communication and reactivity
  • silent patients
  • poor eye contact

-catatonia may be specifier of other psych disorders besides schizophrenia

Question 7

Schizophrenia- positive symptoms

Answer 7

-thought to be caused by excess dopamine receptors in mesolimbic pathway

Question 8

Schizophrenia- negative symptoms

Answer 8

• thought to be caused by dopamine dysfunction in mesocortical pathway
• serotonin may also play a role

Question 9

Schizophrenia- hallucinations

Answer 9

-sensory perception without physical stimuli

• auditory (MC)- sound or voice, often in third person or can be commands
• visual- simple (flashing light) or complex (faces)
• olfactory- stench or foul smells common
• tactile- insects on skin or being touched
• somatic- sensation arising from within body
• gustatory- can be part of persecutory delusions (tasting poison in food)

Question 10

Schizophrenia- delusions

Answer 10

-fixed belief held with strong conviction despite evidence to contrary

• persecution- person or force is interfering, observing, or wishes harm
• reference- random events take on personal significance (directed at them)
• control- some agency takes control of thoughts, feelings, and behaviors
• grandiose- unrealistic beliefs in one’s powers and abilities
• nihilism- exaggerated belief in futility of everything and catastrophic events
• erotomanic- believes another person is in love with them
• jealousy- somebody is suspected of being unfaithful
• doubles- believes a family member or close person has been replaced by an identical double

Question 11

Schizophrenia- management

Answer 11

• acute psychotic episodes= hospitalization
• medication:
  
  • antipsychotics: dopamine receptor antagonists
    
    • first line= second generation* (risperidone, olanzapine, quetiapine)
      
      • clozapine may be used in refractory cases (no significant improvement after 2-6 weeks of pharmacological therapy)
      • MOA: dopamine and serotonin antagonists
    • first generation: better at treating positive symptoms, but associated with increased extrapyramidal symptoms
      
      • haloperidol and chlorpromazine

Question 12

Schizophreniform disorder

Answer 12

-meets criteria for schizophrenia, but <6 months duration*