Schizophrenia Spectrum and Other Psychotic Disorders

Question 1

What is delusional disorder?

Answer 1

otherwise normally functioning person with a belief in something that does not exist
-one or more non-bizarre delusions of thinking - such as expressing beliefs that occur in real life such as being poisoned, being stalked, being loved or deceived, or having an illness, provided no other symptoms of schizophrenia are exhibited

Question 2

What are the characteristics of delusional disorder?

Answer 2

• no accompanying prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect
• beliefs lasting >1 month
• functioning is otherwise unimparied

Question 3

What is the tx of delusional disorder?

Answer 3

• psychotherapy

- pharmacologic - atypical antipsychotic agents

Question 4

What is schizoaffective disorder?

Answer 4

a mental health condition including schizophrenia and mood disorder symptoms

• a combination of symptoms of schizophrenia and mood disorder, such as depression or bipolar disorder
• symptoms may occur at the same time or at a different times

Question 5

What are the characteristics of schizoaffective disorder?

Answer 5

• delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness
• symptoms that meet criteria for a major mood episode are present for th majority of the total duration of the active and residual portions of the illness

Question 6

What is the tx of schizoaffective disorder?

Answer 6

• psychotherapy

- pharmacologic - atypical antipsychotic agents, anticonvulsants, and Selective serotonin reuptake inhibitors (SSRI)

Question 7

What is schizophrenia?

Answer 7

major psychosis for greater than 6 months + difficulty functioning

Question 8

What are the characteristics of schizophrenia?

Answer 8

two (or more) of the following, each present for a significant portion of time during 1-month period (or less if successfully treated)

• At least one of these must be (1), (2), or (3):
• delusions
• hallucinations - auditory (most common), tactile olfactory visual
• disorganized speech/though processes unable to stay on topic (loose associations) unable to provide answer related to questions (tangential response)
• symptoms impair daily functioning
• disorganized behavior - unpredictable agitation, inappropriate sexual behavior, child-like silliness, catatonic motor behavior, lacking self-care/hygiene
• negative symptoms - blunted affect, poor posture, lack goal-directed activities/initiative
• impairment inability to hold a job or maintain relationships
• continuous signs of the disturbance persist for at least 6 months

Question 9

What is the tx for schizophrenia?

Answer 9

• atypical antipsychotics: (risperidone, olanzapine, aripiprazole, ziprasidone, quetiapine, asenapine, paliperidone) for negative symptoms and fewer side effects
• clozapine is an atypical antipsychotic that is not considered first line because of the propensity to cause agranulocytosis
• typical neuroleptics - dopamine antagonists (haloperidol, chlorpromazine, thioridazine, loxapine, fluphenazine) best for positive symptoms

Question 10

What is the tx for resistant cases of schizophrenia?

Answer 10

clozapine or antipsychotic + another med (Benzodiazepines, carbamazepine, valproate, lithium)

• behavioral-oriented/group/family therapy
• watch for side effects: extrapyramidal, parkinsonian symptoms, neuroleptic malignant syndrome, tardive dyskinesia - more likely with typical neuroleptics; clozapine may cause agranulocytosis

Question 11

What is schizophreniform disorder?

Answer 11

major psychosis for >1 month but < 6 months and no social or occupational impairment
-schizophrenia and schizophreniform disorder are essentially the same expect for the fact that the duration of symptoms found in schizophreniform disorder is longer than 1 month and less than 6 months and there is no social or occupational impairment

Question 12

What is the tx for schizophreniform disorder?

Answer 12

• psychotherapy
• medications: atypical antipsychotics as the usual drug of choice
• patients who do not respond to the initial atypical antipsychotic may benefit from being switched to another atypical antipsychotic, the addition of a mood stabilizer such as lithium or an anticonvulsant, or being switched to a typical antipsychotic