Test 4 - Psychosis Flashcards
for schizophrenia, at least __ of the 5 sx must be present
for at least __ mo
one sx must be __ (3)
2 sx
1 mo
delusions, hallucinations, disorganized speech
sx of schozophrenia
delusions
hallucinations
disorganized speech
grossly disorganized or catatonic behavior
negative sx
negative sx ex (2)
diminished emotional expression
avolition
what distinguishes schizophrenia from schizophreniform d.o and brief psychotic d.o
6 mo duration of schizophrenia
shizophreniform d.o lasts
1-6 mo
brief psychotic d.o lasts
1 day - 6 mo
in schizophrenia, level of functioning is
markedly below level achieved prior to onset
shizophreniform d.o lasts
1-6 mo
for schizophrenia, you need to r.o psychosis dt
drugs/meds
brief psychotic d.o lasts
1 day - 6 mo
sensory perceptions in absence of external stimuli
hallucinations
firmly held false beliefs
delusions
disruption in form of organization of thinking - incoherence, difficulty communicating, loose associations, thought blocking, echolalia, clanging
thought d.o
sx that are subtle and often detected only when neuropsychological tests are performed
cognitive sx
cognitive sx include
poor executive functioning
inability to sustain attention
problems w. working memory
prodromal/residual phase of shizophrenia involves
social isolation
impairment of functioning
peculiar behavior
impaired personal hygiene
blunted/inappropriate affect
odd beliefs
unusual perceptual experiences
apathy
mood issues > thought issues when euthymic
schizoaffective d.o
psychosis present only during manic/depressive episodes
bipolar d.o
scz w. < 6 mo duration
schizophreniform d.o
psychotic sx for 1 mo
brief reactive psychosis
fails to meet active phase of schizophrenia
schizotypal personality do
persistent delusions
delusional do
preoccupation w. one or more delusions or frequent auditory hallucinations
paranoid type
paranoid type do does not include (3)
disorganized speech
disorganized/catatonic behavior
flat/inappropriate affect
absence of prominent delusions, hallucinations, disorganized speech, or behavior
continued e.o disturbance (negative sx)
residual type
evaluation of psychosis
physical/neuro exam
med review
mental status
labs
tox screen
+/- brain imaging/EKG
extrapyramidal s.e (EPS) of antipsychotics
stiffness/shuffling gait
loss of automatic associated movements → parkinsinonian sx
EPS occur when > __% of D2 receptors are occupied
80
dose to block for tx of psychosis but avoid excessive blockaid to minimze EPS
minimal effective dosing
low potency antipsychotics are associated w. (2)
postural hypotn
somnolence
what is akathisia
sense of restlessness
tx for akathisia
decrease dose
bb
bzd’s
high potency/long exposure to conventional typical antipsychotics is associated w.
tardive dyskinesia
tx for tardive dyskinesia
decrease dose
switch to novel agents → clozapine
what is neuroleptic malignant syndrome
fever
muscle rigidity
two of: diaphoresis, dysphagia, tremor, incontinence, tachycardia, labile bp, leukocytosis, increased cpk
atypical antipsychotics (risperdal, zyprexa) are associated w.
prolactin elevation
prolactin elevation causes
amenorrhea
galactorrhea
gynecomastia
impotence
increased bone density
wt gain and DM are mc in __ agents (2)
novel
atypical
ex. zyprexa
clozapine can cause
agranulocytosis
mellaril (thioridizine) is associated w.
cardiac s.e
what drug offers best hope of tx after 2 other drugs have failed
clozapine
if 2 antipsychotics fail,
chances for success diminish rapidly
what might improve treatment resistant psychosis
augmentation w. mood stabilizers
supplementation w, another atypical antipsychotic
delusion for one month
delusional d,o
criteria for delusional d.o
one month
does not meet criteria for scz
fxn’ing not impaired (apart from delusion)
for dx of delusional dx symptoms can not
be better explained by another d.o
subtypes of delusions (6)
erotomanic
grandiose
jealous
persecutory
somatic
mixed
delusion that another person is in love w. you
erotomanic
belief that you have some defect or general medical condition
somatic delusion
delusion that you are being malevolently treated
persecutory
mixed delusions
more than one of the subtypes
antipsychotics moa
dopamine antagonists
key differentiator w. different antipsychotic meds
side effects ->
higher dopamine bockade, more eps w. higher potency/older meds
issue w. 2nd gen antipsychotics
metabolic syndrome
DM
