CHAPTER 6 PSYCH Flashcards
(105 cards)
1
Q
A prototype psychotic illness characterized by
chronic course,
deterioration in social and occupational functions,
and positive (delusion, hallucination) and negative
(flat affect, alogia, avolition) symptoms
A
Schizophrenia
2
Q
DSM criteria for Schiz
Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition, Text Revision (DSMIV-
TR) diagnostic criteria
The presence of at least two of five characteristic positive
or negative symptoms for at least 1 month:
A
delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, or negative symptoms
3
Q
In Shiz
only need one of five if the:
A
delusions are bizarre or a voice or voices
are keeping running commentary on the person’s behavior or two or more voices are conversing
4
Q
Other criteria for Schiz
A
b. Deterioration in social, occupational, and interpersonal
relationships
c. Continuous signs of the disturbance for at least 6 months (can include prodromal or residual symptoms like
amotivation)
d. Schizoaffective disorder and mood disorder with psychotic features have been ruled out
e. Not due to effects of substances or general medical
condition
5
Q
hallmarks of schizophrenia
A
Psychotic symptoms
6
Q
In Schiz:
patients experience a confusion of boundaries between
themselves and the world surrounding them, often called
_______
A
“a loss of ego boundaries
7
Q
Postive Sz of Schiz
A
delusions, hallucinations, bizarre behavior
8
Q
Negative symptoms of Schiz
A
blunting of affect, autism, ambivalence, social withdrawal, poverty of speech
9
Q
MC hallucination
A
auditory hallucinations are the
most common
10
Q
Firmly held false beliefs that can be bizarre or nonbizarre
(beliefs unique to certain cultural or religious
groups are not synonymous with delusions)
A
Delusions
11
Q
Types of Delusions
A
Somatic, grandiose, paranoid, religious, nihilistic,
sexual, persecutory, delusions of reference, delusions
of thought (insertion, withdrawal, control,
broadcasting)
12
Q
Belief that a person closely related to him or her has been replaced by a double
A
Capgras syndrome
13
Q
Identifies a familiar person in various other people he or she encounters; even if no physical resemblance, he or she maintains they are psychologically identical
A
Fregoli synrdrome
14
Q
Belief that penis is getting smaller and will
disappear
A
Koro
15
Q
Self-mutilation driven by delusions
A
Van Gogh syndrome
16
Q
Belief that thoughts can be implanted into the brain
A
Thought insertion
17
Q
Negative symptoms in Schiz:
_________ speech that is empty or with decreased
spontaneity
A
Alogia:
18
Q
Negative symptoms in Schiz:
________: sparsity of emotional reactivity
A
blunting
19
Q
Negative symptoms in Schiz:
______unable to initiate or complete goals
A
Avolition
20
Q
Other common negative symptoms in Schiz:
A
anhedonia
(unable to experience pleasure), inability to concentrate
or “attend,” inappropriate affect, poor hygiene
21
Q
Other Sx associated with Schiz
A
1) Poor insight into illness
2) Abnormalities of eye movements (increased frequency
of blinking and abnormal saccades during test of
smooth pursuits)
3) Decreased stage IV sleep
4) Loss of normal gracefulness of body movements
22
Q
Other Sx associated with Schiz
A
5) Up to 25% may have shown schizoid traits before
schizophrenia developed
6) Tend to be less interested in sexual activity
7) Up to 10% of schizophrenics commit suicide within
first 10 years of their illness
8) Up to 20% of schizophrenics drink excessive amounts
of water, which may lead to chronic hyponatremia
and possible water intoxication
9) Alcohol and drug abuse is common, and schizophrenics
smoke cigarettes three times more than the general
population
23
Q
Subtypes of Schiz
A
Paranoid (best prognosis), disorganized, catatonic, undifferentiated, residual
24
Q
Subtype of Schiz
a) Presence of delusions (often persecutory)
b) Frequent auditory hallucinations
c) Onset of illness (late 20s or 30s) later than for
other subtypes
d) More likely to marry and have children
A
Paranoid (best outcome)
25
Subtype of Schiz
a) Display disorganized, nonproductive behaviors
and demonstrate disorganized speech patterns
b) Exhibit flat or inappropriate affect; grimacing is
common
c) Can act silly or childlike and burst out laughing for
no reason
d) Delusions and hallucinations are less organized
and fragmentary
e) Earlier onset
Disorganized (formally called hebephrenic)
26
Subtype of Schiz
i) Motoric immobility (catalepsy, stupor)
ii) Excessive motor activity
iii) Extreme negativism
iv) Stereotypies, mannerisms, grimacing
v) Echolalia, echopraxia
Catatonic (less commonly seen now than in previous
| years
27
_________ these patients do not satisfy criteria
| for any other schizophrenia subtype
Undifferentiated:
28
these patients
no longer have any major psychotic symptoms but
still exhibit evidence of the illness, with negative
symptoms or at least 2 other odd or eccentric behaviors
or perceptual experiences
Residual
29
Prognosis of Schizophrenia
Chronic, usually early onset, poor long-term outcome,
| devastating illness
30
Phases of Schizophrenia
Prodromal phase, Active phase, Residual phase
31
Characterize Prodromal phase of Schizophrenia
often prolonged period of social
withdrawal, delayed developmental milestones, awkward
in motor skills, loss of interest in self-care
32
Good prognostic factors for Schiz
a. Acute onset, short duration, no previous psychiatric
history, no family history of schizophrenia
b) Mood symptoms present, sensorium clouded
c) No obsessive-compulsive disorder, no
assaultiveness
33
Good prognostic factors for Schiz
```
d) Premorbid functioning good, high socioeconomic
class
e) Married, good psychosexual functioning
f) Normal findings on neuroimaging
```
34
Poor prognostic factors for Schiz
a) Insidious onset, chronic duration, psychiatric history
present, positive family history of
schizophrenia
b) Mood symptoms absent, sensorium clear
c) Obsessive-compulsive disorder is present,
assaultiveness is present
35
Poor prognostic factors for Schiz
```
d. Poor premorbid functioning, low socioeconomic
class
e) Never married, poor psychosexual functioning
f) Structural abnormalities present on neuroimaging
```
36
Epidemiology of Schiz
a. Prevalence over lifetime is about 1.0% (no differences
worldwide)
b. Average age at onset: men, _______ years (17-27 years); women, _____ years (17-37 years)
c. Male (M):Female (F) equal frequency
21
27
37
d. M>F in ________
e. F>M in _______
f. Onset before age 10 and after age 45 are uncommon
severity of illness, negative symptoms, suicide risk
mood comorbidity, better prognosis, better
social functioning
38
Etiology of Schiz
_______ idea has strong support: the
subject may have genetic predisposition to develop
schizophrenia but does not manifest it unless other factors are encountered (e.g., environmental stressors)
“Two-hit” or “multiple-hit”
39
In Schiz
Most consistent finding is ______
ventricular enlargement,
| especially third and lateral ventricles
40
In Schiz
Selective reduction in size of :
frontal lobe, basal ganglia,
thalamus, and limbic regions, including the hippocampus
and medial temporal lobe
41
In Schiz
Increased incidence of
1) Cavum septum pellucidum
| 2) Partial callosal agenesis
42
Functional neuroimaging of Schiz
a. __________: negative
symptoms and neurocognitive deficits
b. Positron emission tomographic (PET) studies implicate:
Hypofrontality (frontal and prefrontal cortex)
frontal cortex (orbital, dorsolateral, medial), anterior cingulate gyrus, thalamus, several temporal lobe subregions, and cerebellum
43
anatomic substrate for visual hallucinations
in schizophrenia:
_________ is responsible for visual recognition
of objects and faces
Inferotemporal cortex
44
Neuropathology of Schiz
a. Decreased cell density in the _____
b. Displacement of interneurons in _____
dorsomedial nucleus of thalamus
frontal lobe cortex
45
1) Dopamine-blocking drugs seemed to ________ psychotic symptoms (antipsychotics)
lessen
46
Five types of dopamine receptors: D1, D2, D3, D4,
D5
a) D1: located in ______ and ________
b) D2: located in _______
c) D3 and D4: high concentration in the____
d) D5: located in _________
cerebral cortex and basal ganglia
striatum
limbic system
thalamus, hippocampus, and
hypothalamus
47
receptor occupancy of antipsychotic medications
1) ________: D2 receptors (78% receptor occupancy), no
obvious D1 receptors
2) ______: D2 receptors (48%), D1 receptors (38%-
52%),
_______receptors are associated with fewer
extrapyramidal symptoms
Typicals
Atypicals
D1
48
Mainstay treatments: antipsychotics (D2 receptor blockers
[postsynaptic])
b. Treatment
1) First line, _____ (may improve neurocognitive impairment in schizophrenia
examples are
atypicals
risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), aripiprasole (Abilify)
49
Second line of Tx for Schiz: _____, is atypical, expensive,
and needs monitoring because of the potential
for severe agranulocytosis
clozapine (Clozaril)
50
Maintenance duration for Schiz
at least 1 to 2 years after the
| initial psychotic episode
51
Electroconvulsive therapy (ECT): schizophrenia does
not typically respond to ECT, but it could be considered
for _______
catatonic schizophrenia
52
Goal of Psychosocial rehabilitation for Schiz
1. Restore the patient’s ability to function in the
community
2) Appropriate/affordable housing, group homes
3) Vocational training
4) Assertive community treatment
53
In Schizophreniform d/o, Duration of clinical signs and symptoms is less than ______
6
| months
54
In Schizophreniform d/o:
At least two of the following:
delusions, hallucinations,
disorganized speech, disorganized behavior or catatonia,
or negative symptoms
55
In Schizophreniform d/o:
a. Similar to schizophrenia except for_____
b. ________ fully recover within 6 months
c. 66% usually progress to schizophrenia or schizoaffective
disorder
duration
33%
56
In Schizophreniform d/o:
Good prognostic factors:
onset of psychosis within _____weeks after change of behavior/functioning,
good premorbid functioning,
______
________
4
positive symptoms,
confusion and disorganization at peak of psychotic symptoms
57
Prominent mood symptoms and at least 2 weeks of
| psychotic symptoms in the absence of mood symptoms
Schizoaffective Disorder
58
In Schizoaffective Disorder:
a. Uninterrupted period during which a mood disorder
(major depression, mania, or mixed episode) coexists
with symptoms of the _______
b. Must have delusions or hallucinations present for 2
weeks or more in absence of ______
c. Meets criteria for a mood disorder for a substantial periodof time during the illness (active and residual periods)
d. Symptoms not due to substances, medications, or
general medical condition
active phase of schizophrenia.
mood symptoms
59
Schizoaffective Disorder
Course
a. Prognosis: better than schizophrenia, but worse than
______
b. Suicide risk: ______
major depression
10%
60
_______ is most effective
| but not without risk in Tx of Schizoaffective do
(clozapine
61
Schizoaffective Disorder
________can worsen illness, selective serotonin reuptake inhibitors (SSRIs), and trazodone can be beneficial for_______
tricyclic antidepressants (TCAs)
mood
component
62
Characterized by nonbizarre delusions and does not
| affect other areas of a patient’s life
Delusional Disorder
63
Delusional disorder ________ is the relatively
| more common delusional disorder
persecutory type
64
Overview of DSM-IV-TR criteria for delusional disorder
a. Nonbizarre delusions for______ or more months
b. Active-phase symptoms of ______ have not been
met
c. Functioning usually is not impaired, behavior is not odd
d. If present, _______symptoms are brief in relation to period of illness
e. Not caused by substances or general medical condition
1
schizophrenia
mood
65
Common defense mechanisms for delusional disorder:
denial, reaction formation,
| projection
66
Etiology and pathophysiology of Delusional disorder
a. Not related to schizophrenia or mood disorders
b. Psychosocial stressors may be involved
c. Genetic factors may be important
d. Neurologic injury may precipitate or worsen the disorder
67
Delusions are nonbizarrre, persistent
Difficult to treat: denial of illness, difficulty with
trust
Prevalence: 0.03%, F>M, onset in middle age
Functioning usually not impaired
Delusional Disorder
68
Delusional Disorder
________ antipsychotic agent or high-potency
typical antipsychotic agent
1) Usually helps with anxiety and intensity of delusion
2) _____ can be helpful, even apart from depression
3) ______ is helpful for somatic delusional
disorder
atypical
SSRIs
Pimozide (Orap)
69
1. Shorter duration than other psychotic disorders, sudden onset and termination of symptoms
2. Is often precipitated by a stressor, may occur without
an apparent antecedent
Brief Psychotic Disorder
70
Overview of DSM-IV-TR criteria for BPS
a. At least one of the following symptoms for 1 or more
days but less than 1 month:
b. Not a mood disorder with psychotic features, schizoaffective disorder, schizophrenia, substance-induced, or due to general medical condition
delusions, hallucinations,
disorganized speech, grossly disorganized or catatonic
behavior
71
In BPS
More commonly seen in patients with _____ and _________ disorders
personality (borderline or histrionic) and dissociative
72
In BPS course is:
Brief, sudden onset of psychosis, with full return to premorbid functioning within a month
73
In BPS
Factors associated with good prognosis:
```
sudden onset,
short duration,
severe stressor,
prominent mood symptoms,
maintenance of affective reactivity,
prominent confusion at peak of psychosis
```
74
In BPS
Factors associated with good prognosis:
```
sudden onset,
short duration,
severe stressor,
prominent mood symptoms,
maintenance of affective reactivity,
prominent confusion at peak of psychosis
```
75
In BPS
______ completely recover, and in the other 20%
to 50% _______ disorder may be
diagnosed
50% to 80%
Schizophrenia or a mood
76
a. Presence of prominent hallucinations or delusions
b. Evidence points to substance or medication as a cause of symptoms
c. Not better accounted for by other psychotic disorder or
as part of a delirium
Substance-Induced Psychotic Disorder
77
Work-up for Substance-Induced Psychotic Disorder
1) ________, other stimulants
2) Alcohol, benzodiazepines, barbiturates
3) _______ (lysergic acid diethylamide [LSD],
phencyclidine [PCP], marijuana, mushrooms)
4) ________ (jimson weed, trihexyphenidyl)
5) Medications (glucocorticoids, belladonna alkaloids
Cocaine, amphetamines, ephedrine
Hallucinogens
Anticholinergic agents
78
a. Psychotic symptoms are present
b. Not enough information to make a specific diagnosis
c. May have contradictory information
Psychotic Disorder Not Otherwise Specified
79
Types of Mood disorders
```
major depressive disorder,
dysthymicdisorder,
bipolar I disorder,
bipolar II disorder,
cyclothymic disorder,
substance-induced mood disorder,
mood disorder due to general medical condition,
mood disorder not otherwise specified
```
80
Characterized by severely depressed mood and/or anhedonia
leading to deterioration and inability to function
socially and occupationally
Major Depressive Disorder
81
MDD criteria
“SIG E CAPS” (useful mnemonic for depression)
Need five symptoms for 2 weeks, must also have
depressed mood or anhedonia
```
S—sleep disturbance
I—loss of interest
G—guilt
E—loss of energy
C—loss of concentration
A—appetite change (gain/loss)
P—psychomotor agitation/retardation
S—suicidal ideations
```
82
MDD
Chronic if full criteria are met for at least _________—
clinically challenging!
2 years
83
In MDD
Melancholic feature specifier
a) Loss of pleasure in all or almost all activities or lack
of reactivity to usually pleasurable stimuli and
b) At least three of the following:
distinct quality of depressed mood,
mood worse in the morning,
early morning awakening,
marked psychomotor retardation or agitation,
marked anorexia or weight loss, or excessive or inappropriate guilt
84
In MDD
Atypical feature specifier
a) Mood reactivity: _________
b) At least two of the following:
brightens in response to positive events and
```
considerable weight
gain or increased appetite,
hypersomnia,
leaden paralysis,
long-standing interpersonal rejection sensitivity
```
85
In MDD
Catatonic feature specifier:
At least two of the following:
motoric immobility,
excessive motor activity, extreme negativism, peculiarities
of voluntary movement, echolalia or
echopraxia
86
In MDD
Postpartum onset specifier
a) Onset of episode within _____post partum
b) Can be life-threatening to mother and child
c) High rate of recurrence, _____
d) 1:500 to 1:1,000 births
4 weeks
30% to 50%
87
In MDD
Longitudinal course specifier
a) With full interepisode recovery
| b) Without full interepisode recovery
88
In MDD
Seasonal pattern specifier
a) _______ between onset of mood disorder
and a particular time of year and
b) __________(or change from depression to
mania or hypomania) also occur at a characteristic
time of year
Temporal relation
Full remissions
89
In MDD
_________specifier
a) At least four episodes of mood disturbance in 12
months
b) Episodes have either remission or change to opposite
polarity for at least 2 months between episodes
Rapid-cycling
90
In MDD
Most episodes clear spontaneously within _____ months
6
91
In MDD
________: the most serious complication
Suicide risk
92
Suicide in MDD
Females ________suicide more frequently than males Males ______ suicide more frequently than females
attempt
complete
93
Risk factors for suicide in MDD:
advancing age, feeling hopeless,
psychotic symptoms, severe agitation, substance
abuse, chronic medical illness, living alone
94
low levels of _______, ______, ____ in the limbic
| region may result in depression
serotonin,
| norepinephrine (NE), or dopamine
95
Regulates mood, hunger, sleep, impulsivity, cognition,
| pain, sexual responsiveness. What Nt?
Serotonin (5-hydroxytryptamine [5HT])
96
_________metabolite levels in cerebrospinal fluid are
| usually low in suicidal patients
5HT
97
________ maintains mood, energy, interest, motivation
NE:
98
______important in motivation, drive, and
| pleasure and reward
Dopamine:
99
in MDD
Family studies: first-degree relatives of patients with
major depressive disorder are ______more likely
than controls to have major depressive disorder
2× to 3×
100
In MDD
Twin studies_____ concordance rate in monozygotic
and ______% rate in dizygotic twins
: 50%
10% to 25
101
In MDD
1) Sleep time is usually decreased in patients with major
depressive disorder
2) Patients have shortened______of first rapid eye
movement (REM) period
3) Increased length of ______
latency
first REM period
102
Disorders associated with depression and mood disorders
1) Cancer (especially _______): 25% of cancer
patients often develop depression
2) Dementia: _______ of patients with Alzheimer’s disease
have depression
3) Seizure disorders: up to 60% of patients with seizure
disorders (especially _________) develop
depression
pancreatic
11%
temporal lobe epilepsy
103
Movement disorders
a) _____ of Parkinson’s patients can have depression
b) ______ incidence of depression among patients with
Huntington’s disease
c) _______ incidence of depression among patients with
Wilson’s disease
50%
40%
20%
104
1) _____hemisphere strokes lead to dysphoria
| 2) ______ hemisphere strokes lead to euphoria
Anterior left
Right
105
1) Depressed patients may have increased number of
focal signal hyperintensities in the______
2) Patients with major depressive disorder may have
smaller _______ AND _____
white matter
caudate nuclei and frontal lobes
