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NMSP Exam 1*** > [CLMD CIS] Clinical Approach to Psychotic Disorders [Cooley] > Flashcards

[CLMD CIS] Clinical Approach to Psychotic Disorders [Cooley] Flashcards

1
Q

Describe a person with schizotypal personality disorder

A

People with schizotypal personaility disorder are described as:

  • Odd/eccentric
  • Few (if any) close relationships
  • Severe anxiety/avoid social situations
  • Flat emotions
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2
Q

What is the difference between schizotypal personality disorder vs. schizophrenia?

A

Schizotypal personality disorder may experience brief psychotic episodes with delusions/hallucinations; the episodes are NOT AS FREQUENT, PROLONGED or INTENSE as schizophrenia

Schizotypal personality disorder patients can usually be made aware of the difference b/w their disorted ideas and reality (those w/ schizophrenia generally CANT be swayed from their delusions)

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3
Q

What is the peak onset time of schizophrenia?

A

Late adolescence/early adulthood

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4
Q

What are precipitating events for schizophrenia?

A

Psychosocial stressors

Traumatic events

Drug/alcohol abuse

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5
Q

Symptoms of schizophrenia

Positive vs Negative symptoms

Which one is associated with a better/worse diagnosis?

A

Positive symptoms = better prognosis

Negative symptoms = poor prognosis

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6
Q

What are prodromal signs/sx of schizophrenia?

A

Few close friends as adolescents

Minimal social activities

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7
Q

Is there a genetic component to the etiology of schizophrenia?

A

YES!

Although it does NOT account for the entire eitiology.

In twin studies, monozygotic twins showed 40-50 percent concordance rate. Dizygotic twins showed 10-15 percent concordance.

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8
Q

What are potential enviornmental contributors to the etiology of schizophrenia?

A

Several early life complications (ELCs)

Adverse events in:

  • pregnanc
  • labor
  • delivery
  • early in neonatal life
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9
Q

What is one particular pre-natal exposure that can increase the risk of aquiring schizophrenia by 7 times?

3 times?

A

7 times more likely: Prenatal exposure to influenza virus

3 times more likely: Maternal upper respiratory infection during any time in pregnancy

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10
Q

What is the “revised dopamine hypothesis“ related to schizophrenia?

A

Hyperactive dopamine transmission in the mesolimbic areas

and

Hypoactive dopamine transmission in the prefrontal cortex

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11
Q

In positron emission tomography (PET) studies, where is schizophrenia particularly overactive with dopamine?

A

Hippocampus

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12
Q

What are features that define positive symptoms of schizophrenia?

A

Delusions

Hallucinations

Disorganized thinking (speech)

Grossly disorganized or abnormal motor behavior

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13
Q

What are delusions?

A

Delusions are fixed beliefs that are not likely to change in light of conflicting evidence

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14
Q

What is a hallucination?

A

A perception that occurs without an external stimulus

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15
Q

What are the most common type of hallucinations in schizophrenia?

A

Auditory hallucinations

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16
Q

What is the term for a hallucination that occurs when you are falling asleep?

A

Hypnagogic

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17
Q

What is the term for a hallucination that occurs when you are waking up?

A

Hypnopompic

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18
Q

Are hypnagogic or hypnopompic hallucinations indicative of psychosis?

A

NO!!!

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19
Q

What are some of the features of disorganized thinking (speech)?

A

Derailment/loose associations

Incoherence

Word salad

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20
Q

Grossly disorganized motor behavior:

[Define]

Catatonic behavior

A

Marked decrease in reactivity to the enviornment

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21
Q

Grossly disorganized motor behavior:

[Define]

Catatonic excitement

A

Purposeless and excessive motor activity without obvious cause

22
Q

Grossly disorganized motor behavior:

[Define]

Negativism

A

Resistance to instructions

23
Q

Grossly disorganized motor behavior:

[Define]

Inappropriate or bizarre posture

A

Waxy flexibility

24
Q

Grossly disorganized motor behavior:

[Define]

Mutism and stupor

A

Complete lack of verbal and motor responses

25
Q

Grossly disorganized motor behavior:

[Define]

Repeated stereotyped movements

A

Staring, grimacing, mutism and the echoing of speech

26
Q

What are the features the define negative symptoms of schizophrenia?

A
  • Diminished emotional expression
  • Avolition
  • Alogia
  • Anhedonia
  • Ascociality
27
Q

What is avolition?

A

Decrease in motivated self-initiated purposeful activities

28
Q

What is alogia?

A

Diminished speech output

29
Q

What is anhedonia?

A

Decreased abiilty to experience pleasure

30
Q

What are the specific diagnostic criteria for schizophrenia?

A

Two or more of the following for most of 1 month; at least ONE of the first 3 symptoms with prodromal or residual symptoms for at least 6mo

  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Grossly disorganzed or catatonic behavior
  5. Negative symptoms

*remember, first 4 symptoms are POSITIVE symptoms

31
Q

What is the time frame for diagnosing long standing schizophrenia?

A

Symptoms persist for at least 6 months

32
Q

What is the clinical picture of a patient with schizophrenia (catatonic type)?

A
  • Motoric immobility
  • Excessive motor activity
  • Extreme negativism or mutism

-Peculiarities of voluntary movement (posturing, stereotyped movements, mannerisms, grimacing)

33
Q

Schizophrenics are highly susceptible to ________

A

Schizophrenics are highly susceptible to SUICIDE

34
Q

To diagnose schizophrenia, what should you do first?

A

Rule out medical eitiologies:

Perform medical screening to rule out:

  • Seizure disorders
  • Metabolic disorders
  • Thyroid dysfunction
  • Brain tumor
  • Neurosyphillis
  • Street drug use
35
Q

What is a major comorbid category of condition associated with schizophrenia?

A

Autoimmune disorders

36
Q

What is the treatment fo acute psychosis in schizophrenia?

A

Hospitalization

IM injections of haloperidol, fluphenazine, lorazepam

37
Q

What is the treatment for stabilization phase of schizophrenia?

A

2nd gen antipsychotics

38
Q

What is the second generation antipsychotic drug associated with agranulocytosis?

A

Clozapine

39
Q

What is the second generation antipsychotic drug associated with QTc prolongation?

A

Ziprasidone

40
Q

What has been found to make symptoms of schizophrenia worse?

A

Insight oriented group and individual psychotherapy

(Making the patient more aware of their symptoms has been shown to make their symptoms WORSE!)

41
Q

What are the diagnostic criteria of Delusional disorder?

A
  • Presence of one or more delusions lasting at least 1 month
  • Functioning is not impaired
42
Q

What is the time frame for diagnosis of brief psychotic disorder?

A

Episode disturbance of at least 1 day but less than 1 month

43
Q

What is the time frame of schizophreniform disorder?

A

Episode of the disorder that lasts at least 1 month but LESS THAN 6 months

44
Q

What are the diagnostic criteria of schizoaffective disorder?

A

Delusions or hallucinations for 2 or more weeks in the ABSENCE of a major mood episode

45
Q

What is substance/medication-induced psychotic disorder?

A

Presence of delusions and/or hallucinations that develop with the introduction or withdrawal of substance/medication

46
Q

What are the timelines for

Schizophrenia

Schizophreniform

Brief psychotic disorder

A

Schizophrenia = > 6 months

Schizophreniform = 1-6 months

Brief psychotic disorder = <1 month

47
Q

What is schizoid?

A

Very introverted

Voluntarily withdraws from social interactions

48
Q

What is schizotypal?

A

Schizoid symptoms

+

Magical thinking/odd behavior

49
Q

What is schizophrenia?

A

Schizotypal

+

Psychosis

50
Q

What is schizoaffective?

A

Schizophrenia

+

Mood Disorder

51
Q
A

NMSP Exam 1*** (21 decks)

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