First Aid Psych Clerkship Flashcards
(35 cards)
Delusions of persecution/ paranoid delusions
CIA is after me and tapped my phone
Ideas of reference
TV characters are speaking directly to me
Delusions of control
Thought broadcasting: thoughts are being heard by others
Thought insertion: belief that others’ thoughts are being placed in one’s head
Delusions of grandeur
I am the all-powerful son of god
Delusions of guilt
I am responsible for all of the world’s wars
Somatic delusions
Belief that one is infected with a disease or illness
Ddx of psychosis
Psychotic disorder due to another medical condn Substance/med-induced psychotic disorder Delirium/dementia Bipolar disorder Major depression Schizophrenia and subsets Schizoaffective disorder Delusional disorder
Medical causes of psychosis
CNS disease- cerebrovascular disease, MS, neoplasm, Alzheimer, Parkinson, Huntington, tertiary syphilis, epilepsy, encephalitis, prion, neurosarcoidosis, AIDS
Endocrinopathies- Addison/Cushing, hyper/hypothyroidism, hyper/hypocalcemia, hypopituitarism
Nutritional/ Vitamin def- B12, folate, niacin
Other- Connective tissue disease, SLE, temporal arteritis, porphyria
Substances that can cause psychosis
Anesthetics Antimicrobials Corticosteroids Antiparkinonian agents Anti-convulsants Antihistamines Anticholinergics Antihypertensives NSAIDs Digitalits Methylphenidate Chemotherapeutic agents Alcohol Cocaine Hallucinogens (LSD, Ecstacy) Cannabis Benzos/ Barbiturates Inhalants PCP (phencyclidine)
Schizophrenia
Positive symptoms- hallucinations, delusions, bizarre behavior, disorganized speech (respond well to typical antipsychotics)
Negative symptoms- flat or blunted affect, anhedonia, apathy, logia, and lack of interest in socialization (atypical antipsychotics help more with this)
Cognitive symptoms- impaired attention, executive function, and working memory
Phases of schizophrenia
Prodromal- declined function –> more socially withdrawn and irritable –> may have physical complaints, new-found interest in religion or the occult
Psychotic- perceptual disturbances, delusions, and disordered thought process/content
Residual- mild hallucinations or delusion, social withdrawal, and negative symptoms
DSM V criteria for schizophrenia
Two or more for AT LEAST 1 MONTH; but duration of illness for 6 MONTHS
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms
With at least one of them being 1, 2, or 3
if <1 mo: brief psychotic disorder
if 1-6mo: schizophreniform disorder
5 A’s of schizophrenia
- Anhedonia
- Affect (flat)
- Alogia (poverty of speech)
- Avolution (apathy)
- Attention (poor)
Pathways
Prefrontal cortical/ mesocortical (inadequate dopaminergic response responsible for negative symptoms)
Mesolimbic (excess dopaminergic response responsible for positive symptoms)
Tuberoinfundibular (blocked by antipsychotics- causes gynecomastia, galactorrhea, sexual dysfunction, etc)
Nigrostriatal (blocked by antipsychotics- causes Parkinsonism- tremor, rigidity, slurred speech, akathisia, dystonia, and other abnormal movements)
Other neurotransmitters in Schizophrenia
Increased: serotonin and NE
Decreased: GABA and glutamate
Imaging shows enlargement of ventricles and diffuse cortical atrophy and reduced brain volume
Schizophrenia- treatment
First gen (typical) antipsychotics: chlorpromazine, fluphenazine, haloperidol, and perphenazine- treats + symptoms
Second gen (atypical) antipsychotics: aripiprazole, asenapine, clozapine, iloperidone, lurasidone, olanzapine, quetiapine, risperidone, and ziprasidone
People who are treated with second gen antipsychotics require evaluation for metabolic syndrome: checking weight, BMI, fasting blood glucose, lipid assessment, and blood pressure
High potency- more risk of EPSE, low potency- extra risk of anticholinergic and antiadrenergic side effects
Treatment of Side effects
Anticholinergics for EPSEs- benztropine, diphenhydramine
Benzodiazepines, and beta-blockers: especially for akathisia
Weight-neutral second gens
Aripiprazole and ziprasidone
Thioridazine
Retinal pigmentation at high doses
Chlorpromazine- can cause deposits in the lens and cornea
Schizoaffective disorder
Unique because delusion or hallucinations are present for 2 weeks IN THE ABSENCE OF mood disorder; however mood symptoms otherwise are present for the majority of psychotic illness
Prognosis (best to worst)
Mood disorder with psychotic features > Schizoaffective disorder > Schizophreniform disorder > Schizophrenia
Brief psychotic disorder
1 day to 1mo of psychosis
Not diagnosed as brief psychotic disorder if patient has underlying personality disorder (e.g. borderline) wherein they may have transient, stress-related psychotic experiences
Delusional disorder
Usually non-bizarre delusions
Daily functioning NOT significantly impaired
Does not meet the criteria for schizophrenia as described previously
One or more delusions for at least one month
Treatment: generally independent, supportive therapy; antipsychotic meds
Culture-specific psychosis
Koro: penis recedes into body - Southeast Asia
Amok: violent outburst followed with suicide - Malaysia
Brain fag: Headache, fatigue, eye pain, and other somatic disturbances in male students- Africa
