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Psych Flashcards

1
Q

Psychosis

A

Break from reality involving delusions, perceptual disturbances, and/or disordered thinking

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2
Q

Delusions

A

Fixed, false beliefs that cannot be altered by rational arguments and cannot be accounted for by the cultural background of the individual.

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3
Q

Types of delusions

A

Paranoid delusions: irrational belief of persecutions.
Ideas of reference: thinking events are related to individual
Thought broadcasting: others can hear thoughts
Delusions of grandeur: belief of special powers
Delusions of guilt: false belief of responsibility

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4
Q

Hallucinations and associations

A

Auditory hallucinations: most commonly exhibited by schizophrenic patients.
Visual hallucinations: commonly seen with drug intoxication
Olfactory hallucinations: usually an aura associated with epilepsy
Tactile hallucination: usually secondary to drug abuse or alcohol withdrawal.

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5
Q

Illusion

A

Misinterpretation of an existing sensory stimulus. eg cat for shadow.

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6
Q

Differential diagnosis of psychosis

A 
Psychosis secondary to general medical condition
Substance induced psychotic disorder
Delirium/dementia
Bipolar disorder
MDD w/ psychotic features
Schizophreniform disorder
Schizoaffective disorder
Delusional disorder
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7
Q

Psychosis secondary to general medical condition

A

CNS disease: CVA, MS, neoplasm, PD, Huntington, temporal lobe epilepsy, encephalitis, prion disease.
Endocrinopathies: Addison/Cushing disease, hyper/hypothyroidism.
Nutritional/Vitamin def: B12, folate, niacin
Other: SLE, temporal arteritis, porphyria

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8
Q

Criteria for psychosis secondary to general medical condition

A

Prominent hallucinations or delusions
Symptoms do not occur only during episode of delirium
Evidence to support medical cause from lab area data, history, or physical

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9
Q

Psychosis secondary to medication or substance use

A

Prominent hallucinations or delusions
Symptoms do not occur only during episode of delirium
Evidence to support medication or substance-related cause from lab data, history, or physical
Disturbance is not better accounted for by a psychotic disorder that is not substance-induced

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10
Q

Schizophrenia positive symptoms

A

Hallucinations
Delusions
Bizarre behavior
Thought disorder

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11
Q

Schizophrenia negative symptoms

A

Blunted affect
Anhedonia
Apathy
Inattentiveness

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12
Q

Prodromal phase of schizophrenia

A

Decline in function preceding first psychotic episode, pt becomes socially withdrawn and irritable, w/w/o physical complaints or new found interest in religion

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13
Q

Psychotic phase of schizophrenia

A

Perceptual disturbances, delusions, and disordered thought process/content

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14
Q

Residual phase of schizophrenia

A

Occurs between episodes of psychosis. Marked by flat affect, social withdrawal, and odd thinking/behavior (negative symptoms). Note, pts can continue to have hallucinations despite treatment

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15
Q

Three phases of schizophrenia

A

Prodromal, psychotic, and residual

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16
Q

5 A’s of schizophrenia (negative symptoms)

A 
Anhedonia
Affect (flat)
Alogia (poverty of speech)
Avolition (apathy)
Attention (poor)
17
Q

Diagnosis of schizophrenia

A

2 or more at least 1 month: Delusions, Hallucinations, Disorganized speech, Grossly disroganized or catatonic behavior, Negative symptoms

  • significant social/occupational deterioration
  • duration of illness > 6 months (including early phases)
  • symptoms not due to medical condition
18
Q

Subtypes of schizophrenia and associations

A

Paranoid - highest functioning, older age of onset.
Disorganized - poor functioning, younger age of onset.
Catatonic - mute w/w/o motor immobility, echolalia (repeats words) and echopraxia (practices behaviors).
Undifferentiated - a little bit of everything
Residual - prominent negative symptoms

19
Q

Schizophrenia pathways and associations

A

Dopamine pathways:
Prefrontal cortical - responsible for negative symptoms
Mesolimbic - responsible for positive symptoms
Tuberoinfandibular - blocked by neuroleptics, causing hyperprolactinemia
Nigrostridal - blocked by neuroleptics, causing EPS s/e

20
Q

Schizophrenic head CT

A

enlargement of ventricles and diffuse cortical atrophy

21
Q

Poor prognosis factor in schizophrenia

A 
Early onset
Poor social support
Negative symptoms
Family hx
Gradual onset
Male sex
Many relapses
Poor premorbid function (social isolation, etc)
22
Q

List of typical neuroleptics

A

Chlopromazine
Thioridazine
Trifluoperazine
Haloperidol

23
Q

Mechanism of typical neuroleptics

A

Mostly D2 receptor antagonist.

24
Q

Side effects of typical neuroleptics

A

EPS
NMS
Tardive dyskinesia

25
Q

List of atypical neuroleptics

A 
Risperidone
Clozapine
Olanzapine
Quetiapine
Aripiprazole
Ziprasidone
26
Q

Mechanism of atypical neuroleptics

A

Serotonin receptor antagonist, some dopamine receptor antagonist effect

27
Q

Side effects of atypical neuroleptics

A

Lower incidence of EPS.

28
Q

Schizophreniform diagnosis

A

same as schizophrenia but lasting between 1 and 6 months.

29
Q

Anti-psychotic medications s/e EPS

A

Dystonia (spasm)
Parkisonism (resting tremor, rigidity, bradykinesia)
Akathisia (feeling restlessness)

30
Q

Treatment of EPS 2/2 antipsychotics

A

Benztropine, amantadine, benzodiazepines

31
Q

Anti-psychotic medications s/e anticholinergic symptoms

A

Dry mouth, constipation, blurred vision

32
Q

Treatment of anticholinergic symptoms

A

symptomatic

33
Q

Anti-psychotic medication s/e Tardive diskinesia

A

Darting or writhing movements of face, tongue, and head

34
Q

Treatment of Tardive diskinesia

A

D/C offending agent, substitute with atypical. Benzodiazepines, beta blockers, and cholinenomimetics for short term.

35
Q

Diagnosis of NMS

A

Confusion, high fever, elevated blood pressure, tachycardia, “lead pipe” rigidity, sweating, and elevated CPK levels

36
Q

Schizoaffective disorder

A

meets criteria for MDD, manic episode, or mixed episode.
Delusion and hallucinations for 2 weeks in absence of mood disorder (otherwise you might be looking as schizoaffective d/o vs mood d/o w/ psychotic features).

37
Q

Brief psychotic d/o

A

psychotic symptoms between 1 day to 1 month

38
Q

Treatment for brief psychotic d/o

A

brief hospitalization, supportive psychotherapy, course of antipyschotics for psychosis with benzodiazepines for agitation

39
Q

Diagnosis of delusional disorder

A

Non-bizarre, fixed delusions for at least 1 month
Does not meet criteria for schizophrenia
Not significantly affecting functioning

Psych (4 decks)

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