psych psychotic disorders Flashcards
(97 cards)
1
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axis 1
A
all diagnoses of mental illness (incl substance abuse and developmental disorders) not including personality disorders and mental retardation
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axis 2
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developmental (mental retardation) and personality disorders
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axis 3
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physical disorders (genral medical conditions)
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axis 4
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severity of psychosocial factors (homelessness, divorce, etc.)
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axis 5
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global assessment of function on scale of 0-100
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GAF limit for hospitalization
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less than 30
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roschach test
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interpretation of inkblots used to identify thought disorders and defense mechanisms
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thematic apperception test
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test taker creates stories based on pictures of people in various situations; used to evaluate motivations behind behaviors
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psychosis def
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distorted perception of reality
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delusions
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fixed false beliefs that cannot be accounted fro by the cultural background of the individual; categorized as bizarre or non-bizarre
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bizarre delusions
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false belief that is impossible
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ideas of reference
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belief that cues in the external environment are uniquely related to that individual
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thought broadcasting
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belief that one’s thoughts can be heard by others
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thought insertion
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belief that other people’s thoughts are being placed in one’s head
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delusions of grandeur
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belief that one has special powers beyond those of a normal person
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somatic delusions
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false belief that one is infected with a disease or has a certain illnes
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illusion vs hallucination
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illusion is misinterpretation of existing sensorystimulus, whereas hallucination is sensory perception without external stimulus
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auditory hallucinations typical of who?
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schizophrenic
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visual hallucinations typical in who?
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drug intox, drug and alc withdrawal, or delirium
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olfactory hallucinations
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seen in epilepsy
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tactile hallucinations
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usually secondary to drug abuse or alc withdrawal
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medical causes of psychosis
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CNS disease, endocrinopathies, nitritional/vit deficient states, other
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meds that may cause psychosis in some patients include
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corticosteroids, antiparkinsonian agents, anticonvulsants, antihistamines, anti-cholinergics, some antihypertensives like beta blockers, digitalis, methylphenidate, and fluoroquinolones
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drugs (not meds) that cause psychosis
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alcohol, cocaine, hallucinogens (LSD, ecstasy), marijuana, benzos, barbiturates, and PCP
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to make the dx of schizophrenia, patient must have sx for at least how long?
6 mos
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schizophrenia def
constellation of abnormalities in thinking, emotion, and behavior
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positive symptoms of schizophrenia
hallucinations, delusions, bizarre behavior, disorganized speech; these tend to respond more robustly to meds
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neg symptoms of schizophrenia
blunted affect, anhedonia, apathy, alogia, and lack of interest in socialization; often tx resistant
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cognitive sx of schizophrenia
impairments in attention, exec function, and working memory
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three phases of schizophrenia
prodromal, psychotic, residual
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prodrome of schizophrenia
decline in functioning that precedes the first psychotic episode
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psychotic phase of schizophrenia
perceptual disturbances, delusions , and disordered thought process
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residual phase of schizophrenia
occurs between episodes of psychosis; marked by flat affect, social withdrawal, and off thinking or behavior (neg symptoms)
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catatonic schizophrenic patients
stereotyped movement, bizarre posturing, rigidity
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what drug is considered when a patient fails typical and atypical psychotics?
clozapine
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criteria for schizophrenia
two or more of: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, neg symptoms; cause signif functional impairment; last at least 6 mos; sx not due to another cause
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five subtypes of schizophrenia
paranoid, disorganized, catatonic, undifferentiated, residual
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paranodi schizophrenic
often higher functioning, older patient
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disorganized schizophrenic
poor functioning, early onset; must have disorganized speech and behavior; mut have flat or inapprop affect
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catatonic schizophrenic
must meet at least 2 of the following: motor immobility, excessive purposeless motor activity; extreme negatism or mutism; peculiar movements; echolalia or echopraxia
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undifferentiated schizophrenic
characteristic of more than one or none of subtypes
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residual type schizophrenic
prominent negative symptoms (flattened affect or social withdrawal) with only minimal evidence of positive sx (such as hallucinations or delusions)
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echolalia
repeats words or phrases
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echopraxia
mimics behavior
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presentation in men vs women of schizophrenia
equal frequency, but men average of 20 years and women are 30 years; men tend to have more neg sx and more impaired social functioning than women
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genetic predisposition in schizophrenia
high
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postpsychotic depression
phenomenon of schizophrenic pateitns developing a major depressive episode after resolution of their psych sx
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downward drift hypothesis
people suffering from schizophrenia are unable to function well in society and hence enter lower socioeconomic groups
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pathophys of schizophrenia
increased dopamine in prefrontal cortex and mesolimbic pway
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prefrontal cortex
inadequate dopaminergic activity responsible for neg sx for schizophrenia
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mesolimbic dopamine pway in schizophrena
excessive dopaminergic activity responsible to pos symptoms
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tuberoinfundibular pway
blocked by neuroleptic; causes hyperprolactinemia, which may cause gynecomastia, galactorrhea, and menstrual irregularities
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nigrostriatal pway
blocked by neuroleptics; causes extrapyramidal sx
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akathisia
subjective sense or restlessness; inability to sit still
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other neurotransmitter abnormalities in schizophrenia other than dopamine
elevated serotonin, elevated norepi, decreased GABA, decreaed glutamate (NMDA) receptors
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ketamine
NMDA antagonist
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CT scans of patients with schizophrenia
enlarged ventricles and diffuse cortical atrophy
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neologism
use of words that have meaning only to the person who used them and is different from the orthodox meaning of the word
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first gen anti-psychotics used for schizophrenia
chlorpromazine, thioridazine, trifluoperazine, haloperidol; these are D2 antags
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first gen anti-psychotics and their use in schizophrenia
more effective against pos sx, with minimal impact on neg sx; side effects incl extrapyramidal sx, neuroleptic malignant syndrome, and tardive dyskinesia
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what are the second gen antipsychotics?
risperidone, clozapine, olanzipine, quetiapine, ariprazole, ziprosidone
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how are the second gen different than first gen anti-pscyhotics
second gen antagonize serotonin receptors as well as dopamine receptors, much lower incidence of EPS but incr risk of metabolic syndrome
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clozapine risk
agranulocytosis
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important side effects of antipsych medications
extrapyramidal sx, anticholinergic sx, metabolic syndrome, tardive dyskinesia, neuroleptic malignant syndrome, prolonged QT
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treatment for extrapyramidal sx associated with anti-psych use
antiparkinsonian agents (benztropine, diphenhydramine, etc.), benzos, beta blockers (specifically for athisia)
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anticholnergic sx
dry mouth, constipation, blurry vision
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treatment for metabolic syndrome assoc with second gen antipsychotics
consider switching to first gen antipsych or a more weight neutral second gen like ariprazole, or ziprasidone
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treatment of tardive dyskinesia assoc with second gen antipsychotics
discontinue offending agent and consider switching to atypical neuroleptc; benzos, beta blockers, and cholinomimetics can be used short term
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movements of tardive dyskinesia
usually persist even after withdrawal of offending drug; although less common, atypical neuroleptics can cause tardive dyskinesia in some patients
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symptoms of neuroleptic malig sydnrome
change in mental status, autonomic changes, "lead pipe" rigidity, sweating, elevated CPK, leukocytosis, and metabolic acidosis
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treatment of malignant neuroleptic syndrome
emergency withdrawal of meds
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major optho complication of thioridazine
irreversible retinal pigmentation
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major optho complication of chlorpromazine
deposits in lens and cornea
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schizophreniform disorder
same criteria as schizophrenia but sx last between 1 and 6 mos
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prognosis of schizophreniform
1/3 recover, whereas 2/3 progress to schizophrenia or schizoaffective
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treatment of schizophreniform disorder
3-6 mos of antipsychotics
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schizoaffective disorder
patients meet criteria for major depress disorder, manic episode, or mixed episode (during which criteria for schizophrenia are also met); have had delusions or hallucinations for 2 wks in absence of mood disorder sx
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prognosis for schizoaffective disorder patients
60-80 percent will progress to schizophrenia
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treatment for schizoaffective disorder
hospitalization and supportive psychotherapy; med therapy with antipsychotics and mood stabilizers; antidepressants or ECT may be indicated for treatment of mood symptoms
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brief psychotic disorder
patient with pscyh sx as defined for schizophrenia, but sx last from 1 day to 1 month; may be seen in reaction to extreme stress like bereavement, sexual assault
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treatment for brief psychotic disorder
brief hospitalization, supportive psychotherapy, course of antipsychotics for psychosis itself, and/or benzos for agitation
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delusional disorder
nonbizarre, fixed delusions for at least 1 month; does not meet criteria for schizophrenia, functioning in life not signif impaired
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delusional disorder occurs most commonly in what populations
patients over 40, immigrants, and the hearing impaired
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erotomanic type delusion
revolves around love
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gradiose type delusion
inflated self worth
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somatic type delusion
physical delusions
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persecutory type delusions
delusions of being persecuted
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jelous type delusion
delusions of unfaithfulness
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mixed type delusions
more than one type of delusions
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treatment for delusional disorder
try anti-psych meds, though these are usually ineffective;
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shared psychotic disorder
when a patient develops the same delusional sx as someone he or she is in a close relationship with;
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treatment for shared psychotic disorder
separate the patient from person who is the source of shared delusions; try psychotherapy and psych meds if sx do not resolve in 1-2 weeks
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koro
paient believes that his penis is shrinking and wlll disappear causing his deat; seen in Asian cultures
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Amok
sudden unprovoked outbursts of violence of which person has no recollection; person often commits suicide after; seeen in malayasia, southeast asia
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brain fag
headache, fatigue, and visual disturbances in male students; seen in Africa
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schizotypal
personality disorder; paranoid, odd or magical beliefs, eccentric, lack of friends, social anziety; criteria for true psychosis are not met
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schizoid
personality disoder; withdrawn, lack of enjoyment from social interactions, emoionally restricted
