Flashcards in Psychosis Deck (69):
1
Define Psychosis
A loss of contact with reality
2
Define Delusions
Strongly held false beliefs that are not part of the patient's cultural or religious backgrounds
3
Types of Delusions
Persecutory
Grandiose
Erotomanic
Somatic
Delusions of reference
Delusions of control
4
Define Hallucinations
Wakeful experiences of content that is not actually present
Auditory most common
5
Thought Disorganization
Alogia/poverty of content
Thought blocking
Loosening of association
Tangentiality
Clanging or clang association: rhyming words
Word salad: words linked incoherently
Perseravation: repeating words phrases no matter the topic
6
Differential Diagnosis of Psychotic Disorders
Schizophrenia
Bipolar disorder + psychotic features
Major depression + psychotic features
Schizoaffective disorder
Schizophreniform disorder
Brief psychotic disorder
Substance induced psychotic disorder
Delusional disorder
Psychosis secondary to medical condition
7
Define Schizoaffective Disorder
Affective disorder but have psychotic features at a separate time than the affective disorder
8
Define Schizophreniform Disorder
Schizophrenia that doesn't quite meet the criteria for Schizophrenia
9
Labs for Psychosis Work-up
CBC
CMP
RPR/VDRL
TSH
HIV
UA
Urine drug screen
10
What is the peak age of schizophrenia?
Men: 12-25
Women: 25-35
11
Items that make schizophrenia difficult to deal with
Highly disabling
Persists throughout patient's life
Poor care & social ostracism
Only 1/2 obtain treatment
12
DSM-5 Criteria: 2 of the following characteristics during a 1 month period
Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior
Negative symptoms
Social or occupational dysfunction
Continuous signs of disturbance persisting for at least 6 months within 1 month of "active-phase" symptoms
13
Positive Symptoms of Schizophrenia
Delusions
Hallucinations
14
Negative Symptoms of Schizophrenia
Affective flattening
Poverty of speech (Alogia)
Blocking
Poor grooming
Lack of motivation
Anhedonia
Social withdrawal
15
Which types of symptoms have better responses to treatment?
Positive symptoms
16
Subtypes of Schizophrenia
Paranoid type
Disorganized type
Catatonic type
17
Define Paranoid Schizophrenia
Preoccupation with one or more delusions or frequent auditory hallucinations
No disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect
18
Characteristics of Disorganized Schizophrenia
Disorganized speech
Disorganized behavior
Flat or inappropriate affect
19
Characteristics of Catatonic Schizophrenia
Motoric immobility
Excessive purposeless motor activity
Extreme negativism or mutism
Peculiarities of voluntary movement
Echolalia or echopraxia
20
Define Echolalia & Echopraxia
Mimic your movements or your speech
21
Four Components of Delusions
False belief
Based on incorrect inference about external reality
Not consistent with patient's intelligence & cultural background
Cannot be corrected by reasoning
22
Name this type of Delusion: "I can't believe that they've now sabotaged my car! Last week they stole my mail and I know they are following me overtime I leave the house"
Delusion of Persecution
23
Name this type of Delusion: "God has chosen me to be the world's representative at the universal meeting at Mars next month"
Delusion of Grandeur
24
Name this type of delusion: "Invaders from space have infiltrated my testicles so I wouldn't be allowed to father any children."
Bizarre Delusion
25
Name this type of delusion: "It doesn't matter anyway with how my thoughts are controlled by the government."
Delusion of Control
26
Name this type of delusion: "The DJ is really giving me instructions on what to do. He just disguises it so no one will pick up on it."
Delusion of Reference
27
Different Thought Form & Process's
Flight of ideas
Thought blocking
Incoherence
Poverty of content
Poor abstraction abilities
Verbigeration
Tangentiality
Circumstantiality
Loose associations
Derailment
Neologisms
28
Parts of a Mental Status Examination
General description
Mood, feelings, affect
Perception
Thought: content, form & process
Sensorium & cognition: oriented x3, memory intact, poor insight
Impulsiveness
29
Neurotransmitters Associated with Schizophrenia
Dopamine
Glutamate
Gamma-amino-butyric-acid (GABA)
Acetylcholine
Serotonin
30
Dopamine in Schizophrenia
Decreased dopamine: cognitive & negative symptoms
31
Glutamate in Schizophrenia
Major CNS excitatory neurotransmitter
Hypofunction of glutamate receptor may contribute to pathology
32
Gamma-amino-butyric-acid (GABA) in Schizophrenia
Major CNS inhibitory neurotransmitter
Important for regulation of the prefrontal cortical function
Interneurons are dysfunction in schizophrenia
33
Acetylcholine in Schizophrenia
Nicotine can normalize some eye-tracking & EEG abnormalities
34
Serotonin in Schizophrenia
Antagonism at 5-HT2 receptors reduces psychotic symptoms
35
Pattern of Symptoms in Schizophrenia
Quiet, passive, & introverted personality
Few friends growing up
Adolescents may have no close friends, dates, & may avoid team sports
Enjoy movies & TV or listening to music instead of social activities
36
Poor Outcomes of Schizophrenic Patients
Repeated hospitalizations
Exacerbation of symptoms
Episodes of major mood disorders
Suicide attempts
37
What is common among untreated schizophrenic patients?
Violent behavior
38
What percent of schizophrenic patients attempt suicide?
50%
39
How is Schizoaffective Disorder Different from Schizophrenia
Major depressive or manic episode
AND patient must have experienced delusions or hallucinations IN THE ABSENCE of the mood symptoms
40
How is Brief Psychotic Disorder Different from Schizophrenia
Symptoms of delusions, hallucinations, disorganized speech, or disorganized behavior that persist for more than 1 day but less than 1 month
41
How is Delusional Disorder Different from Schizophrenia?
Delusion WITHOUT other signs/symptoms of psychosis
Delusions are non bizarre
42
How is Schizophreniform Disorder Different from Schizophrenia?
Schizophrenia like symptoms for more than 1 month but less than 6 months
43
Examples of First Generation Antipsychotics (FGAs)
Haloperidol (Haldol)
Chlorpromazine (Thorazine)
Thioridazine (Mellaril)
44
MOA of First Generation Antipsychotics (FGAs)
Antagonism of D2 receptors in both cortical & stratal areas
45
SE of First Generation Antipsychotics (FGAs)
Extra-pyramidal symptoms (EPS)
Tardive dyskinesia (TD)
Hyperprolactinemia
Neuroleptic malignant syndrome (NMS)
QT prolongation
Sudden death
Increased risk of mortality when treating elderly patients with dementia
Akinesia
Weight gain
46
Extra-pyramidal Symptoms
Akathisia
Parkinsonian syndrome
Acute dystonias
47
Examples of Second Generation Antipsychotics (SGAs)
Respirdone (Resperdol)
Aripiprazole (Abilify)
48
MOA of Second Generation Antipsychotics (SGAs)
Post-synaptic blockade D2 receptors PLUS 5HT2 receptor binding
49
SE of Second Generation Antipsychotics (SGAs)
Weight gain
Hyperglycemia
Hyperlipidemia
EPS
TD
NMS- neuromalignant syndrome
Hyperprolactinemia
Increased mortality in elderly patients with dementia
50
Primary Use of FGAs
IV for emergent situations
Depot preparations
51
SE of Risperidone (Risperdal)
Sedation
Hypotension
Akathisia
Prolactin elevation
Weight gain
52
SE of Olanzapine (Zyprexa)
Weight gain
Sedation
Akathisia
Hypotension
Dry mouth
Constipation
53
What is quetiapine (Seroquel) used to treat?
Mood disorders
Anxiety disorders
PTSD
Parkinson disease
54
SE of Quetiapine (Seroquel)
Sedation
Orthostatic hypotensions
Akathisia
Dry mouth
Weight gain
55
Pharmacokinetics of Aripipraole (Abilify)
Agonist at D2 receptors
Partial agonist at 5HT1a receptors
Antagonist at 5HT2a, H1 & alpha-1-adrenergics
56
SE of Aripipraole (Abilify)
Headache
N/V
Akathisia
Tremor
Constipation
Minimal weight gain
57
What does clozapine (Clozaril) have a high risk of?
Agranulocytosis
58
When do we use clozapine (Clozaril)?
Treatment-Resistant patients
59
SE of Clozapine (Clozaril)
Orthostatic hypotension
Tachycardia
Weight gain
Metabolic syndrome
Sialorrhea
Sedation
Constipation
Seizure risk that increases with dose
60
How to treat akathisia as a SE of antipsychotics?
Benzodiazepine
Beta-blocker
Benztropine
61
How to treat parkinsonian syndrome as a SE of antipsychotics?
Benztropine
Amantadine: SE hypotension & mild agitation
62
How to treat dystonia as a SE of antipsychotics?
Change to antipsychotics with lower EPS
Benztropine
Diphenhydramine
63
Tardive Dyskinesia Movements
Sucking/smacking lips
Choreaoathetoid movement of tongue
Facial grimacing
Lateral jaw movements/clenching
Choreiform or athetoid movements of the body
64
Risk Factors for Tardive Dyskinesia
Long use of antipsychotics
EPS
Elderly
Use of other meds
65
Metabolic Effects of Antipsychotics
Weight gain
Hyperglycemia
Hyperlipidemia
NMS: fever, mental status changes, rigidity, autonomic instability
66
Treatment Options in Addition to Medication for Schizophrenia
Family psychoeducational intervention
Social skills training for the patient
Cognitive behavioral therapy
67
Family Psychoeducational Intervention
Educates family that schizophrenia is a disease, factors about the disease, how to help the person with the disease & fosters optimism
Monthly sessions for 6-9 months
68
Social Skills Training for the Patient
Uses behaviorally based instruction, role modeling, rehearsal, corrective feedback, & positive reinforcement
Helps with deficits in skills as a result of negative symptoms
69