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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

Cognitive Behavioral Therapy

Used to treat medication-resistant psychosis