Psychosis Flashcards
(14 cards)
Schizophrenia
At least two of the five symptoms must be present for at least
one month. One of the two symptoms must be delusions, hallucinations, or disorganized speech.
• 1. Delusions.
• 2. Hallucinations.
• 3. Disorganized speech (e.g., frequent derailment or incoherence).
• 4. Grossly disorganized or catatonic behavior.
• 5. Negative symptoms (i.e., diminished emotional expression
or avolition)
Schizophrenia: duration?
- Six-month duration that distinguishes schizophrenia from schizophreniform disorder (one to six months) and brief psychotic disorder (one day to six months).
- Level of functioning… is markedly below the level achieved prior to the onset
- Rule out psychosis due to drugs or a medical condition.
Hallucinations=
Sensory perceptions in absence of external
stimuli
Delusions=
– Firmly held false beliefs
Thought Disorder=
Disruption in form or organization of
thinking – incoherence, difficulty communicating, loose
associations, thought blocking, echolalia, clanging (“he raged at the hypocrisy of the aristocracy democracy” ).
Cognitive symptoms=
• Cognitive symptoms are subtle and are often
detected only when neuropsychological tests are
performed. They include the following:
• Poor “executive functioning” (the ability to
absorb and interpret information and make
decisions based on that information),
• Inability to sustain attention
• Problems with “working memory” (the ability to
keep recently learned information in mind and
use it right away)
Prodromal or Residual Phase=
Social Isolation, Withdrawal • Impairment of Functioning • Peculiar Behavior • Impaired Personal Hygiene • Blunted or Inappropriate Affect • Abnormal Speech • Odd Beliefs • Unusual Perceptual Experiences • Apathy
DDX of Schizophrenia
Mood Disorders:
• Schizoaffective Disorder: Mood issues > Thought Issues when
euthymic
• Bipolar Disorder
• Psychosis is present only during manic or depressive episodes
• Psychotic Depression
• Schizophreniform Disorder – Scz w < 6mo duration
• Brief Reactive Psychosis- Psychotic sx ,1month
• Schizotypal Personality Disorder – Fails to meet active
phase of schizophrenia criteria
• Delusional Disorder – persistent, delusions
• Organic Etiologies
Paranoid Type (DSM IV)
Preoccupation with one or more delusion or frequent auditory hallucinations • None of the following • disorganized speech • disorganized or catatonic behavior • flat or inappropriate affect
Residual Type
Absence of prominent delusions, hallucinations, disorganized
speech or behavior
• Continued evidence of disturbance e.g. negative symptoms
Evaluation of Psychosis
Complete Physical and Neurological Exam
• History – Subst Use, Past Psychosis, FHx, Medical Hx,
Medications.
• Mental Status Exam
• Laboratory Screens:
• Electrolytes, BUN, Cr, CA, Glucose, CBC, Thyroid Pannel, Liver
enzymes, VDRL, B12, Folate, HIV when indicated
• Tox Screen
• Brain Imaging when indicated, or w/ neurological
findings
• EEG when suspicious of absence or partial seizures
Antipsychotic Medications:
-classification
Conventional
• Low Potency – Chlorpromazine (Thorazine), Thioridizine (Mellaril)
• High Potency – Haloperidol (Haldol), Fluphenazine (Prolixin),
Trifluoperazine (Stelazine), Pimozide (Orap)
• Long Acting / Depot – Oil Based Injection
• Prolixin or Haldol Decanoate
Antipsychotic Medications:
-novel or atypical
5HT/DA Antagonists: • Clozapine (Clozaril) • Risperidone (Risperdal) • Olanzapine (Zyprexa) • Quetiapine (Seroquel) • Ziprasidione (Geodon) • Dopamine Partial Agonist/Antagonist • Aripiprazole (Abilify) • D2 Receptor Blockade • Essential for antipsychotic efficacy • 5HT2 Blockade
Side Effects: Key Differentiator for
Antipsychotics
Extrapyramidal Side Effects (EPS)
• Common with Conventional Agents
• High Potency»_space; Low Potency
• Stiffness, shuffling gait, loss of automatic associated movements.
PARKINSONIAN SX
• Occur when > 80% of D2 Receptors are occupied
• Therapeutic Antipsychotic Effects: 65-70% Blocked
• Minimal Effective Dosing - Dose to block for tx of psychosis but
avoid excessive blockaid to minimize EPS
