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19 Psychiatry > Psychotic Disorders > Flashcards

Psychotic Disorders Flashcards

1
Q

what is psychosis

A

state in which the person’s thoughts, affective response, ability to recognize reality, and ability to communicate and relate to others are sufficiently impaired

out of touch with reality!

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2
Q

common characteristics of psychosis

A
  • hallucinations
  • delusions
  • disorganized thinking
  • disorganized behavior
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3
Q

five domains of psychosis

A
  • delusions
  • hallucination
  • disorganized thinking
  • disorganized behavior
  • negative symptoms
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4
Q

what are delusions

A
  • false belief
  • unshakable
  • not consistent with person’s background
  • not amenable to change in light of conflicting evidence
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5
Q

types of delusions

A
  • persecutory, paranoid!!
  • referential
  • grandiose
  • erotomanic
  • infidelity or jealousy
  • nihilistic
  • somatic
  • bizarre
  • folie a deux (shared by two)
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6
Q

what are hallucinations

A
  • false sensory perceptions without any external stimuli
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7
Q

hallucinations involve:

A

hearing, vision, touch, smell, taste

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8
Q

what is disorganized thinking

A

disturbance in flow and content of thoughts

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9
Q

what is magical thinking

A

thoughts, words, or actions that assume power

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10
Q

what is neologisms

A

new words coined by patient or old words with new meanings

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11
Q

what is looseness of association

A

unrelated or unconnected ideas that shift from one subject to another

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12
Q

what is perseveration

A

repetition of the same verbal response to different questions

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13
Q

what is circumstantiality /tangientiality

A

patient digresses or answers to questions may be unrelated

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14
Q

what is clang association

A

words are associated by the sound of the word rather than meaning (punning and rhyming)

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15
Q

echolalia

A

repeating of words or phrases heard

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16
Q

characteristics of disorganized behavior

A
  • talking/whispering to self
  • abnormal gesturing
  • catatonia
  • hebephrenia
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17
Q

diminished emotional expression is prominent in ___

A

schizophrenia

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18
Q

what is avolition

A

decrease in motivated self-initiated purposeful activities such as work, studies, and self care

19
Q

what is alogia

A

diminished speech output

20
Q

what is ahedonia

A

decreased ability to experience pleasure from positive stimuli

21
Q

what is associality

A

lack of interest in social interaction

22
Q

psychotic disorders

A
  • schizophrenia
  • schizophreniform
  • brief psychotic disorder (schizotypal, delusional, schizoaffective)
  • psychotic disorder due to substance
  • psychotic disorder due to medical condition
23
Q

what is schizoprenia

A
  • before age 25
  • persists throughout lifetime
  • based on history and mse (no lab test)
  • psychosis 6 mos or greater
24
Q

biological basis of schizophrenia

A
  • genetics: largest risk factor, dopaminergic and glutamatergic neurons
  • biochemical hypotheses: dopamine hypothesis and glutamatergic hypothesis
  • neuropathology
25
Q

dopamine vs glutamatergic hypothesis

A

dopamine:

  • too much dopaminergic activity
  • too much dopamine
  • too many dopamine receptors
  • hypersensitivity to dopamine

glumatine:
- hypofunctioning signaling

26
Q

dopamine pathways

A
  • nigro-striatal pathway
  • meso-limbic pathway: reward pathway and positive symptoms
  • meso-cortical pathway: motivation, emotions, and negative symptoms
  • tubulo-infundibular pathway
27
Q

most abundant excitatory neurotransmitter

A

glutamate

- concentrated in hippocampus and amygdala

28
Q

neuropathologies in schizophrenia

A
  • neurochemical abnormalities
  • loss of brain volume
  • presence of lateral and third ventricular enlargement and some reduction in cortical volume
29
Q

psychoanalytic theories in schizophrenia

A
  • sigmund freud
  • margaret mahler
  • harry stack sullivan
30
Q

learning theories in schizophrenia

A
  • learning from parents with emotional problems and adverse circumstances
  • avoid punishment
31
Q

family theories in schizophrenia

A
  • schism (division) between the parents

- skewed (distorted) relationship between child and one parent

32
Q

outcomes in schizophrenia

A
  • 20% favorable outcome
  • require constant daily living support
  • progressive deterioration
33
Q

what is schizophreniform disorder

A
  • 1-6 mos!
  • unknown cause
  • no prodromal phase
  • functional impairment during episode
  • no deterioration after episode
34
Q

what is brief psychotic disorder

A
  • <1 month
  • sudden acute transient psychosis
  • full recovery
  • not due to drugs, medical illness, or mood disorder
35
Q

characteristics of schizotypal personality disorder

A
  • unusual perceptual distortions
  • eccentricities of behavior
  • ideas of reference
  • odd beliefs, magical thinking
  • odd thinking and speech
36
Q

what is delusional disorder

A
  • exhibits non-bizarre delusion at least 1 month duration
  • no other psychiatric disorders
  • no other features
  • person is generally functional with some relationships
37
Q

what is schizoaffective disorder

A
  • features of both schizophrenia and affective disorders

- psychosis and major mood episode

38
Q

psychosis from general medical condition

A
  • dementia: delusions can occur early in the course

- delirium: hallucinations, fluctuation consciousness, confusion, impaired cognitive abilities

39
Q

typical antipsychotics (1st gen)

A
  • dopamine receptor antagonists
  • inhibit dopaminergiic transmission or high affinity antagonism of dopamine d2 receptors
  • more neurologic side effects
  • chlorpromazine, haloperidol, levopromazine, fluphenazine
40
Q

what is neuroleptic malignant syndrome

A
  • potentially fatal side effect
  • extreme hyperthermia, muscular regidity and dystonia, akinesia, increased pulse rate and bp -> cardio collapse
  • lab: inc wbc, creatinine, liver enzymes, plasma myoglobin, myoglobinuria
  • evolves over 24-72 hours
  • untreated syndrome: 10-14 days
41
Q

what are extrapyramidal symptoms

A
  • tardive dyskinesia
  • adverse effect of long-term antipsychotic treatment (10-20 years after)
  • irreversible
42
Q

treatment for extrapyramidal symptoms

A

ex bi tri di

  • biperiden
  • benztropine
  • trihexyphenidyl
  • diphenhydramine
43
Q

what are atypical antipsychotics (2nd gen)

A
  • selective dopamine receptor antagonists
  • more metabolic side effects (increased weight, sugar, lipids)
  • targets both negative and positive symptoms

19 Psychiatry (9 decks)

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