Psychotic Disorders

Question 1

what is psychosis

Answer 1

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!

Question 2

common characteristics of psychosis

Answer 2

• hallucinations
• delusions
• disorganized thinking
• disorganized behavior

Question 3

five domains of psychosis

Answer 3

• delusions
• hallucination
• disorganized thinking
• disorganized behavior
• negative symptoms

Question 4

what are delusions

Answer 4

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

Question 5

types of delusions

Answer 5

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

Question 6

what are hallucinations

Answer 6

• false sensory perceptions without any external stimuli

Question 7

hallucinations involve:

Answer 7

hearing, vision, touch, smell, taste

Question 8

what is disorganized thinking

Answer 8

disturbance in flow and content of thoughts

Question 9

what is magical thinking

Answer 9

thoughts, words, or actions that assume power

Question 10

what is neologisms

Answer 10

new words coined by patient or old words with new meanings

Question 11

what is looseness of association

Answer 11

unrelated or unconnected ideas that shift from one subject to another

Question 12

what is perseveration

Answer 12

repetition of the same verbal response to different questions

Question 13

what is circumstantiality /tangientiality

Answer 13

patient digresses or answers to questions may be unrelated

Question 14

what is clang association

Answer 14

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

Question 15

echolalia

Answer 15

repeating of words or phrases heard

Question 16

characteristics of disorganized behavior

Answer 16

• talking/whispering to self
• abnormal gesturing
• catatonia
• hebephrenia

Question 17

diminished emotional expression is prominent in ___

Answer 17

schizophrenia

Question 18

what is avolition

Answer 18

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

Question 19

what is alogia

Answer 19

diminished speech output

Question 20

what is ahedonia

Answer 20

decreased ability to experience pleasure from positive stimuli

Question 21

what is associality

Answer 21

lack of interest in social interaction

Question 22

psychotic disorders

Answer 22

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

Question 23

what is schizoprenia

Answer 23

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

Question 24

biological basis of schizophrenia

Answer 24

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

Question 25

dopamine vs glutamatergic hypothesis

Answer 25

dopamine: - too much dopaminergic activity - too much dopamine - too many dopamine receptors - hypersensitivity to dopamine glumatine: - hypofunctioning signaling

Question 26

dopamine pathways

Answer 26

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

Question 27

most abundant excitatory neurotransmitter

Answer 27

glutamate | - concentrated in hippocampus and amygdala

Question 28

neuropathologies in schizophrenia

Answer 28

- neurochemical abnormalities - loss of brain volume - presence of lateral and third ventricular enlargement and some reduction in cortical volume

Question 29

psychoanalytic theories in schizophrenia

Answer 29

- sigmund freud - margaret mahler - harry stack sullivan

Question 30

learning theories in schizophrenia

Answer 30

- learning from parents with emotional problems and adverse circumstances - avoid punishment

Question 31

family theories in schizophrenia

Answer 31

- schism (division) between the parents | - skewed (distorted) relationship between child and one parent

Question 32

outcomes in schizophrenia

Answer 32

- 20% favorable outcome - require constant daily living support - progressive deterioration

Question 33

what is schizophreniform disorder

Answer 33

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

Question 34

what is brief psychotic disorder

Answer 34

- <1 month - sudden acute transient psychosis - full recovery - not due to drugs, medical illness, or mood disorder

Question 35

characteristics of schizotypal personality disorder

Answer 35

- unusual perceptual distortions - eccentricities of behavior - ideas of reference - odd beliefs, magical thinking - odd thinking and speech

Question 36

what is delusional disorder

Answer 36

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

Question 37

what is schizoaffective disorder

Answer 37

- features of both schizophrenia and affective disorders | - psychosis and major mood episode

Question 38

psychosis from general medical condition

Answer 38

- dementia: delusions can occur early in the course | - delirium: hallucinations, fluctuation consciousness, confusion, impaired cognitive abilities

Question 39

typical antipsychotics (1st gen)

Answer 39

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

Question 40

what is neuroleptic malignant syndrome

Answer 40

- 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

Question 41

what are extrapyramidal symptoms

Answer 41

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

Question 42

treatment for extrapyramidal symptoms

Answer 42

ex bi tri di - biperiden - benztropine - trihexyphenidyl - diphenhydramine

Question 43

what are atypical antipsychotics (2nd gen)

Answer 43

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