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psychotic disorders Flashcards

1
Q

psychosis: defn

A
  • distorted perception of reality
  • poor reality testing
  • delusions
  • perceptual disturbances
  • disorganized thinking
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2
Q

delusions: defn/types

A
  • fixed, false beliefs that can’t be altered by rational arguments
  • nonbizarre vs bizarre
  • types: persecution/paranoia, reference, control (thought broadcasting/insertion), grandeur, guilt, somatic
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3
Q

types of hallucinations

A
  • auditory: most commonly in SCZ pts
  • visual: not common in SCZ, more in drug use/withdrawal, delirium
  • olfactory: usually w/epileptic aura
  • tactile: 2ary to drug abuse/withdrawal
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4
Q

endocrine causes of psychosis

A
  • Addison/Cushing
  • hyper/hypothyroidism
  • hyper/hypocalcemia
  • hypopituitarism
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5
Q

nutritional causes of psychosis

A
  • B12, folate, niacin deficiencies
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6
Q

mx that may cause psychosis

A
  • steroids
  • antiparkinsonian agents
  • anticonvulsants
  • antihistamines
  • anticholinergics
  • antihypertensives
  • digitalis
  • methylphenidate
  • fluoroquinolones
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7
Q

drugs that may cause psychosis

A
  • alcohol
  • cocaine
  • hallucinogens
  • marijuana
  • BZOs
  • barbiturates
  • PCP
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8
Q

SCZ sx

A
  • positive: hallucinations, delusions, bizarre behavior, disorganized speech
  • negative: blunted affect, anhedonia, apathy, alogia, lack of interest in socialization
  • cognitive: attention, executive fn, working memory all impaired
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9
Q

SCZ phases

A
  • prodromal: decline in functioning preceding first psychotic episode
  • psychotic
  • residual: between psychotic phases, usually negative sx exhibited
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10
Q

SCZ diagnosis

A
  • sx for at least 1 month (2+ of delusions, hallucinations, disorganized speech, behavior chg, negative sx)
  • total duration > 6 mos
  • significant social or occupational function deterioration
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11
Q

SCZ: paranoid type

A
  • higher fn, older age of onset
  • preoccupation with delusions/AH
  • no predominance of disorganized speech/behavior or inappropriate affect
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12
Q

SCZ: disorganized type

A
  • poor fn, early onset
  • disorganized speech
  • disorganized behavior
  • flat/inappropriate affect
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13
Q

SCZ: catatonic type

A
  • rare
  • motor immobility
  • excessive purposeless motor activity
  • extreme negativism or mutism
  • peculiar voluntary movements or mutism
  • echolalia/echopraxia
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14
Q

SCZ: residual type

A
  • prominent negative sx

- minimal evidence of positive sx

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15
Q

SCZ: epidemiology

A
  • 1%
  • men present ~20yo (women ~30yo), more negative sx, more impaired social fn
  • rare before 15yo or after 55yo
  • genetic predisposition (MZ twins 50% concordance)
  • comorbid substance abuse common (alcohol>MJ>cocaine)
  • higher incidence if born in winter/early spring, lower socioec groups
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16
Q

SCZ pathophys

A

DOPA

  • mesolimbic: excess dopa activity –> positive sx
  • prefrontal cortical: inadequate dopa activity –> negative sx
  • tuberoinfundibular: hyperprolactinemia from antipsychotics
  • nigrostriatal: EPS from antipsychotics
17
Q

other NTs in SCZ

A
  • increased 5HT
  • increased NE
  • decreased GABA
  • decreased NMDA rcptrs
18
Q

SCZ and brain chgs

A
  • enlargement of ventricles

- diffuse cortical atrophy

19
Q

SCZ: prognosis

A
  • significant improvement in 70% on medications
  • 40-50% remain significantly impaired
  • 50% attempt suicide
  • better prognosis: later onset, social support, positive/mood sx, acute onset, female, few relapses, good premorbid fn
20
Q

SCZ: tx

A
  • first gen antipsychotics (D2 antag): work better with pos sx, more EPS/NMS/tardive dyskinesia SEs
  • high potency 1st gen: more EPS; low potency 1st gen: more anticholinergic
  • second gen (D2 and 5HT2 antag): positive and some negative sx, decreased EPS SEs, increased risk metabolic syndrome
21
Q

tardive dyskinesia

A
  • darting/writhing mvmt of face/tongue/head
  • up to 20% of long-term hospitalized pts on antipsychotics
  • tx: d/c offending agent; BZOs/betaBs/cholinomimetics short term
  • more common in older women, after >6 mos mx
  • 50% pts achieve spontaneous remission
22
Q

schizophreniform

A
  • same criteria as SCZ but lasts b/w 1-6 mos
  • 1/3 recover completely
  • 2/3 progress to SAD or SCZ
  • tx: hospitalization, 3-6 mos antipsychotics, psychotherapy
23
Q

SAD: diagnosis

A
  • criteria for MDE, manic episode, or mixed episode PLUS criteria for SCZ
  • delusions/hallucinations for 2 wks in absence of mood sx (to differentiate from mood d/o with psychotic features)
  • mood sx present for substantial portion of psychosis
24
Q

SAD: prognosis/tx

A
  • 60-80% will progress to SCZ
  • hosp and psychotherapy
  • antipsychotics and mood stabilizers
  • antidepressants or ECT for mood sx
25
Q

brief psychotic d/o

A
  • SCZ sx for 1d to 1 mo
  • RARE; may be in rxn to stress/trauma
  • 50-80% recovery
  • tx: hosp, psychotherapy, antipsychotics, BZOs if agitation
26
Q

delusional d/o

A
  • more often in older pts, immigrants, hearing impaired
  • nonbizarre fixed delusions >1mo
  • not SCZ criteria, not impairing fn
  • types of delusions: erotomanic, grandiose, somatic, persecutory (esp in deaf), jealous, mixed
  • 50% full recovery, 20% decreased sx, 30% no chg
  • difficult to treat; try course of antipsychotic mx
27
Q

shared psychotic d/o

A
  • pt develops same delusional sx as someone else in close relationship (usually family members)
  • 20-40% recover upon removal of person
  • psychotx and antipsychotic mx if sx do not improve w/in 1-2 wks of separation
28
Q

Koro

A
  • Asia

- penis shrinking and will disappear –> death

29
Q

Amok

A
  • Malaysia, SE Asia
  • sudden unprovoked outbursts of violence w/o recollection
  • often commit suicide afterward
30
Q

brain fag

A
  • Africa

- H/A, fatigue, visual disturbance in male students

31
Q

comparative prognoses of psychotic d/os

A

best –> worst:

mood > brief psychotic d/o > SAD > schizophreniform > SCZ

psych (15 decks)

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