Psychotic disorders Flashcards

(39 cards)

1
Q

difference btwn

1) schizoaffective
2) schizophrenia
3) MDD with psychotic features

in terms of psychotic sx and mood d/o symptoms?

A

schizophrenia: + psychotic sx (delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, negative sx) for >1 month
schizoaffective: + psychotic sx for >2 weeks; criteria for MDE met only during psychotic sx

MDD with psychotic features: mood symptoms for >2 weeks; criteria for psychotic met only during mood sx

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2
Q

Define psychosis

A

distorted perception of reality: delusions, illusions, hallucinations, disorganized thinking

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3
Q

Hallucinations can be olfactory, gustatory, tactile, auditory, or visual. In what disease states would you generally find them in?

A

olfactory, gustatory, tactile = medical conditions

auditory, visual = psychotic disorders

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4
Q

What kinds of delusions are there?

A
Persecution/Paranoid delusions 
Ideas of reference
Delusions of control
Delusions of grandeur
Delusions of guilt
Somatic delusions
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5
Q

What are 2 delusions of control?

A

thought broadcasting - belief that one’s thoughts can be heard by others

thought insertion - belief that other people thoughts are being placed in one’s head

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6
Q

What is the difference btwn illusions and hallucinations?

A

illusion - misinterpretation of an existing sensory stimulus (mistaking a shadow for a cat)

Hallucinations: sensory perception without an actual external stimulus

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7
Q

most common hallucination experienced by schizophrenics

A

auditory

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8
Q

most common hallucination experienced by an epileptic person

A

olfactory

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9
Q

What are some Rx that can cause psychosis?

A

anything that alters the dopaminergic response:

benzodiazepines (intoxication/withdrawal)
amphetamines
steroids
anticholinergics
anti-parkinsonian agents
anticonvulsants
antihistamines
Anti-HTN (ß blockers)
digitalis
fluroquinolones
barbiturates
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10
Q

What are some recreational drugs that can cause psychosis?

A
OH withdrawal
hallucinogens (LSD, Ecstasy)
marijuana 
cocaine
phencyclidine
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11
Q

Vitamins deficiencies that can cause psychosis (3)

A

B12
folate
niacin

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12
Q

What should you think of when an medically ill elderly patient presents with psychotic symptoms?

A

delirium

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13
Q

What are + sx of schizophrenia?

What is the biochemical abnormality and pathway that cause this?

A

hallucinations, delusions, bizarre behavior, disorganized speech

excess dopaminergic activity in the mesolimbic pathway (improves with anti-psychotics)

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14
Q

What are - sx of schizophrenia?

What is the biochemical abnormality and pathway that cause this?

A

flat affect, anhedonia, apathy, alogia, lack of interest in socialization

inadequate dopaminergic activity in the prefrontal cortex (worsens with anti-psychotics)

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15
Q

3 phases of schizophrenia

A

1) prodromal - decline in functioning
2) psychotic - perceptual disturbances, delusions, disordered thought process/content
3) residual - btwn episodes of psychosis; flat affect, social withdrawal, odd thinking/behavior

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16
Q

DSM diagnostic criteria (duration of sx) of schizophrenia

A

+/- symptoms for at least ONE month, but symptoms (includes prodrome, psychotic, and residual) have lasted for >6 mo

17
Q

5 types of schizophrenia?

A
paranoid
disorganized
catatonic
undifferentiated (>1 or none of the subtypes)
residual (- sx)
18
Q

When do men tend to present with schizophrenia? Women?

A

men: 20
women: 30

19
Q

What is highly comorbid with schizophrenia in many patients?

A

substance abuse

20
Q

What is the downward drift hypothesis of schizophrenia?

A

lower socioeconomic groups have higher rates of schizophrenia. Why?
Schizophrenics are unable to function well in society and hence enter lower socioeconomic groups

21
Q

What is the pathophysiology of schizophrenia

A

+ sx = increased dopamine activity in mesolimbic pathways

- sx = decreased dopamine activity in prefrontal cortex

22
Q

why can cocaine and amphetamine cause schizophrenic-like symptoms?

A

because they increase dopamine activity

23
Q

What are two other pathways (other than the mesolimbic/prefrontal cortex pathways) that are affected by neuroleptics

A

tuberoinfundibular - blocked by neuroleptics - causes hyper-PRL -> gynecomastia, galactorrhea, menstrual changes

nigrostriatal - blocked by neuroleptics - causes EPS (tremors, slurred speech, akathisia, dystonia, abnormal movements)

24
Q

What does the brain of a schizophrenic patient look like on a CT? 2

A

enlarged ventricles

diffuse cortical atrophy

25
What are the main mxn and 3 main ADR of 1st generation antipsychotics?
D2 (dopamine) antagonist ADR: EPS, NMS, TD
26
What are the main mxn and main ADR of 2nd generation antipsychotics?
Antagonist of 5-HT2 and dopamine receptors ADR: metabolic syndrome
27
What do you treat EPS sx with?
anti-parkinsonian agents: benztropine, diphenhydramine benzodiazepine ß blockers
28
If a patient develops metabolic syndrome, what should you do?
consider switching to a 1st gen. antipsychotic or a more weight-neutral 2nd gen. antipsychotic such as apiprazole or ziprasidone
29
If a patient develops TD, what should you do?
d/c or reduce offending agent and start atypical antipsychotic benzo, ß blockers, or cholinomimetic may be used short-term
30
If a patient develops NMS, what should you do?
d/c all antipsychotics
31
ADR of clozapine
agranulocytosis
32
ADR of thioridazine
irreversible retinal pigmentation at high doses
33
ADR of chlorpromazine
deposits in lens and cornea
34
DSM diagnostic criteria (duration of sx) of schizophreniform
sx (including prodrome, psychotic, and residual) that lasted for < 6 mo
35
DSM diagnostic criteria (duration of sx) of schizoaffective d/o
meets criteria for MDE, but has had psychotic sx for > 2 weeks without mood d/o sx
36
DSM diagnostic criteria (duration of sx) of brief psychotic d/o
sx (including prodrome, psychotic, and residual) that lasted for <1 mo
37
DSM diagnostic criteria (duration of sx) of delusional d/o
non-bizzare, fixed delusions for at least 1 mo; functioning in life not significantly impaired
38
type of delusions present in delusional d/o
``` erotomaniac grandiose somatic persecutory jealous mixed (more than one of the above) ```
39
what is folie a deux?
aka "shared psychotic disorder (IPD)" - occurs when a patient develops the same delusional symptoms as someone he/she is in a close relationship with