Psychotic Disorders

Question 1

When looking at brain imaging for a psychotic patient, the more organic changes you see…

Answer 1

The worse the prognosis

Question 2

What is the definition of psychosis?

Answer 2

Loss of contact with reality as evidenced by:
• Delusion
• Hallucinations
• Disorganized thoughts and speech
• Disorganized or catatonic behavior

Question 3

Fixed false beliefs despite disproving evidence

Answer 3

Delusions

Question 4

What are the different types of delusion?

Answer 4

Bizarre vs non-bizarre

Paranoid or persecutory

Grandiose

Reference

Somatic

Question 5

Sensory perceptions in the absence of stimulus

Answer 5

Hallucinations

Question 6

What are the different types of hallucination?

Answer 6

Auditory***

Visual

Tactile

Olfactory

Gustatory

Question 7

What is the most common type of hallucination?

Answer 7

Auditory

Question 8

If a patient has auditory hallucinations, what should you ask them?

Answer 8

“What do they say?”

“Do they ever tell you to do something specific?”

Question 9

If a patient has tactile hallucinations, think…

Answer 9

SUD, withdrawal

Question 10

If a patient has olfactory hallucinations, consider…

Answer 10

Brain tumor with sudden onset

Question 11

What’s an example of a gustatory hallucination?

Answer 11

“I can taste the poison in my food…”

Question 12

Examples of disorganized speech

Answer 12

Derailment, tangentiality
Incoherence, word salad
Neologism
Echolalia
Blocking, paucity

Question 13

What is considered disorganized or catatonic behavior?

Answer 13

Activity that is not goal-directed

Inability to complete simple tasks

Immobility

Waxy flexibility***

Question 14

These symptoms alone are not psychotic but they are often present in psychotic disorders

Answer 14

Negative Symptoms

Decrease or absence of function

Question 15

Examples of negative symptoms

Answer 15

Apathy
Anhedonia
Asociality
Alogia

Question 16

_________ antipsychotics may be more effective against negative symptoms

Answer 16

Atypical

Question 17

What are the different causes of psychosis that you’re gonna wanna put in your differential…

Answer 17

Substance intoxication or withdrawal
Med side effect (steroids, stimulants, dopamine agonists, anticholinergics)
Delirium
Dementia
Endocrine (thyroid)
CNS infection (syphilis)
Epilepsy
Vitamin deficiency (B12)
Autoimmune (SLE)
Huntington’s 
Wilson’s
Psychiatric disorders (psychotic, mood, personality)

Question 18

Substances that stimulate ________ mimic symptoms of schizophrenia

Answer 18

Dopamine

Examples: Cocaine/Levodopa/Meth

Question 19

Substances that mimic _____ at the NMDA receptor mimic symptoms of schizophrenia

Answer 19

Glutamate

Examples: Ketamine/PCP

Question 20

Substances that mimic _______ result in symptoms of schizophrenia

Answer 20

Serotonin

Examples: LSD/Mescaline/Ecstasy

Question 21

Which NT serves as a regulatory hormone of dopamine?

Answer 21

Serotonin

Question 22

When might you want to do an EEG for a psychotic patient?

Answer 22

If you think it might be delirium and not psychosis

Question 23

What are non-bizarre delusions?

Answer 23

Plausible but false (ie infestations, being followed by police)

NOT alien abductions, chips implanted in brain

Question 24

What disorder:

Non-bizarre delusions
Does not meet Criterion A for Schizophrenia
Hallucinations could be related to delusional theme (bugs)
Psychosocial functioning NOT markedly impaired
Normal thought process
Poor insight

Answer 24

Delusional Disorder

Question 25

What are the DSM5 criteria for Delusional Disorder?

Answer 25

A. Non-bizarre delusions for at least 1 month B. Criterion A for Schizophrenia has NEVER been met (but hallucinations related to delusion ok) C. Functioning NOT markedly impaired (behavior not obviously odd or bizarre) D. Mood episodes (if present) are brief relative to delusion E. Not due to substance or GMC

Question 26

What are the subtypes of delusional disorder?

Answer 26

Erotomanic Grandiose Jealous Persecutory Somatic Mixed Unspecified

Question 27

What type of delusional patient? Another person is in love with the patient Usually person of high status (think celebrity stalker)

Answer 27

Erotomanic

Question 28

What type of delusional patient? Inflated worth, power, knowledge, identity, or special relationship to deity or famous person

Answer 28

Grandiose

Question 29

What type of delusional patient? Spouse, significant other, or sexual partner is unfaithful

Answer 29

Jealous

Question 30

What type of delusional patient? Being treated malevolently Conspired against, cheated, spied on, followed, poisoned, harassed

Answer 30

Persecutory

Question 31

What type of delusional patient? Physical defect or medical condition

Answer 31

Somatic

Question 32

Sudden onset of at least 1 positive symptom lasting 1 day to 1 month, with return to normal premorbid functioning

Answer 32

Brief Psychotic Disorder Emotional, labile, confused Onset in late 20s to early 30s - may be with marked stressor or post-partum onset R/o culturally appropriate experience, malingering, personality disorder

Question 33

Patients with brief psychotic disorders are at high risk for ...

Answer 33

Suicide

Question 34

DSM 5 for brief psychotic disorder

Answer 34

A. Presence of 1 or more: 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behavior B. Duration 1 day to 1 month with eventual full return to premorbid level of functioning C. Not due to schizophrenia, schizoaffective, or mood d/o, substance, or GMC

Question 35

What is the main difference between schizophreniform disorder and schizophrenia?

Answer 35

Essential features identical (delusions, hallucinations, disorganization, neg sx) but SHORTER DURATION (1-6 months) Social/occupational functioning may or may not be impaired

Question 36

______ of schizophreniform patients recover, but ______ progress to schizophrenia or schizoaffective d/o

Answer 36

1/3 recover 2/3 progress

Question 37

DSM5 for Schizophreniform Disorder

Answer 37

A. Presence of 2 or more: 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behavior B. Duration 1 month - 6 months C. Not due to schizophrenia, schizoaffective, or mood d/o, substance, or GMC

Question 38

Prevalence of schizophrenia is equal between males and females but...

Answer 38

Males have earlier age of onset Males 18-25 Females 25-35