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Psychotic Disorders and Mood Disorders Flashcards

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1
Q

Psychosis

A

Distorted perception of reality. Marked by delusion, impaired perceptions (hallucinations of illusions) and/or disorganized thinking.
Is a SYMPTOM of Schizophrenia, mania and severe depression.

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2
Q

Delusions

A

Fixed, false beliefs that cannot be explained or changed by rational arguments.

Classified as either bizarre or non-bizzare

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3
Q

Delusion Themes

A

Paranoid Delusions: someone is out to get you or persecuting you

Ideas of reference: cues in the external environment are uniquely related to the individual.

Delusions of control: patients thoughts can be read or are broadcast

Grandeur: belief that the person has powers beyond that of a normal human

Delusion of guilt: Unrealistic responsibility for bad occurrences

Somatic delusions: False Belief that they are affected with a disease.

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4
Q

Illusion

A

improper perception of an existing stimulus

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5
Q

Hallucination

A

Perception without a sensory stimulus

AUditory: most common in schizophrenia
Visual: Often seen in DT’s
Olfactory: seen in epilepsy with an aura
Tactile: secondary to drug or alcohol withdrawal.

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6
Q

Endocrinopathies that can cause psychosis

A

Addison/Cushing syndrome, hyper/hypoparathyroidism, hypocalcemia and hypopituitarism

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7
Q

Nturitional deficiencies leading to psychosis

A

B12, Thiamine, Folate, niacin

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8
Q

Psychotic Disorder due to Medical COndition

A

Prominent hallucination of delusions
Symptoms are not explained by delirium
Evidence supported by medical. lab and physical exam

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9
Q

Drugs that induce psychosis

A

Corticosteroids, Parkinson Disease treatments, Anticonvulsants, antihistamines, anti-cholinergics, Alcohol, cocaine, hallucinogens, marijuana.

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10
Q

Positive symptoms of Schizophrenia

A

Hallucination, Delusion, bizarre behavior and disorganized speech

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11
Q

Negative symptoms of schizophrenia

A

Blunted Effect, Anhedonia, apathy, a logia and lack of interest in socialization.

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12
Q

Cognitive symptoms of schizophrenia

A

impairment of attention and executive function and working memory.

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13
Q

3 phases of schizophrenia

A

Prodromal
PSychotic
Residual

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14
Q

DSM Criteria for Schizophrenia

A

Two or more of the following for at least one month with overall duration of disease being over 6 months:

Delusions (if bizarre, you can make diagnosis without anything else)
Hallucinations 
Disorganized speech
Catatonic behavior
Negative symtoms
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15
Q

5 Subtypes of Schizophrenia

A

Paranoid: Delusions and auditory halucinations w/o disorganized speech or catatonia

Disorganized type: Disorganized speech or behavior , flat affect.

Catatonic: Excessive purpoeless motor activity, extreme negativism or mutism, EHOLALIA, ECHOPRAXIA

Undifferentiated: More than one subtype
Residual Type: Prominent negative symptoms

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16
Q

5 A’s of schizophrenia

A 
Anhedonia
Affect is flat
ALogia (poverty of speech)
Avolition: (apathy)
Attention: Poor
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17
Q

Most commonly used substance abuse in schizophrenia ?

A

Alcohol

Cannabis

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18
Q

Affect of Dopamine in prefrontal cortex leading to negative symptoms

A

Too little in this area

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19
Q

Effect of Dopamine in the Mesolimbic system leading to positive symptoms

A

Excessive dopaminergic activity.

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20
Q

What occurs when dopamine is blocked in the nigrostriatal system ?

A

EPS

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21
Q

What occurs when dopamine is blocked in the tuberoinfundibular region ?

A

Hyperprolacinemia

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22
Q

Associated with better prognosis in schizophrenia

A 
Late onset
Good support
Positive symptoms
Mood Symptoms
Acute onset
Female Sex
Few relapse
Good premorbid functioning
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23
Q

First Gen Anti-psychotics

A

Chlorpromazine
Thioridazine
Trifluoperazine
haloperidol

Block D2 receptors

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24
Q

Side Effects of Gen 1 AP’s

Study These Flashcards
A

EPS
Neuroleptic Malignant Syndrome
Tardive Dyskinesia

25
Second Generation anti-psychotics
``` Risperidone Clozapine Olanzapine Quetiapine Aripiprazole Ziprasidone ``` ROCQ AZ Antagonize Serotonin receptors Lower incidence of EPS but increase risk for metabolic syndrome
26
EPS
Major side effect of First Gen AP's Dystonia: spasm of fce and neck Parkinsonism (due to DA antagonism) Akithesia
27
Treament for EPS
Antiparkison Agents ( iNcrease DA) such as... benztropine diphenhydramine ``` Benzodiazepines Beta BLockers (mainly for akithesia ```
28
MEtabolic Syndrome (2nd Gen)
Switch to more weight neutral 2nd gen like Aripiprazole or ziprazidone GO to 1st gen (risk of EPS)
29
Tardive Dyskinesia
Darting or writhing movements of the face tongue and head. TAKE OFF OFFENDING MED Give benzos or beta blockers.
30
Neuroleptic Malignant Syndrome
High fever, Lead Pipe rigidity, high bp and tachycardia, increased CPK, leukocytosis and metabolic acidosis.
31
Schizophreniform Disorder
Same as schizophrenia in terms of descriptors, however the time frame is different. ( between 1-6 months, no longer)
32
Schizoaffective Disorder
1. MDD or Manic episode | 2. Delusions or hallucinations for at least 2 weeks in the ABSENCE of Mood disorder symptoms.
33
Brief Psychotic Disorder
Patient with psychotic symptoms that are like schizophrenia except that the symptoms are last less than one month. (longer than one month = Schizophreniform. Add mood disorder and you have Schizoaffective)
34
Dulusional Disorder
Non-bizarre fixed delusions for at least on month DOESNT MEET CRITERIA FOR SCHIZO (aka no negative symptoms, no disorganization, no catatonic states) Functioning in life not impaired
35
Shared psychotic disorder
a patient develops the same delusional symptoms as someone he or she is in a close relationship with.
36
Koro
Asians: Believes penis is shrinking and will disappear causing death
37
AMok
Malaysia: Sudden outbursts of violence which person has no recollection of
38
Brain Fag
Africa: Headache fatigue and visual disturbance in male student .
39
Schizoid (Personality disorder, Axis II)
Social withdrawal and emotionally restricted
40
Schizotypal (Personality disorder Axis II)
Belief in magical things. Criteria for psychosis not met
41
Mood Episode
single event (Depression, Mania, Mixed State, hypomania)
42
Mood disorder
pattern of mood episodes MDD, Bipolar I/II, Dysthymic Disorder and Cyclothymic disorder. May have psychotic features.
43
Major Depressive EPISODE
Five of the following and must have #1 or 2 for at least a 2 WEEK PERIOD : ``` Depressed mood Anhedonia Changes in appetite or weight Insomnia Decreased Concentration Psychomotor agitation Fatigue Thoughts of death or suicide ``` SIGECAPS !!!!!!
44
Manic EPISODE
Lasts at least ONE WEEK and must include at least 3 of the following: ``` Distractibility Iritability/ Insonmnia (lack of need for sleep) Grandiosity Flight of ideas Activity increased Speech (pressured) Thoughtlessness ``` Manic Episode is an EMERGENCY
45
Hypomania
Same criteria as Manic episode except it only lasts 4 days (instead of one week) and it does not disrupt your everyday activities and does not have psychotic features
46
Major Depressive Disorder
Marked by multiple depressive episodes without the concurrent finding of manic states. Remember: Depressive Episode must last for 2 weeks and have Depression or Anhedonia plus 4 others SIGECAPS modifiers.
47
Sleep problems associated with MDD
Multiple Awakenings Insomnia Hypersomnia Decreased REM
48
SSRIs
More safe and better tolerated than other forms of antidepressants Major Side Effects: Sexual Dysfunction and Rebound Anxiety
49
Tricyclic ANti-depressants:
MOST LETHAL IN OVERDOSE Side effects: Weight Gain, section, orthostatic hypotension, anticholinergic effect. PROLONGED QTC
50
MAOi
useful in treatment of refractory depression Hypertensive crisis when mixed with tyramine rich foods or sympathomimetics (increased epi) SEROTONIN SYNDROME if used with SSRI's
51
5 Stages of Grief
``` Denial Anger Bargaining Depression Acceptance ```
52
Bereavement
Reaction to a major loss. Typically up to 2 months duration.
53
Bipolar I
Can have Mania and Depressio, however depression is not needed for diagnosis Onset usually before age 30 Highest genetic link of all psych diseases (first relatives have 8-18x more likely chance)
54
Lithium
Mood stabilizer used to treat mania Side Effects: Weight gain, tremor, GI probs, Fatigue, CARDIAC ARYHTMIAS, Seizures, Leukocytosis, Coma, DIABETES INSIPIDUS (nephrogneic) , Polydypsia
55
Treatments of Bipolar I (besides Lithium)
Anticonvulsants (Carbamazepine and Valproic Acid) Atypical Antipsychotics (Risperidone, Olanzapine, Clozapine, QUetiapine, Aripiprazole, Zaprasidone) Anti-Depressants: NOT USED AS MONOTHERAPY DUE TO ABILITY TO EXACERBATE MANIA ECT: Especially pregnant patients (since can't take lithium.. causes Ebstein Anomaly)
56
Bipolar II
Recurrent MDD with Hypomania
57
Dysthymic Disorder
Chronic Mild Depression most of the time w/o discrete episodes for at least 2 years (cannot go without symptoms for over 2 months, no true major depressive episode, no manic or hypomanic state)
58
Cyclothymic Disorder
ALternating periods of hypomania and mild to moderate depression ( if full on MDD it would be Bipolar II). Numerous periods within prevalence of at least 2 years. Cannot have been symptom free for more than 2 months No Hx of MDD of Mania
59
Adjustment Disorder
Maladaptive behavioral or emotional symptoms develop after a stressful life event. Begins 3 months after, lasts for 6 months after event.

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