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Psych Final! (🐈,👵🏻,🌭) > Psychotic Disorders (Lauren 🌭) > Flashcards

Psychotic Disorders (Lauren 🌭) Flashcards

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1
Q

What is psychosis?

A

Loss of contact with reality 🚀

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2
Q

What are the Positive symptoms of psychosis?

A

Delusions

Hallucinations

Disorganized thoughts and speech

Disorganized or catatonic behavior

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3
Q

What is this:

“Fixed false beliefs, despite disproving evidence’

A

Delusions

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4
Q

What is the difference between bizarre and non-bizarre delusions?

A

Non-bizarre delusions are technically plausible. (But are obviously not true)
Ex: The Chandler Police, the Phoenix Police and the Tucson Police are all trying to catch me
🏃‍♂️🚓🚓🚓

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5
Q

What are paranoid delusions?

A

“People are following me”🕶

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6
Q

What are persecutory delusions?

A

“Everyone is against me” 🕴

Conspired against, cheated, spied on, followed, poisoned, etc

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7
Q

What are grandiose delusions?

A

I’m gorgeous and super intelligent, that’s why people hate me💅🏻🧖🏻‍♀️🤳🏻💵

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8
Q

What are Reference Delusions?

A

“Getting messages in the headlines” 📺📻🗞

Ex: someone is putting secret messages in the soap operas just for me to tell me that the world is going to end

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9
Q

What are somatic delusions?

A

Feeling things in their body🕷🐍

Ex: “I can feel a snake in my belly and worms in my brain and the doctors just keep missing it, I know it’s there”

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10
Q

What is this:

“Sensory perceptions in absence of a stimulus”

A

hallucinations🧿

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11
Q

What is important to ask a patient if they have auditory hallucinations?

A

What do the voices say?🗣

Do they tell you to hurt yourself or others?🔪

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12
Q

Visual hallucinations are usually:

A

Shadows🕴

People appearing in mirrors or windows 💿

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13
Q

Tactile hallucinations are usually caused by _________

A

Substance abuse🚬

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14
Q

What is a very important possible cause of olfactory hallucinations?

A

Brain tumor🧠

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15
Q

If someone says they can taste poison in their food, what kind of hallucination is that?

A

Gustatory hallucination👅

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16
Q

What are some examples of disorganized speech?

A

Derailment, tangentiality

Incoherence, word salad

Neologisms

Echolalia

Blocking, paucity

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17
Q

What is tangential speech?

A

They kind of try to answer the question but they never actually get to it

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18
Q

What kind of speech is this:

Words are not related to each other

A

Word salad🥗

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19
Q

What is a neologism?

A

Creating new words

Ex: Brangelina, chillax, metrosexual

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20
Q

What is echolalia?

A

Repeating part of what you say back to them/

You: How are you doing today, joe?

Joe: how are you doing today joe

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21
Q

What would this be an example of:

The patient hears so many voices that when you talk to him, it takes him a moment to pick out what you said to him and answers you after a long pause

A

Paucity

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22
Q

What are some examples of disorganized or catatonic behavior?

A

Activity that is not goal directed (Ex: standing up from chair and reaching for nothing)

Unable to complete simple tasks

Immobility

Waxy flexibility

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23
Q

What is waxy flexibility?

A

You can move them into whatever position and they will just hold it

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24
Q

true or false:

Negative symptoms alone can be psychotic

A

False

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25
What are negative symptoms?
Decrease or absence of function Ex: apathy, anhedonia, asociality, alogia (reduced speech)
26
Which is more effective against negative symptoms: Typical or atypical antipsychotics
Atypical | But negative symptoms are REALLY hard to treat
27
When a patient shows up with psychosis, what should be in your differential that you need to rule out before you assume its due to a psychiatric disorder?
Substance intoxication or withdrawal Medication side effect Delirium Dementia Dementia Thyroid problem Neurosyphilis/ CNS infection Epilepsy (Temporal) B12 deficiency Lupus Huntington’s, Wilsons
28
What three chemicals in the brain cause the symptoms of schizophrenia?
Dopamine Glutamate Serotonin
29
What drugs can cause increased levels of dopamine and thus, symptoms of schizophrenia?
Cocaine Meth Levodopa
30
What drugs mimic glutamate at the NMDA receptor and thus, cause symptoms of schizophrenia?
Ketamine PCP
31
What drugs mimic serotonin and result in symptoms of schizophrenia?
LSD Mescaline Ecstasy
32
What effect does serotonin have on dopamine?
Increased release of serotonin results in decreased release of dopamine (??) slides 11 and 12 seem to contradict each other on this
33
What are the 7 psychotic disorders in the DSM5?
1. Schizotypal Personality Disorder 2. Delusional Disorder 3. Brief Psychotic Disorder 4. Schizophreniform Disorder 5. Schizophrenia 6. Schizoaffective 7. Substance induced, due to General Medical Condition, or Not Otherwise Specified
34
What is this: Non-bizarre delusions (Plausible, but false. Ex: being followed by the police) Hallucinations related to the delusion (ex: sirens) Psychosocial functioning NOT impaired Normal thought process Poor insight Does not meet criterion A for schizophrenia
Delusional Disorder
35
In Delusional Disorder, the delusions are (bizarre/non-bizarre)
Non-bizarre | *********
36
Can someone with delusional disorder hold down a job?
Yes. Psychosocial functioning not impaired👨🏻‍🚒
37
What is the DSM5 criteria for delusional disorder?
A. Non-Bizarre delusions for 1 month B. Criterion A for schizophrenia has never been met (but hallucinations related to the delusion is ok) C. Functioning is 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
38
What are the subtypes of Delusional Disorder?.
Erotomanic 🥰 Grandiose 🤑 Jealous👺 Persecutory😭 Somatic🏥 Mixed Unspecified
39
What is an Erotomanic Delusional Disorder?
Patient believes that someone is in in love with them, usually a celebrity, or someone of high status. Ex: Lebron James is following me around⛹🏾‍♂️
40
What is a Grandiose Delusional Disroder?
Inflated worth, power, knowledge, identity or special relationship to a deity or famous person Ex: Has a special relationship with God🎙
41
What is a Jealous Delusional Disorder?
Patient believes their partner is CHEATING🧨
42
What is a persecutory Delusional Disorder?
Patient believes they are being treated malevolently and that they are being conspired against, cheated, spied on, followed, poisoned, harassed, etc....
43
What is a Somatic Delusional Disorder?
Patient believes they have some sort of physical defect or medical condition
44
What is a mixed delusional disorder?
Patient has features of more than one subtype, but none predominate
45
What is this: Sudden onset of at least 1 positive symptom Lasts 1 day to 1 month, which a return to normal premorbid functioning High risk of suicide Onset in late 20’s-early 30’s often with a marked stressor or post-partum
Brief psychotic disorder Ex: Kony 2012 guy
46
How long does brief psychotic disorder last?
1 day to 1 month
47
What are the DSM5 criteria for Brief PScyhotic Disorder?
A. Presence of 1 or more: Delusions, hallucinations, disorganized speech, disorganized or catatonic behavior B. Duration of 1 day to 1 month with FULL return to premorbid (normal) level of functioning C. Not due to schizophrenia, schizoaffective or mood disorder, substance, or GMC
48
What is this: IDENTICAL to schizophrenia except it only lasts 1-6 months
Schizophreniform Disorder
49
What is the prognosis for Schizophreniform Disorder?
1/3 of patients recover 2/3 progress to schizophrenia or schizoaffective disorder ****
50
What is the DSM5 criteria for Schizophreniform Disorder?
A. PResence of 2 or more: Delusions, hallucinations, disorganized speech, disorganized or catatonic behavior B. Duration 1 month - 6 months C. Not due to anything else
51
Is schizophrenia a common diagnosis?
Yes, 1% of the population has it
52
What age do men vs women develop schizophrenia?
Men 18-25 (younger, in college)👨🏻‍🎓 Women 25-35 (older, married with kids)👩‍👦‍👦
53
Who gets schizophrenia more often: men or women
Equal
54
Is there a genetic link for schizophrenia?
Yes, if you have a 1st degree releative with schizophrenia you have a 10x risk
55
Does having schizophrenia affect your life expectancy?
Yes, people die earlier due to heart disease and cancer. This is because they were dismissed as other medical conditions or we were just trying to get them out of our office as quick as possible. How does that make you feel (Also, they have a higher rate of suicide)
56
Whatis the DSM5 for shchizophrenia?
A. At least 2 of the following for 1 month: Delusions Hallucinations Disorganized speech Disorganized or catatonic behavior Negative symptoms B. Social/occupational dysfunction C. Duration 6 months (1 month criterion A + prodrome/residual period) D. Schizoaffective and Mood disorders ruled out E. Not due to substance/GCM
57
What are some factors that have a good prognosis for schizophrenia?
Female 💄 Later onset 🗓 Acute onset with precipitating factor Brief duration, early intervention Treatment compliance💊 Positive symptoms (easier to treat) Mood disturbance, family hx of mood disorder Wealthy 💰 Married 🤵🏻👰🏻 Good support system Good premorbid functioning
58
What is Schizoaffective Disorder?
Schizophrenia + a mood disorder
59
What are the two types of Schizoaffective Disorder?
Bipolar Type Depressed Type
60
What are the DSM5 for Schizoaffective Disorder?
A. Meets Criterion A for Schizophrenia and concurrently has major depressive, manic, or mixed episode B. Must have 2+ weeks of delusions of hallucinations **without** prominent mood symptoms C. Mood symptoms are present for a significant portion of the illness D. Not due to substance/GMC
61
When Alex drops off a patient who is having a schizophrenic crisis, what steps do you have to do during the “Acute Stabilization” part of treatment?
Start antipsychotic at low dose and titrate up Safety is the priority, preventing the patient from becoming a danger to self or others Consider need for hospitalization
62
When a patient who is having a schizophrenic crisis comes to your facility, how long will it take for the agitation, hallucinations, and negative symptoms to improve?
Agitation= quickly. minutes to hours Hallucinations= a few days Negative sx, delusions= much longer or never
63
What was her rule for using more than one antipsychotic?
Best to avoid, but if you have to, MAXIMIZE the first one before adding a second
64
What are the indications for hospitalization for someone having a schizophrenic crisis?
Danger to self (DTS) Danger to others (DTO) Command auditory hallucinations Unable to care for self (eat, drink, take meds)
65
What can you do to help increase medication compliance in schizophrenia?
Simplify med regimen (once a day dosing vs TID. Maybe look into long acting injectables) Minimize side effects
66
What are the First Generation (Typical) Antipsychotics that you need to know?
Chlorpromazine (Thorazine) Haloperidol (Haldol)
67
What is the MOA of first generation (typical) antipsychotics?
D2 receptor blockers
68
What is the side effect she mentioned about Chlorpromazine (Thorazine)?
The “Thorazine Shuffle” | Shuffling gait
69
What can happen if you use Haloperidol (Haldol) long-term?>
EPS and tardive dyskinesia DONT USE IT LONG TERM
70
What forms is Haloperidol (Haldol) available in?
PO tablet or elixir IM IV Long-acting injection Topical
71
What are the Atypical Antipsychotics you need to know for this course?
Aripiprazole (Abilify) Clozapine (Clozaril) Onlazapine (Zyprexa) Quetiapine (Seroquel) Risperidone (Risperdal)
72
Which atypical antipsychotic is a partial D2 agonist and is metabolically neutral?
Aripiprazole (Abilify)
73
Which atypical antipsychotic is a good choice to start with
Aripiprazole (Abilify) Its great for negative symptoms
74
Which atypical antipsychotic is a drug of last choice? Why?
Clozapine (Clozaril) Agranulocytosis risk
75
Which atypical antipsychotic requires weekly CBC w/ diff monitoring?
Clozapine (Clozaril) because it can cause agranulocytosis | *******
76
What is the main side effect of Olanzepine (Zyprexa)?
Weight gain
77
Which atypical antipsychotic did she say that meth addicts love to use to come down from their high
Quetiapine (Seroquel)
78
What is the side effect of Risperidone (Risperdal)
Prolactinemia= gynecomastia and galatorrhea EPS
79
What is the MOA of atypical antipsychotics?
5HT2A receptor blockers
80
What is the BLACK BOX WARNING for all atypical antipsychotics?
Increased mortality when treating OLD PEOPLE for dementia-related psychosis
81
What are Extra Pyramidal Symptoms (EPS)?
Acute dystonic reaction Parkinsonism Akathisia Tardive dyskinesia Neuroleptic Malignant Syndrome ⚰️
82
What is an “Acute Dystonic Reaction?”
Torticollis Jaw spasms, dysphagia, dysarthria, tongue protrusion etc
83
What does Tardive Dyskinesia look like?
Blinking Lip smacking Tongue protrusion
84
If someone has tardive dyskinesia, which tract in their brain is affected?
Nigrostriatial
85
HOw long does it take for tardive dyskinesia to show up? | When does it go away?
6 months. May be irreversible
86
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