Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Q4 Psych > Psychotic Disorders (lec 3) > Flashcards

Psychotic Disorders (lec 3) Flashcards

Lecture objectives: Define psychosis • Identify the DSMIV criteria for the five most common psychotic disorders and be able to differentiate between them • Describe the medications used to treat psychotic disorders • Understand the common side effects of these medications and their management

1
Q

Disorganized Speech types (5)

A
  1. derailment, tangentiality
  2. incoherence, world salad
  3. neologism
  4. echolalia
  5. blocking, paucity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Disorganized or Catatonic Behavior def

A

activity is not goal directed
inability to complete simple tasks
immobility
waxy flexibility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

causes of psychosis (12)

A
  1. substance intox/withdrawal
  2. med SEs: steroids, stimulants, dopamine agonists, anticholinergics
  3. delirium
  4. dementia
  5. denocrine (thyroid)
  6. CNS infection (syphilis)
  7. epilepsy (temporal)
  8. Vit deficiency (b12)
  9. Autoimmune (SLE)
  10. Huntigton’s
  11. Wilson’s
  12. Psychiatric d/z: psychotic, mood, personality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Evaluation of Psychosis (10 elements)

A
  1. HPI
  2. Past psych hx
  3. substance use hx
  4. family hx
  5. social hx
  6. PMH
  7. physical exam (neuro)
  8. MSE
  9. labs: UDS, UA, CBC, CMP, TSH, RPR, B12
  10. EEG, imaging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Psychotic Disorders (7)

A
  1. Schizophrenia
  2. Schizophreniform disorder
  3. Schizoaffective disorder
  4. Delusional disorder
  5. Brief psychotic disorder
  6. Shared psychotic disorder
  7. substance induced, due to general medical condition or not otherwise specified
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Schizophrenia: prevalence, affects who, when?

A

lifetime prevalence 0.5% to 1.5% worldwide (high heritability: 1st degree relative’s risk is 10x the general population)
males=females for prevalence and:
earlier age of onset
Smales early 20s, females late 20s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pathophysiology of schizophrenia

A

progressive gray matter deficits (slide 12?)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Schizophrenia: negative sxs

A

alogia (poverty of speech) affective blunting
anhedonia
avolition
attentional impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Schizophrenia: positive sxs

A

hallucinations
delusions
disorganized behavior
disorganized speech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Schizophrenia course

A
  • chronic
  • abrupt onset vs. prodrome
  • negative sxs appear first
  • complete remission is uncommon
  • decreased life expectancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Schizophrenia disorder life expectancy

A

men die 15 yrs earlier, women 12 (primarily due to ischemic heart disease & cancer)

  • 5% will commit suicide
  • 10% of completed suicides are schizophrenia pts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Schizophrenia DSM-IV dx criteria

A

A. at least 1 MONTH of 2+ of the following: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, negative sxs (only 1 sx if bizarre delusions or AH or running commentary or 2+ voices conversing)

B. significant social/occupational DYSFUNCTION in 1+ area

C. duration 6 MONTHS: 1 mo criterion A + prodrome/residual period

D. schizoaffective & mood d/o are ruled out (mood episodes are brief if present)

E. not due to substance or general medical condition
-if autistic/PDD must have prominent delusions/hallucinations at least 1 mo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Schizophrenia paranoid subtype

A

1+ delusion or frequent AH

not prominent: disorganized speech/behavior, inappropriate affect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Schizophrenia disorganized subtype

A
  • prominent disorganized speech & behavior
  • flat or inappropriate affect
  • not catatonic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Schizophrenia catatonic subtype

A

clinical picture dominated by at least 2:

  • motoric immobility/catalepsy, waxy flexibility, stupor
  • excessive motor activity (purposeless)
  • extreme negativism (resists movement), mutism
  • inappropriate/bizarre posturing, stereotypies, prominent mannerisms/grimacing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Schizophrenia undifferentiated subtype

A

meets criteria for schizophrenia, but no subtype

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Schizophrenia residual subtype

A

ABSENCE of prominent hallucinations, delusions or disorganized speech/behavior or catatonia

PRESENCE of negative symptoms or 2+ attenuated positive symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Mental Status Exam (MSE)Appearance

A

age, hygiene/clothing (disheveled, malodorous, unkempt)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

MSE: Behavior (3)

A
  1. cooperativeness & relation (uncooperative/combative, guarded/suspicious)
  2. eye contact (poor, looking around room, watching door, looking over shoulder
  3. motor activity (hypo or hyper; rocking, pacing, grimacing, or other abnormal movements)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

MSE: Affect

A

Appropriate (congruent w/mood)

Inappropriate (constricted/blunted/flat vs. labile, laughing inappropriately)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

MSE: Mood

A

whatever pt tells you, in quotes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

MSE: Speech

A

quantity
amplitude
rate
tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

MSE: thought process

A

logical vs. illogical
tangential
circumstantial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Hallucinations: definition

A

sensory perceptions in absence of stimulus:

  • auditory
  • visual
  • tactile
  • olfactory
  • gustatory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Thought content (3 possible components)
Hallucinations: whispering, conversing, commanding Delusions: paranoid, religious, grandiose, ideas of reference, thought broadcasting/insertion Suicidal & Homicidal ideation: document plan & intent, if pt denies SI/HI but has command hallucination to harm self/others, document & address it!
26
Another component of MSE
Insight & Judgment
27
Schizophrenia: factors indicating more positive prognosis
- Female - Later onset - Acute onset w/precipitating factor - Brief duration, early intervention, tx compliance - Positive symptoms - mood disturbance, family hx of mood do - high SES, married, good support system - good premorbid functioning
28
Schizophreniform Disorder
- Essential features identical to Schizophrenia (delusions, hallucinations, disorganization, neg sxs) - SHORTER duration: 1-6 months - social/occupational fxn may/may not be impaired
29
Schizophreniform disorder prognosis
1/3 recover (schizophreniform is final dx) 2/3 progress to schizophrenia or schizoaffective disorder
30
DSM-IV dx criteria for schizophreniform disorder
A. criteria A, D and E of schizophrenia are met (characteristic sxs, not schizoaffective or mood d/o, not due to substance or GMC) B. Episode (prodrome + active + residual phases) lasts between 1-6 months
31
Schizoaffective disorder: essential definition and types
Schizophrenia + mood disorder -Bipolar or Depressed type delusions/hallucinations 2 wks & normal mood
32
Schizoaffective disorder: prevalence & prognosis
more common in women (esp depressed type) | better prognosis
33
Schizoaffective disorder->increased risk of what in 1st degree relatives
increased risk of schizophrenia & mood d/o in 1st degree relatives
34
DSM4 Diagnostic Criteria for SchizoAFEECTIVE d/o
A. meets crit A fo SCHIZOPHRENIA (charactersic sxs) & CONCURRENT MAJ. DEPRESSIVE, MANIC or MIXED episode B. must have 2+ weeks of delusions or hallucinations w/out prominent mood sxs C. mood sxs present for a sig portion of illness D. not due to substance or GMC
35
Delusions: definition
fixed false beliefs, despite disproving evidence
36
4 types of delusions which can be one of which 2 things
-paranoid or persecutory -grandiose -reference -somatic BIZARRE vs. NON-BIZARRE
37
Delusional disorder: prevalence, demographics
* prevalence=0.03%, males=females, but variation among subtypes * variable age at onset (teen-late adulthood) * variable course (may remit & relapse) * possible familial relationship to Schizophrenia
38
Non-bizzare delusions
plausible but false i.e. infestations, being followed by police (NOT alien abduction)
39
Delusional disorder: can it co-occur with schizophrenia?
no, it does NOT meet criterion A for Schizophrenia
40
Describe the following in DELUSIONAL DISORDER: hallucinations, psychosocial function, thought process, insight
Hallucinations could be related to delusional theme (bugs) Psychosocial fxning NOT markedly impaired NORMAL thought process POOR insight
41
DSM4 dx criteria for DELUSIONAL DISORDER
A. NON-BIZZARE delusions for at least 1 MONTH B. crit A for schizophrenia has NEVER been met (but hallucinations rltd to delusion OK) C. Fxning NOT markedly impaired, normal behavior D. mood episodes, if any, are brief relative to delusion E. not due to substance or GMC
42
Delusional disorder: 7 subtypes
1. Erotomania 2. Grandiose 3. Jealous 4. Persecutory 5. Somatic 6. Mixed 7. Unspecified
43
Erotomania
delusion that another is in love with pt, usually a person of higher status (celebrity stalkers)
44
Grandiose
delusion of inflated worth, power, knowledge, identity or special relationship to deity or famous person
45
Jealous
delusion that spouse, significant other, sexual partner is unfaithful
46
Persecutory
delusion that pt is being treated malevolently | conspired against, cheated, spied on, followed, poisoned, harassed...
47
Somatic
delusion of physical defect or medical condition
48
Mixed delusion
features of more than one, but non predominate | erotomania, grandiose, jealous, persecutory, somatic
49
Unspecified delusion
delusion, that has not been specified
50
Brief Psychotic Disorder
- SUDDEN ONSET of at least 1 positive symptoms - lasts 1 DAY TO 1 MONTH w/RETURN TO NORMAL premorbid fxning - emotional, labile, confused
51
Brief psychotic disorder onset
onset in pate 20s to early 30s | may be marked with a stressor or post-partum onset
52
Brief psychotic disorder: what do you need to rule out
rule out culturally appropriate experience, malingering, personality disorder
53
Brief psychotic disorder: DSM-IV dx criteria
A. 1 OR MORE of: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior B. duration of 1 DAY TO 1 MONTH, w/eventual RULL RETURN TO PREMORBID LEVEL OF FUNCTIONING c. not due to SCZ, schizoaffective, mood d/o, substance, or GMC
54
Acute stabilization of psychotic d/os: medication
start antipsychotic at low dose & titrate as needed, avoid using 2 antipsychotics
55
Acute stabilization of psychotic d/o: priority, sxs
``` priority=safety, ↓ DTO/DTS may need hospitalization agitation improves fast(min-hrs) hallucinations improve in days negative sxs, delusions, cognitive deficits take much longer, if they improve ```
56
Indications for hospitalization in psychotic d/os (4)
1. Danger to self (DTS) 2. Danger to others (DTO) 3. command auditory hallucinations 4. unable to care for self
57
Maintenance of psychotic d/os goal
symptom control and relapse prevention
58
Maintenance of psychotic d/os
compliance is an issue - simplify med regimen (daily vs BID/TID dosing) - minimize SEs * day/partial hospitalization or intensive outpatient programs * assertive community tx, case management * involve social network
59
Monitoring/atypical antipsychotic protocol
- BMI monthly x 3 mos, then q 3 mos - waist circumference annually - lipids at 12 weeks & q 5 yrs - fasting glucose at 12 wks & annually - AIMS q 6 mos
60
Clozapine monitoring
CBC x 6 mos CBC biweekly x 6 mos CBC monthly for remainder of tx
61
First generation (conventional) antipsychotics (6+)
CHLORPROMAZINE (Thorazine) Haloperidol (Haldol) [PO tab or elixir, IM, IV, long-acting injection, topical] Thioridazine (Mellaril) Prochlorperazine (Compazine) Fluphenazine (Prolixin) [PO & inhaled] many others: Trilafon, Navane, Orap, Moban....
62
Second generation, atypical antipsychotics (9)
``` Aripiprazole (Abilify) Asenapine (Saphris) Clozapine (Clozaril) Lurasiodone (Latuda) Paliperidone (Invega Sustenna) Olanzapine (Zyprexa) Quetapine (Seroquel) Risperidone (Risperdal) Ziprasidone (Geodon) ```
63
Aripriazole (Ability): metabolic activity
partial D2 agonst | metabolically neutral
64
Asenapine (Saphris): unique
sublingual administration
65
Clozapine (Clozaril): unique characteristic
agranulocytosis risk: requires regular CBC monitoring of WBCs & ANC (weekly initially)
66
Lurasidone (Lutada): unique characteristic
pregnancy category B
67
Olanzapine (Zyprexa): what does the presentation want you to note?
weight gain
68
Risperidone (Risperidal): what does the presentation find unique abt this?
prolactin, EPS
69
Ziprasidone (Geodon): unique feature
50% less bioavailable without food
70
What to consider in selection of antipsychotics
``` Dx! r/o non-psych causes drug-drug intrxns (CYP metabolism) personal & fam hx of response to meds setting (ICU, ED, involuntary vs. voluntary, inpatient, outpatient) route (PO, ODT, IV, IM, long-acting IM) SE profiles ```
71
Side Effects of Antipsychotics
1. Extrapyramidal symptoms (EPS): acute dystonic reaction, Parkinsonism, akathesia, Tardive Dyskinesia (TD), Neuroleptic malignant syndrome (NMS) 2. Other: anticholinergic, adrenergic, cardiac, endocrine, hepatic
72
Acute dystonic rxn
(an extrapyramidal symptom) | torticollis, jaw spasms, dysphagia, dysarthria, tongue protrusion, oculogyric crisis, etc.
73
Extrapyramidal Symptoms (5)
``` ACUTE DYTONIC REACTION Parkinsonism Akathisia Tardive dyskinesia (TD) Neuroleptic malignant syndrome (NMS) ```
74
Akathisia
restlessness, fidgeting, rocking, pacing
75
Tardive Dyskinesia
ABNORMAL INVOLUNTARY MOVEMENTS 1. Choreiform: rapid, jerky, non-repetitive 2. Athetoid: slow, sinuous, continual 3. Rhythmic: stereotypies
76
Tardive dyskinesia prevalence, remission
prevalence: 20-30%, incidence 3-5% per year -higher risk in older adults, longer exposure, mood d/I ONLY 5-40% OF ALL CASES REMIT! use AIMS to screen EVERY 6 MONTHS
77
Tx of ACUTE DYSTONIA
benztropine, diphenhydramine
78
Tx of PARKINSONISM
amantadine, benztropine, diphenhydromine
79
Tx of AKATHISIA
propranolol
80
Tx of TARDIVE DYSKINESIA
benztropine or diphenhydramine AND decrease or stop the antipsychotic
81
Neuroleptic Malignant Syndrome (NMS)
POTENTIALLY LIFE THREATENING! | sever muscle RIGIDITY + INCREASED TEMP
82
Risk factors for NMS
- dehydration, ?hot/humid weather - agitation - high dose, rapid increase, IM injection - hx of NMS - Lithium use
83
NMS associated features (5)
1. mental status change (often 1st sx) 2. autonomic instability(↑BP/HR) 3. leukocytosis (>10,000) 4. ↑CK (often >300) 5. electrolyte abnormalities
84
NMS mnemonic
``` (FEVER) Fever Encephalopathy Vitals unstable Elevated enzyme (CK) Rigidity NMS ```
85
NMS treatment
theory: Dantrolene Reality: supportive/symptomatic NO neuroleptics for at least 2 weeks
86
All atypical antipsychotics black box warning
increased mortality when treating elderly pts for dementia-related psychosis (all atypicals)
87
Other atypical antipsychotic SEs (9)
1. Anticholinergic 2. Adrenergic (alpha 1 blockade) 3. Weight gain 4. Endocrine 5. Ocular 6. Cardiovascular 7. Hepatic: Transaminitis 8. Neuro (decreased seizure threshold, dose dependent w/most 1st gen & clozapine) 9. Leukocytosis & agranulocytosis
88
Anticholinergic Effects
dry mouth, blurry vision, constipation, urinary retention, confusion, delirium
89
Adrenergic effects of antipsychotics
(alpha 1 blockade) | -hypotension, dizziness
90
Endocrine effects of antipsychotics (atypicals, 1st gen)
atypicals: hyperglycemia, HLP, metabolic syndrome 1st gen & Risperidone elevated prolactin, gynecomastia, galactorrhea, amenorrhea, decreased libido
91
Ocular side effects of antipsychotics
pigmentary retinopathy (chronic Thioridazine)
92
Cardiovascular effects of antipsychotics
``` QT prolongation (can lead to torsades) Orthostatic hypotension Tachycardia ```
93
Neurological side effects of antipsychotics
decreased seizure threshold | dose-dependent risk with most 1st gen & clozapine

Q4 Psych (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions