Schizo

Question 1

Psychosis mood disorders

Answer 1

Schizoaffective
Bipolar
Major Depression w/ psychotic

Question 2

Psychosis 2ndary to Med condition

Answer 2

Brain tumor, tertiary syphilis, HIV

Question 3

Personality disorders

Answer 3

Schizoid personality
Schizotypal personality
Paranoid Personality

Question 4

Delusion

Bizarre vs. Non-bizarre

Answer 4

• Bizarre = not at all possible in reality

* Non-bizarre = possible in reality

Question 5

Hallucination vs. delusion

Answer 5

Hallucination = a false sensation/perception

Delusion = a false belief

Question 6

Disorders of thought

Answer 6

• Ideas of reference
• loose associations/derailment/flight of ideas = one topic to next, RELATED topics
• Tangientiality= UNRELATED answers to questions
• word salad = nearly incomprehensible

Question 7

Negative symptoms vs. Positive symptoms

timeline

Answer 7

Negatives usually come first on a timeline, then positives later

Question 8

Working memory

Answer 8

Immediate conscious perception and linguistic processing

Question 9

Attention

Mini mental status exam

Answer 9

WORLD backwards

Serial 7s

Question 10

Congnitive s/s

Answer 10

Working memory
Executive function
Attention
Learning

LACK= fall out of society, worse prognosis

Question 11

Mesolimbic vs. mesocortical pathway

Answer 11

Mesolimbic = too much Dopa (+ S/S)

Mesocortical = too little dopa
(- S/s)

Nigrostriatal pathway = too little dopa (EPS)

Tuberoinfundibular = too little dopa (release prolactin = breasts)

Question 12

Glutamate in schizophrenia

Answer 12

Regulates dopamine = releases or starts GABA (inhibit)

NMDA receptor has role (PCP)

Question 13

what part of brain involved

Answer 13

Many, not localized

Question 14

Schizophrenia

Dx

Answer 14

Must have 2 + at least 1 starred:

• Delusions*
• Hallucinations*
• Disorganized speech*
• Grossly disorganized/catatonic behavior
• neg symptoms

6 months over all, positive symptom for min 1 month

NO MOOD DISORDER FOR MAJORITY of DURATION

Question 15

Schizophrenia exclusion

Answer 15

*no major depressive, manic, mixed episode in active-phase symptoms
(If so, brief duration)
*not due to drug/med condition

Question 16

Must have catatonia

Answer 16

• motor immobility
• excessive activity motor
• extreme negativism
• peculiarities of voluntary movement = posturing
• stereotyped movements

Question 17

Catalepsy

Answer 17

Muscular rigidity, fixity of posture regardless of stimuli

Question 18

Echolalia

Answer 18

Mimicking sounds

Question 19

Echopraxia

Answer 19

Mimicking movements

Question 20

Treating catatonia

Answer 20

Benzos

Gaba inhibitory effects
In state = info overload

Question 21

Genetic causative agents

Answer 21

Chromosome 6 (too much C4-A)

Pruning of synapses during brain development
Prefrontal pruning - going on too long

Men get first, women later (time normal pruning stops)

Question 22

DX + Treating early w/ anti-psychs

Answer 22

• Change course

* Longer brain is under stress, more NT toxicity damaging brain

Question 23

Schiz Brain abnormality

Answer 23

*hypoperfusion = globus pallidus
*anterior hypothalamus smaller
*ventricles enlarged
*sulci enlarged
BRAIN TISSUE LOSS = degenerative

Question 24

Brain damage = precipitating factors

Answer 24

Birth trauma
Viral infections
Nutritional issues

Question 25

Diathesis-stress model

Answer 25

Genes + stressors (life events)

Question 26

Downward drift vs. social causation

Answer 26

Drift = dz causes you to drop social class So more seen in lower socioeconomic status

Question 27

Course

Answer 27

``` *Prodromal: Negative s/s -males 18-25 -females 25-30 -late >40 (women) ``` * Acute - Positive s/s * Recovery/Residual - improve/hospital/institution/suicide

Question 28

Prognosis Better

Answer 28

``` Late/sudden onset Female Higher function prior Good compliance Family History Paranoid subtypes ```

Question 29

Prognosis Worse

Answer 29

``` Early age of Onset Male More Negative s/s Lower functioning prior Substance abuse Disorganized type ```

Question 30

EPS effects from Rx

Answer 30

*actue

Question 31

Higher potency typical anti-psycs effects on

Answer 31

*Strong D2 receptor block +cut Positive s/s -EPS, hyperprolactinemia

Question 32

Low potency binds to

Answer 32

histamine alpha adrenergic or histaminic

Question 33

EPS Acute dystonia

Answer 33

Torticollis, opisthotonos, oculygyric crisis, 24-48 HOURS FROM ANTI-PSYC INITIATION

Question 34

EPS Akathasia

Answer 34

Restlessness --> movement Days-weeks after anti-psyc treatment start

Question 35

EPS Parkinsonism

Answer 35

Traid, rigidity, tremors Within DAYS of initiating anti-psyc Rx

Question 36

EPS Tardive dyskinesia

Answer 36

Long-term, early as 1 month after antipsyc onset Lip smacking common

Question 37

Dystonia Tx

Answer 37

Benztropine

Question 38

Parkinsonism Tx

Answer 38

* reduce anti-psyc * benztropine * change to atypical anti-psyc

Question 39

Akathisia Tx

Answer 39

* reduce anti-psyc * beta blocker (propranolol) * Benzo (valium) * change to atypical antipsyc * benztropine

Question 40

Tardive Dyskinesia Tx

Answer 40

* regular AIMS to detect early * cease anti-psyc if possible * change to atypical anti-psyc * lowest dose possible

Question 41

Neuroleptic Malignant Syndrome

Answer 41

* Mental status change - acute, rapid onset * autonomic instability - fever/hyperpyrexia - tac/HTN - diaphoresis * neuromuscular findings - lead pipe rigidity * labs - CPK UP, myoglobinuria - renal failure - leukocytosis

Question 42

Atypical anti-psycs

Answer 42

D2 + 5HT2a in mesolymbic circuit

Question 43

Noncompliance?

Answer 43

Depot drugs

Question 44

Assertive Community Treatment

Answer 44

Very good, Personalized care Not available in many states ("freedom of client to refuse care")

Question 45

Brief Psychotic Disorder

Answer 45

1 day to 1 month

Question 46

Schizophreniform

Answer 46

LESS THAN 6 MONTHS Schizo s/s, NO Schizoaffective/mood disorder

Question 47

Delusional Disorder

Answer 47

* women more * NO FUNCTIONALITY LOSS * NO DISORGANIZED THOUGHT/BEHAVIOR * mood congruent beliefs = false beliefs consistent w/ patient mood * mood non-congruent beliefs =

Question 48

Schizoaffective Disorder

Answer 48

* PSYCHOTIC SYMPTOMS 2 WEEK PERIOD + W/O MOOD SYMPTOMS | * other schizophrenia s/s

Question 49

Bipolar/depression

Answer 49

PSYCHOSIS w/in MOOD DISORDER PHASE Just need 1 manic episode for bipolar

Question 50

Schizoid NOT ON TEST

Answer 50

Excessive detachment from social relationships, restricted range of expression of emotions NO ACUTE PSYCHOTIC S/S

Question 51

Schizotypal NOT ON TEST

Answer 51

*acute discomfort with/Reduced capacity for close relationships by cognitive or perceptual distortions + eccentricities of behavior NO ACUTE PSYCHOTIC SYMPTOMS

Question 52

Delusional disorder types

Answer 52

* persecutory * Erotomaniac * Grandoise * Jealousy * Somatic

Question 53

Disorganization s/s

Answer 53

* speech * thought * catatonia * Stereotypy = repeated, non-goal directed movement (rocking) * Mannerisms (odd) * Echopraxia * Automatic obedience * Negativism