Thought Questions FA

Question 1

DDX for Psychosis?

Answer 1

1. Substance/meds
2. Delirium / Dementia
3. Bipolar…manic/mixed
4. Major depression w/ psychotic features
5. Delusional disorder
6. Schizophrenia
   
   • brief psychotic, schizophreniform, schizophrenia
7. Schizoaffective

Question 2

Name 4 positive symptoms of Schizo?

Answer 2

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Bizarre behavior

Question 3

Name the five A’s of negative symptoms of Schizo?

Answer 3

1. Flat Affect
2. Anhedonia
3. Apathy/Avolition
4. Alogia (poverty of speech)
5. Alone - lack of interest in socialization
   Attention (poor)

Question 4

DSM V Criteria for Schizo

Answer 4

2+ from the following for at least 1 month. 1 must be from #1,2,3

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Disorganized behavior/catatonic
5. Negative Symptoms

Question 5

In addition to 2 of the 5 criteria for Schizo, what else must be present?

Answer 5

Must cause significant social, occupational, or self-care functional deterioration

Question 6

Why is it thought that increased dopamine activity is connected to Schizo?

Answer 6

1. Antipsychotics effective in treating Schizo are dopamine antagonists
2. Cocaine and amphetamines increase dopamine activity and both can produce Schizo-like symptoms

Question 7

Are the following associated w/ worse or better prognosis in Schizo?

• later onset
• male gender
• negative symptoms
• positive symptoms
• acute onset
• mood symptoms

Answer 7

Later = good
Male = bad
Negative = bad
Positive = good
Acute = good
Mood = good

Question 8

Somatic symptom disorder vs.

Illness anxiety disorder

Answer 8

Somatic: excessive anxiety + preoccupation w/ 1+ unexplained symptoms

Illness anxiety: fear of serious illness despite few or NO symptoms…idea of an illness

Question 9

What lab tests would you order before prescribing Lithium?

Answer 9

Creatinine, BUN, urinalysis
Thyroid function tests
ECG in pt’s w/ coronary risk factors

Question 10

Which disorder do you remember dream content?
Which disorder can you be consoled?
Which disorder can child have incomplete awakenings?

Answer 10

Nightmare disorder - yes content, yes consoled

Sleep terror - no comfort, no recall, incomplete awakenings

Question 11

Which substance abuse has:

• aggressive behavior
• tactile hallucinations
• excoriations

Answer 11

Methamphetamine abuse
- also poor dentition & delusions

Tactile - bugs crawling under the skin

Question 12

What seen in amphetamine intoxication?

Answer 12

Agitation
Psychosis
Tachycardia, hypertension, diaphoresis
Mydriasis
                                        Can subside in a few hours

Question 13

What seen in opioid withdrawal?

Answer 13

Irritability
Lacrimation, rhinorrhea
N/V/Diarrhea, abdominal cramps
Muscle spasms, joint pain
                                                       Often last 3-5 days

Question 14

Arthralgia, thrombocytopenia, hematuria, proteinuria

Psychosis, depression, mania, anxiety

Answer 14

If young women, think SLE

- test for anti-dsDNA, anti-Smith, anti-U1 ribonucleoprotein