Term
| What is the definition of psychosis? |
|
Definition
| break from reality involving delusions, hallucinations, or disordered thinking with only minimal evidence of positive sxs (hallucinations or delusions) |
|
|
Term
| What are the 2 main categories of thought disorders? |
|
Definition
1. D/O's of content:
-reflect the patient's beliefs, ideas, and interpretations of surroundings (i.e. paranoid delusions)
2. D/o's of thought process:
-manner in which the patient links ideas and words together (i.e. tangentiality, circumstantiality, loose assocations) |
|
|
Term
|
Definition
| false beliefs that cannot be altered by rational arguments aren't culturally held beliefs |
|
|
Term
Delusions:
Paranoid delusion? |
|
Definition
| belief that one is being persecuted |
|
|
Term
Delusions:
ideas of reference? |
|
Definition
| beleif that some event is related to the individual "Jesus is speaking to me through TV characters" |
|
|
Term
Delusions:
Thought broadcasting |
|
Definition
| belief that one's thoughts can be heard by others |
|
|
Term
Delusions:
Delusions of grandeur? |
|
Definition
belief that one has special powers beyond those of a normal person
"I am the allpowerful son of God and I shall bring my wrath down upon you if I cannot have a smoke" |
|
|
Term
Delusions:
Delusions of guilt? |
|
Definition
false belief that one is guilty or responsible for something they could have had nothing to do with
"I was responsible for Hurricane Katrina" |
|
|
Term
| Name 5 major types of delusions |
|
Definition
1. Delusions of grandeur
2. Thought broadcasting
3. Delusions of Guilt
4. Paranoid delusions
5. Ideas of reference |
|
|
Term
| What are some clinical signs that someone maybe psychotic? |
|
Definition
-Hallucinations
-Delusional Thinking
-Disordered thought process |
|
|
Term
| Define hallucinations. What are the 4 types? |
|
Definition
Def: sensory perception without external stimulus
1. Visual (commonly seen withdrug intoxication)
2. Auditory (most commonly in schizophrenia)
3. Tactile (2/2 drug abuse, alcohol withdrawl)
4. Olfactory (seen with seizures) |
|
|
Term
| What is an illusion vs. hallucination? |
|
Definition
| Illusion is mistaking an existing sensory stimulus for something else (i.e. mistaking a shadow for a cat) |
|
|
Term
| What is the differential diagnosis of psychosis? |
|
Definition
-psychosis due to general medical/neurologic condition
-iatrogenic or substance induced
-delirium/dementia
-bipolar
-MDD with psychotic features
-brief psychotic disorder
-schizophrenia
-shizophreniform
-delusional disorder |
|
|
Term
| What are the DSM-4 criteria for psychotic disorder 2/2 a general medical condition? |
|
Definition
1. Prominent hallucinations or delusions
2. Sxs must occur outside of delirium
3. Evidence to support medical cause (i.e. lab tests, history, physical) |
|
|
Term
| What are some causes of psychosis secondary to general medical condition? |
|
Definition
1. CNS disease (MS, cerebrovascular dz, neoplasm, epilepsy)
2. Endocrinopathies (Addison's, Cushing's, hyper/hypothyroidism)
3. Nutritional/Deficiency states: B12, folate, niacin
4. Other (SLE, temporal arteritis, porphyria) |
|
|
Term
| 22y.o. college student. Stays in room most of the time and avoids social activities. His friends have noticed he has been very religious for the past 9 months and often talks about the meaning of life. He reveals to you that he is "Jesus"and his purpose is to save the human race. |
|
Definition
Schizophrenia.
-DSM4 Criteria
A. 2 or more of the following must bepresent for 1 month:
1. Delusions
2.Hallucinations
3. Disorganzied speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (5As=anhedonia, alogia (poverty of speech), affect (flat); avolition (apathy), Attention (poor))
B.Significant social or occupational functional deterioration
-Duration of entire illness for 6 months(including prodromal or residual periodsinwhich above criteria may not be met)
-Sxs are not due a medical, neurological or substance-induced disorder |
|
|
Term
| What are the 3 phases of schizophrenia? |
|
Definition
1. Prodromal-decline in functioning that precedes the first psychotic episode; social withrawal, irritability
2. Psychotic-hallucinations, delusions, diordered thoughts
3. Residual phase-between episodes of psychosis; marked by negative sxs (flat affect, anhedonia, alogia, avolition, inattention) |
|
|
Term
| What are 5 subtypes of schizophrenia? |
|
Definition
1. Paranoid-
2. Disorganized-
3. Catatonic-
4. Undifferented-
5. Residual- |
|
|
Term
|
Definition
| high functioning type, older age of onset; must preoccupation with one or more delusions or frequent auditory hallucinations; no predominance of disorganized or catatonic behavior or inappropriate affect |
|
|
Term
| Disorganized type schizophrenia |
|
Definition
| Poor functioning type, early onset. Must have: disorganized speech, diorganized behavior, flat or inappropriate affect |
|
|
Term
| Catatonic-type Schizophrenia |
|
Definition
| Rare. Must have: motor immobility, excessive purposeless motor activity, extreme negativity or mutism, peculiar voluntary movements or posturing, echolalia, echopraxia |
|
|
Term
|
Definition
| prominent negative sxs. (affect, anhedonia, attention, alogia, avolition) with only minimal positive sxs |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Downward drift schizophrenia hypothesis |
|
Definition
| people suffering from Schizophrenia are unable to function well in society and hence enter lower socioeconomic groups |
|
|
Term
| What is the postulated pathophysiology of schizophrenia? |
|
Definition
| related to excess dopamine activity in certain neuronal tracts |
|
|
Term
| Where in the brain do the positive and negative schizophrenic signs originate? |
|
Definition
positive=mesolimbic
negative=prefrontal cortex |
|
|
Term
| Dopamine pathways blocked by neuroleptics |
|
Definition
-Tuberoinfundibular--blocked by neuroleptics, causing hyperprolactinemia
-Nigrostriatal--blocked by neuroleptics causing EPS |
|
|
Term
| What NTs are affected in Schizophrenia? |
|
Definition
Serotonin-Elevated
NE-Elevated
Dopamine-Elevated
GABA- Low |
|
|
Term
| Good prognostic factors for schizophrenia |
|
Definition
later onset
positive sxs
mood sxs
acute onset
female sex
few relapses
good premorbid functioning |
|
|
Term
| Poor prognostic indicators in schizophrenia |
|
Definition
Male sex
early onset
negative sxs
family hx
gradual onset
poor premorbid functioning |
|
|
Term
| Treatment of schizophrenia (positive sx predominant) |
|
Definition
Neuroleptics:
1.Typicals
-chlorpromazine, thiodazine, haldol
-D2 antagonists
-better for positive sxs
Side effects: EPS, neuroleptic malignant syndrome |
|
|
Term
| Treatment of negative symptom predominant schizophrenia |
|
Definition
Atypical neuroleptics:
-(-apines) clozapine,olanzepine, quietapine; aripiprazole; (-idones) Resperidone,ziprosidone
-antagonize both serotonin and dopamine receptors
-lower incidence of EPS than traditional neuroleptics |
|
|
Term
| Just started my schizophrenic patient on a neuroleptic. How long should Iwait before reassessing? |
|
Definition
| 4 weeks. if no improvement, move to another drug. |
|
|
Term
| Side effects in high-potency traditional antipsychotics?(Haldol, trifluoperazine) |
|
Definition
EPS:
dystonia
akisthesia
parkinsonism
tardive dyskinesia
-Treatment: antiparkinsonian agents (benztropine, amantidine, benzos) |
|
|
Term
| Side effects seen with low-potency traditional anti-psychotics (chlorpromazine, thioridazine) |
|
Definition
| Anti-cholinergic sxs-dry mouth; dry eyes |
|
|
Term
|
Definition
Caused by high potency anti-psychotics
-darting or writhing movements of the face, tongue,or head
-Tx:discontinue offending agent and substitute atypical neuroleptic; benzos, betablockers, and cholinomimetics may be used shortterm |
|
|
Term
| Confusion, high fever, elevated blood pressure, tachycardia, lead pipe rigidity,elevated CPK, leukocytosis |
|
Definition
|
|
Term
| 7 weeks, a 25 year-old student has been living in a car; claims that the FBI has put cameras in his dorm room to monitor his every action. Friends say he has been more withdrawn and rarely shows up for lectures. He exhibits looseness of association, poor association, and poor insight, and is concrete to proverbs. |
|
Definition
| Schizophreniform disorder
Same DSM criteria as schizophrenia, except in schizophreniform disorder, the sxs have lasted between 1-6 months
Prognosis: 2/3 progress to schizoaffective
Tx: Hospitalization, 3-6 months of antipsychotics, supportive psychotherapy |
|
|
Term
| Patient just tried to light his body on fire. Patient with tears. States that "satan is trying to freeze his body. He never went out during the winter because of this. He is sad to the point of suicide. He has had a few similar episodes over the past several years. |
|
Definition
Schizoaffective disorder
Dx:
Meet criteria for depressive episode, manic episode, or mixed episode WITH delusions and/or hallucinations for 2 weeks in the absence of mood symptoms; AND ysmptoms not due to a general medical condition or drugs
Tx: HOspitalization and supportive psychotherapy, antipsychotics for shorterm control of psychosis, mood stabilizers, antidepressants or ECT for treatment of mood component |
|
|
Term
| Patient with sx criteria for schizophrenia that last from 1 day to 1 month |
|
Definition
| Brief psychotic disorder
Prognosis: good recovery rate; 20-30% of patients will develop clincal schizophrenia
Tx:Brief hospitalization, supportive psychotherapy, course of antipsychoitics, benzos for agitation |
|
|
Term
Rank prognosis from best to worst:
brief psychotic disorder, schizophreniform disorder, schizoaffective disorder, schizophrenia, mood disorder |
|
Definition
Prognosis from best to worst:
mood disorder> brief psychotic disorder > schizoaffective disorder > schizophreniform disorder> schizophrenia |
|
|
Term
| Two weeks after the death of her son, 30 year old lady with hallucinations of baby crying. Often carries a pillow and sings nursery rhymes to it |
|
Definition
|
|
Term
| 48 year-old pathology professor says that the students complain about him to the dean to try to get frid of him. Despite reassurance, he says he "knows" he is correct. |
|
Definition
Delusional Disorder
Dx: Nonbizarre (beliefs that might/could occur in reallife but are not currently true
-does not meet criteria for schizophrenia
-functioning in life not markedly affected
Prog: 50% recover fully
Tx: psychotherapy; antipsychotic meds are often not helpful but may try a course of high-potency traditional antipsychotics |
|
|
Term
| 28 year-old woman caring for her schizophrenic husband starts believing his claim that he invented the telephone. When she went abroad for a few months, her beliefs disappeared |
|
Definition
| Shared psychotic disorder
Dx: patient develops the same delusional sxs as someone he or she is in a close relationship with
Prognosis: 40% improve when weirdo is removed from the situation
TX: separation, psychotherapy; if sxs do not improve following separtions should prescribe antipsychotics |
|
|
Term
| Headache, fatigue, and visual disturbances in male sudents in africa |
|
Definition
|
|
Term
| Sudden unprovoked outbursts of violence of which the person has no recollections in southeast Asia and Malaysia |
|
Definition
|
|
Term
| Patient in Asia believes his penis is shrinking and will disappear causing his death |
|
Definition
|
|
