B&b: Dx, Ddx, Tx, Course, Comorbidity 2

Front 1

Positive vs Negative Psychoses symptoms

Back 1

o Positive= Things patient do
o Negative= Things patients don’t do

Front 2

Schitzophrenia

Back 2

...

Front 3

Schitzophrenia- Dx

Back 3

o 6 Months

o “A” Critieria:
• 2 or more (1-4 are +ve symptoms)
1. Delusion
2. Hallucinations
3. Disorganized speech/ thought disorder
a. Illogical thinking
4. Disorganized/ catatonic behavior

5. Negative Sx

Front 4

Delusion?

Back 4

fixed, false beliefs w/ no logics

Front 5

Hallucination? Most common type?

Back 5

perception w/ out external stimuli

auditory

Front 6

Disorganized/ Catatonic behaviors? (6 ex)

Back 6

1. Catatonic stupor = immobile, mute, yet conscious

2. Catatonic excitement= uncontrolled, aimless motor activity

3. Stereotypy= repetitive/ ritualistic movement

4. Mannerisms= habitual gesture

5. Deterioration of social functioning – hygiene, home environment, socially inappropriate behavior

6. Substance abuse

Front 7

Negative symptoms of schitzophrenia?

Back 7

a. Flat affect = lack of emotional expression
b. Alogia= lack of speech
c. Anhedonia= inability to experience pleasure
d. Avolition/ apathy= lack of motivation
e. Can’t pay Attention

Front 8

What causes +ve side effects?

What causes -ve side effects?

Back 8

+ve side effects= inc dopamine in Nigrostriatal pathway

-ve side effects= dec dopamine in Mesocortical pathway

Front 9

Schitzophrenia - Tx

Back 9

Typical Antipsychotics:
• Haloperidol (high potency) = more Extrapyramidal side effects
• Chlorpromazine (low potency) = more anticholinergic side effects


Atypical Antipsychotics
• Clozapine (dirty= targets all over)
• Risperidone (metabolic synd)
• Olazapine (metabolic synd)


• Side effect:
o Metabolic Syndrome = hypercholesterolemia, Diabetes, Weight gain
• Must monitor metabolic syndrome

• Side effect of both typical & atypical
• Neuroleptic Malignant Syndrome =muscle rigidity, fever, autonomic instability, ↑WBC, ↑CPK

• Psychosocial Treatment
• More effective when combined with drugs than drugs alone
• CBT, Assertive community tx, Supportive employment

Front 10

What does potency mean?

Back 10

Drug affinity for D2 Receptor

Front 11

How do Typical antipsychotics work?


How do Atypical antipsychotics work?

Back 11

D2 antagonist = block DA
• Also block Muscarinic (M1), Histamic (H1), NE (a-1)
• Treat only the positive Sx

D2 Block + 5-HT Block
• 5-HT blockade → ↓ DA release , just enough to avoid Typical side effects
• Positive & Negative symptoms

Front 12

• How does D2 block ↓ +ve symptoms?

Back 12

o dec dopamine in Mesolimbic

Front 13

Side effects of Typical antipsychotic? Caused by?

Back 13

D2 Block:
o Nigrostriatal = Extra pyramidal
o Mesocortical = ↑negative Sx
o Tuberoinfundibular = hyperprolactinemia

o M1 Block: Anticholinergic side effects (dry mouth, blurry vision, constipation, urinary retention)
o H1 Block: weight gain, sedation
o A1 Block: Antinorenergic side effects= orthostatic hypotension

Front 14

Extra pyrdamidal symptoms?

Back 14

Akathesia= restless lower extremities

Parkinsonism → why? ACh >DA

Dystonia= spasms

Tardive dyskinesia =late onset- uncontrolled movement

Front 15

Hyperprolactinemia? Normal?, D2 block leads to?

Back 15

Normally: DA→ ↓Prolactin

D2 block ↓ DA→ ↑ Prolactin → Hypogonadism, infertility, ↓bone density

Front 16

Pros of Atypical compared to typical? Why?

Back 16

Pro: < EPS, negative Sx, hyperprolactinemia than Typical Neuroleptics

o 5-HT Block →↓Dopamine @ Nigrostriata, mesocortical, tuberoinfundibular pathway

o B/c ↓DA in mesocortical → ↓(-)ve symptoms

Front 17

Schitzophrenia Course- what age?

Back 17

Late teens- early 20's (rarely after 40)

Front 18

Schitzophrenia Course- 3 stages?

Back 18

• Three stages:
1. Prodromal -- social withdrawl years before
2. Active -- A criteria, psychotic Sx
3. Residual -- similar to prodromal, worse sx

Front 19

Schitzophrenia - DDx

Back 19

Delirium (acute state) = delusions, hallucinations

Dementia (Chronic state) = delusions, hallucinations

Neurological disorders

Front 20

Schitzophrenia- comorbidities

Back 20

o Substance abuse
o Mood Disorders
o Medical Disorders

Front 21

Paranoid Schitzophrenia

Back 21

schitzo w/ paranoia

Front 22

Disorganized Schitzophrenia

Back 22

schitzo w/ disorganized speech/ behavior

Front 23

Catatonic Schitzophrenia

Back 23

Schitzo w/ catatonic behavior (immobile or uncontrolled movement)

Front 24

Undifferentiated Schitzophrenia

Back 24

Schitzo w/ elements of all symptoms

Front 25

Residual Schitzophrenia

Back 25

schitzo w/ social withdraw

Front 26

Schitzophrenia time course?

Back 26

Brief psychotic disorder = < 1mo
Schitzophreniform= 1-6 mo
Schitzophrenia= 6 mo

Front 27

Schitzoaffective

Back 27

Schitzophrenia + mood disorder

Front 28

Delusional disorder

Back 28

persistent delusions but no hallucination

Front 29

Shared psychotic disorder

Back 29

Shared w/ 2 people

Front 30

Personality Disorder

Back 30

....

Front 31

What is a personality trait?

Back 31

enduring, repetitive pattern of behavior

Front 32

What is a personality disorder?

Back 32

Collection of Personality traits that are maladaptive

Front 33

Comorbidity of personality disorders? Axis 1 vs Axis 2?

Back 33

Axis 1: Clinical disorders (Psychoses, mood disorders, anxiety, substance abuse)

Axis 2: Other Personality disorder & developmental disorder (mental retardation)

Front 34

• Generally How to make dx for personality disorder?

Back 34

5-factor model

Front 35

What are the 5 criteria of 5 factor model? Spectrum of each? What does it measure?

Back 35

1. Openness to experience – curious? Cautious? = measures curiosity

2. Conscientiousness – organized? Careless? = measures dependability

3. Extraversion – outgoing? Solitary? = measures stimulation by others

4. Agreeableness – friendly? Cold? = measures compassion

5. Neuroticism- nervous? Confident? = measures degree to which we tolerate unpleasant emotions

Front 36

• What are 2 important factors to consider when making personality disorder dx?

Back 36

o TIME= longitudinal
o Detailed SOCIAL & DEVELOPMENTAL hx

Front 37

• 3 Personality Types? General characteristic of each?

Back 37

o A= “Awkward” / weird

o B = “Bad”/ dramatic, emotional

o C = “Cowardly” / anxious

Front 38

A personalities? (3) Describe each

Back 38

Paranoid =distrustful & suspicious (others are plotting)

Schizoid = “loners” ; flat affect

Schizotypal = “Magical types”; like schitzophrenia but <severe; Odd thought patterns; inappropriate

Front 39

B personalities? (4) Describe each

Back 39

Narcissitic=grandiosity; lack empathy; low self-esteem underlies – ex: Roman

Antisocial = disregard for others rights; aggressive

Borderline= intense but unstable relationship; fear abandonment; impulsive- ex: Danielle

Histronic = Attention seeking; Assume intimacy – ex: He loves me, he loves me not

Front 40

C Personalities? (3) Describe each

Back 40

Avoidant = fear humiliation/ rejection so avoid interpersonal relationships

Obsessive-compulsive = perfectionist; interpersonal control - ex: Amadeo

Dependent = extreme need for others for emotional support; can’t make own decisions; poor self-confidence –ex: Katie