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62 Cards in this Set
- Front
- Back
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List the 5 Axes
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1. Clinical
2. Personality and MR 3. Medical 4. Psychosocial/Enviornmental 5. GAF Score |
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Schizophrenia is what axis?
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One
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Explain downward drift
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People with schizo wind up homeless because of their craziness...
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Give diagnostic criteria for schizophrenia
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A: At least 2 sx, each present for a significant portion of a 1 mo period.
B. Social/Occupational dysfunction C. Continuous signs of disturbance for at least 6 months. At least 1 month of Criteria A sx (less if tx). Prodromal or Residual sx for rest of 6 mo period |
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Examples of "positive" schizo sx
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delusions, hallucinations, agitation, talkativeness
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Examples of negative schizo sx
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lack of motivation, social withdrawal, flattened affect, cognitive disturbance, poor grooming/speech
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Negative sx respond better to what type of drugs
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atypical antipsychotics
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positive sx respond to
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typical and atypical antipsychotics
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3 phases of schizo
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prodromal
psychotic residual |
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Describe prodromal phase
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Avoids social activity
Quiet, passive Irritable Physical complaints Interest in occult, religion, etc In touch with reality |
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Describe psychotic phase
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Loses touch with reality
hallucinations (false perceptions) delusions (false beliefs) |
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Describe residual phase
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period between psychotic episodes.
In touch with reality, but does not behave normally Flat affect, peculiar thinking, eccentric behavior, social withdrawal |
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Is there a genetic basis for schizo
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yes. Monozygotic twins have 50% chance if one twin has it.
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Are there sex differences in schizo
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Yes. Equal occurance. Women get it at later age (25-35) than men (15-25). Women respond better to antipsychotics
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Do viral infections contribute to schizo
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Yes. More people with schizo born during cold weather months. 2nd trimester especially
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Describe gross brain changes in schizo
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dec use of glucose in prefrontal cortex
dec volume of: hippocampus, amygdala, parahippcampal gyrus. Inc volume of lateral ventricles |
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Describe EEG changes in schizo
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dec alpha waves
inc theta, delta waves epileptiform activity poor smooth visual pursuit |
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Describe NT abnormalities in schizo
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inc dopaminergic, serotonergic, and noradrenergic activity.
Abnl transmission of glutamate |
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What evidence exists to support the "dopamine hypothesis" as a cause for schizo
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Use of stimulants that inc dopamine (cocaine, amphetamines) can cause psychotic sx. Inc HVA in schizo blood
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Evidence for Serotonin Hyperactivity as a cause of schizo
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LSD inc 5HT = psychotic sx
Clozapine has anti-5HT-2 activity. |
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NE is implicated in what subtype of schizo
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Paranoid
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Why is glutamate implicated in schizo
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NMDA antagonists increase schizo sx.
NMDA agonists dec schizo sx |
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List 5 subtypes of schizo
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Undifferentiated
Paranoid Residual Disorganized Catatonic |
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Term for medical illnesses that cause psychotic sx
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psychotic disorders caused by a general medical condition (PDMC)
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List PDMC's that may be mistaken for schizo
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Parkinson's
Huntington's Neoplasm Neuro infection Temporal Lobe Epilepsy Thyroid Cushing's/Addison's SLE Porphyria Vit. def. |
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List some medications that can cause schizo sx
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Analgesics
Antibiotics Anticholinergics Antineoplastics Anti-TB meds Anti-parkinson's Anti-HTN Stimulants Cardac Glycosides (digitalis) Steroids |
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Give some psych illness mistaken for schizo
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Manic/Bipolar
Cognitive disorders Substance-related disorders |
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How can you tell a patient with schizo from a patient with medically induced sx
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Patients with medically caused sx will show preservation of affect
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21-yo, disheveled. Hears voices. No delusions. Believes she can communicate with animals. Blunt (not flat) affect. No catatonia. Type?
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Undifferentiated Schizo
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34 yo pt seems fearful. Gov't has been listening to her phone convos for 2 years
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Paranoid
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30yo M, hospitalized 5y ago with autitory hallucinations has since shown flat affect, social withdrawal and strange behavior with no delusions or hallucinations
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Residual
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18yo M, unshaven, dirty. Stares into mirror, posturing and grimacing. Giggles when he tells the doctor that his stomach is a monster amchine ready to throw me on the train.
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Disorganized
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27yo does not speak. Extreme agitation to the point of exhaustion. Hold body in unusual positions
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Catatonic
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Name some traditional antipsychotics
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Haloperidol
chlorpromazine |
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Name atypical antipsychotics
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clozapine
olanzapine quetiapine risperidone ziprasidone aripiprazole |
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Bad side effects of traditional antipsychotics
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Parkinsonism
Tardive dyskinesia (writhing movements) |
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What % of pt's are helped by antipsychotics
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70%
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What % of pt improvement can be attributed to placebo effect
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25%
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Name two treatments you can give to non compliant patients
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Injectable long acting meds:
haloperidol decanoate fluphenazine decanoate |
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What % of patients with schizo attempt suicide, and what % succeed
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50% attempt
10% succeed |
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What lowers schizo suicide risk
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Older age
Married Good social relationships Female Good employment have Mood sx have + sx few relapses |
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What is it called if a pt has schizo sx for at least one day but less than 1 month
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brief psychotic disorder
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what is it called if a pt has schizo sx for at least 1 month but less than 6 months
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schizophreniform disorder
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How is schizoaffective disorder different from schizo
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addition of mood sx. psychotic sx must be present for at least 2 wks without mood sx and mood sx must persist during psychotic and residual phase
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Describe delusional disorder
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highly systematized by non-bizarre (possible in real life) delusions for at least 1 month with no other schizo sx. starts in middle age. Pt's remain sociall functional.
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Subtypes of delusional disorder and describe beliefs associated with them
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Erotomanic: a famous person is in love with pt
Jealous: partner is cheating on pt. Persecutory: someone is trying to harm pt. |
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Describe shared delusional disorder (folie a deux)
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delusions occuring in close relatives of pt's with delusional disorder
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62 yo F with delusional disorder believes people are putting anthrax dust in her house. Husband is worried about how to remove the dust. His worries slowly abate if separated from wife.
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Shared delusional disorder
Folie a deux |
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A woman interprets the appearance of a dress in a dark closet as a person
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Illusion
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Pt hears 2 voices talking about her when she is alone in a room. Smells nonexistant odors
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Hallucination
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Pt believes she is being discussed on national news program
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Ideas of reference
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Pt believes she is being followed by gov't.
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Delusions
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Pt feels she is "merged" into others
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Loss of ego boundaries
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When asked what brought him to the hospital, the patient says, "a bus".
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Impaired abstraction ability
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A person knock on wood after saying something positive about his health
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magical thinking
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Pt says, "I'm very sure I've got a cure and I'm not pure"
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Echolalia
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Pt begins to answer question about parents, then launches into diatribe about world hunger
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Loose association
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Pt refers to a restaurant as an "automatic automat"
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Neologisms
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Pt says, "I'm bad, I'm bad, I'm bad..."
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Perseveration
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pt says, "I'll tell you about my thoughts, but let me also tell you about brains and blood"
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Tangentiality
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Pt suddenly stops talking, but keeps moving lips
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Thought blocking
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Pt says, "I'm not so utterly pure that I'm going away anyway to break it"
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Word Salad
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