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38 Cards in this Set

  • Front
  • Back
what is psychosis?
break w/reality (symptom, not an illness)

**included hallucinations delusions and though disorder
**caused by a variety of conditions that affect the fuctioning of the brain
psychosis can be seen in primary/functional cases such as mood disorders or schizophrenia or secondary mental disorders such as substance abuse. What could be on your DDx if someone has psychosis?
medical/surgical/subsance-induced
schizophrenia
schizoaffective
mood disorders (bipolar/major dression)
personality disorders
Misc (PTSD, dissociative disorders, etc)
how does the DSM-IV diagnose schizophrenia?
psychotic symptoms (2 or more) for at least one month
Hallucinations: sensory perceptions that occur in absence of any stimuli
Delusions: fixed false beliefs even with contrary evidence
Disorganized speech
Disorganized catatonic behavior
negative symptoms (affect flattening, alogia (poverty of speech), or avolition (lack of motivation)
hallucinations are mostly in what sensory group?
auditory
how do you get on the fast track for schizophrenia?
1.one criterion need if delusions are bizarre or hallucinations consist of a voice w/runnign commentary or two or more voices
2. duration of illness at least 6mo
3. impairment in social or occupational functioning
4. sx not due to mood disorder or schizoaffective disorder
5. sx not due to medical, neurological, or substance-induced disorder (this is why you always give a tox screen)
describe the voices heard in schizophrenia?
derogatory, threatening, obscene, accusatory
non-auditory hallucinations are suggestive of?
problems other than a primary psychotic disorder

VISUAL, TACTILE, GUSTATORY, OLFACTORY
think temporal lob epilepsy for what type of hallucinations?
Gustatory and olfactory
are haullucinatory voices usually inside or outside of head?
usually inside
what are some red flags that should raise when giving a proper diagnosis of schizo
if they can't specifically describe the voice, if it is an inside voice
illuions, bereavemnt, hypnagogic (while falling asleep), hypnopompic (while waking up), over interpretation of own thoughts are all?
normal hallucinations
neologisms, tangentiality, derailment, loosening of associates (word salad), preservation are all part of what clinical feature of psycosis?
disorganized thinking and/or grossly disorganized behavior
excessive motor distubances or immobility, stereotyped movements (repetitive, purposeless) waxy flexibiity are all part of what symptom assoicated with psycosis?
catatonic symptoms
what are the postivie symptoms of psycosis?
delusions
hallucinations
behavioral dyscontrol
thought disorder
what are the negative symptoms of psychosis?
ADREASEN"S "A"s
affective flattening
alogia (poverty of speech)
avoltion (poverty of movement)
attentional impairment
anhedonia (loss of pleasure)
what is this subtype of psychosis?
disorganized thinking, emotionally unstable, undifferentiated.
catatonic
what is this subtype of psychosis?
delusions or frequent auditory hallucinations. older onset, less loss of function, better prognosis.
No disorganized speech, no catatonic behavior, no flat or inappropriate affect, but has a delusion.
Paranoid subtype (doesn't have to have a paranoid delusion)
STATS
lifetime prevalence 1.4%
1. M>F OR F>M?
concordance rate 40-50%
2. 10% die from?
1. M>F
2. suicide while 20-40% attempt suicide
what causes schizophrenia acording to the dopamine theory?

*(other hypothesis: infections, autoimmune, serotonin, glutamate?NMDA hypothesis, Genetic, Neurodevelopmental)
over abundance of dopamine in the mesolimbic area
dopamine agonists like amphetamines, cocaine and L-dopa can?
precipitate a psychosis
how do antipsychotics work to treat psychosis?
reduce dopamine levels
(typicals [old reduce dopamine in all pathways] that is why they have more SEs)
what are the 3 dopamine pathways in the brain?
meso=cortic
meso-limbic
nigrostriatal pathway
imbalances in the NT dopamine were once thought to be the prime cause of schizophrenia, but new finding suggest taht impoverished signaling by the more pervassive NT ___________, or more specifically, by one of ____________'s key targets on neurons the _______________ receptor.
glutamate
glutamate
NMDA
what are the anatomical abnormalities involved with schizophrenia?
enlarged lateral ventricles
small brain volume
cortical atrophy
widening of third ventricle
smaller hippocampus
primary psychotic disorders include:
schizophrenia
schizophreniform disorder
schizoaffective disorder
delusional disorder
brief psychotic disorder
shared psychotic disorder
psychotic symptoms of 1 day to 1 month duration witha full return to function w/or w/o stressor is called?
brief psychotic disorder
non-bizrre delusions (could happen in real-life) 1 month duration, absence of hallucinations, no disorgnized thoughts or flat affect, insidious onset w/relatively intact functioning is?
delusional disorder
what is the difference b/e schizophrenia and delusional disorder?
the duration of schizophrenia is >6 months while DD is >1 mo. and there are many symptoms for schizophrenia
what disorder has sx of schizophrenia but is greather than 1mo but less than 6mo. You treat is like schizophrenia, and 2/3 go on to have schizophrenia or schizoaffective disorder?
schizophreniform disorder
mood symptoms present during a "substantial protion" of the psychotic illiness with manin or major depression; you treat it like schizophrenia and mood disorder with prognosis being better that schizophrenia, worse than mood disorder
schizoaffective disorder
can be bipolar type, depressive tive
durges of abuse and medication toxicity, Huntington's dz, parkinson diz, head trauma, migrain, pellagra and pernicious anemia, infections, endocrine dz, porphyria, whithdrawal states, cerevrovascular dz all represent
DDx with secondary psychotic symptoms
antibiotics, antidepressants, L-dopa, bromocriptine, amantadine, ephedrine, phenylpropanolamine, cortiosteroids, disulfiram, digoxin, propranolol all represent
prescription drugs assoc. w/psychotic symptoms
what does the work-up of new onset psychosis contain?
good clinical hx, collateral info
psysical Exam
Labs: metabolic panel, CBC w/diff, B12, Folate, RPR, VDRL, HIV, serum alcohol, urinalysis, thyroid profile, CSF/LP, CT/MRI, EEG
psychopharm/ antipsychotics typicals mechanism of action?

common SE?
antagonize dopamine D2 recpetor in all pathways

Extrapyramidal (EPS) parkinosnian (tremor, cogwheel)
acute dystonia, akathisia, tardive dyskinesia
what is the gold standard drug for efficay but there is a fatal rist for agranulocytosis?
clozapine (clozaril)
which anti psychotic has a SE of prolong Qtc?
geodon
which anti psychotic has a low risk of metabolic syndrome?
abilify
psychosocial treatment of schizophrenia says to hospitalize for acute loss of functioning, outpatien treatment is rehabilitative, psychoanalysis, exploratory therapies have limited values, famlies should be involved and education and compliance are #1
*just for reading purposes