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34 Cards in this Set
- Front
- Back
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Differential diagnosis of psychotic disorders
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tumour
head trauma dementia/delirium substance-induced affective: psychotic depression, bipolar disorder - manic phase with psychotic features personality disorders: schizotypal, schizoid, borderline, paranoid primary psychotic disorder: schizophrenia, schizoaffective |
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schizophrenia - dopamine hypothesis
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excess activity in the mesolimbic dopamine pathway may mediate positive symptoms of psychosis, i.e. delusions
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how do anti-psychotic drugs work
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act by blokcing post-synaptic DA receptors
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schizophrenia - neuroanatomy
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decreased frontal lobe function
assymetric temporal limbic function decreased basal ganglia function + subtle changes in thalamus, cortex, corpus callosum, ventricles |
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schizophrenia - neurodegenerative theory
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natural history of schizophrenia is downhill
glutamate system may mediate progressive degeneration by an excitotoxic mechanism which leads to production of free radicals |
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schizophrenia - neurodevelopmental theory
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abnormal development of brain from prenatal life
neurons fail to migrate correctly, make inappropriate connections, break down in later life inappropriate apoptosis during neurodevelopment resulting in wrong connections made between neurons |
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paranoid schizophrenia
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preoccupation with one or more delusions (persecutory or grandiose) or frequent auditory hallucinations
relative preservation of cognitive functioning and affect onset later in life thought to have best prognosis |
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catatonic schzophrenia
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at least two of:
motor immobility (catalepsy or stupor) excessive motor activity (purposeless, not influenced by external stimuli) extreme negativism or mutism peculiar voluntary movement (e.g. posturing) echolalia, echopraxia |
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catalepsy
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indefinitely prolonged maintenance of a fixed posture
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undifferentiated schizophrenia
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symptoms of criterion A of dsm-IV met but does not fall into other types
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residual schizophrenia
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absence of prominent delusions, hallucinations, disorganised or catatonic behaviour
continuing evidence of disturbance indicated by presence of negative symptoms or two or more symptoms in cirteria A present in attenuated form |
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DSM-IV TR for schizophrenia
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symptoms: 2 or more of following, each present for a significant period of time during a one month period: delusions, hallucinations, disorganised speech, disorganised or catatonic behaviour, negative symptoms (e.g. affective flattening)
since the onset - social or occupational dysfunction continuous signs of the disturbance persist for at least six months schizoaffective and mood diorders excluded substance-abuse and GMC excluded |
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GMC
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general medical condition
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psychosocial management of schizophrenia
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supportive psychotherapy
CBT assertive community treatment social skills training and employment programs housing in group home, boardine home, transitional home psychoeducation for individual and family |
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prognosis for schizophrenia
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1/3 improve
1/3 same 1/3 worsen |
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good prognostic factors for schizophrenia
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acute onset
good cognitive functioning good premorbid functioning no family history presence of affective symptoms absence of structural brain abnormalities good response to drugs good support system |
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schizophreniform disorder
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symptoms of schizophrenia are met except symptoms last for 1 to 6 months
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brief psychotic disorder
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acute psychosis (present of 1 or more positive symptoms in criteria A for schizophrenia) lasting from 1 day to 1 month
can occur after stressful event or post partum treatment is secure environment, antipsychotics, anxiolytics gneral good prognosis as is self-limiting |
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schizoaffective disorder
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uninterrupted period of illness during which, at some point, there is either major depressive episode, manic episode, or mixed episode CONCURRENT with symptoms meeting criteria A for schizophrenia
in the same period, delusions or hallucinations for at least 2 weeks without prominent mood symptoms symptoms that meet criteria for mood epidode are present for a substantial portion or total duration of active and residual periods |
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delusional disorder
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non-bizarre delusions for at least one month
criterion A for schizophrenia is never met functioning not markedly impaired behaviour not odd or bizzare |
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what are subytypes of delusions in delusional disorder
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erotomanic
grandiose jealous persecutory somatic mixed unspecified |
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shared psychotic disorder (folie a deux)
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a delusion that develops in an individual who is in close relationship with anoher person who alrady has a psychotic disorder with prominent delusions
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folie a deux treatment
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seperation of the two people results in the disappearance of the delusions in the healthier member
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schizophrenia vs schizophreniform
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symptom complex is the same
with schizophreniform disorder the prodromal, residula and active phases last less than six months with schizophrenia the symptoms last longer than six months |
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schizophreniform vs brief psychotic disorder
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inclusion criteria for brief psychotic disorder are broader and only require presence of one of: delusions, hallucinations, disorganised speech or behaviour.
brief psychotic disorder symptoms last less than one month with eventual full return to premorbid level of functioning |
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schizophrenia vs. schizoaffective disorder
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the psychotic symptoms are the same in both disorders
BUT in schizoaffective disorder a manic or depressive episode must be present and the duration of mood symptoms cannot be brief relative to the duration of the psychosis to be diagnosed with schizoafffective disorder there must also be at least a 2 week period during which psychotic symptoms are present in the ABSENCE of mood symptoms |
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schizoaffective verus manic bipolar with psychotic features
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in a mood disorder with psychotic features the moody symptomt and psychosis must always overlap in time
in schizoaffective disorder, psychotic symptoms must be present in the absence of mood symptoms for at least two weeks |
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hebephrenic schizophrenia
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characterised by:
changes in affect (flattening, incongruity) thought disorder aimless or disjointed behaviour mannerisms - can be common hallucinations and delusions are fragmentary and don't dominate the picture individuals become isolated and develop negative symptoms diagnosed in young people |
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simple schizophrenia
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characterised by:
1 year history of progressive development of negative symptoms (apathy, blunting of affect, lack of initiative and drive) gradual changes in social behaviour social withdrawal no evidence of preceding acute psychotic symptoms |
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negative symptoms of schizophrenia
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apathy, blunting of affect, lack of initiative and drive
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A 25-year-old male is taken to hospital by the police as he was
found screaming on the streets. He had been trying to light himself with a lighter, claiming that he was invincible and had the power to fix all evil in the world. His speech was highly pressured and he complains that his thoughts are going out of control. According to hospital records, he had been admitted to hospital three times in the last year for similar episodes. |
Bipolar affective disorder is a mood disorder characterised
by the presence of several depressive and manic/hypomanic episodes during the lifetime of a patient. In this example, the patient is exhibiting grandiose delusions with manic symptoms such as pressured speech and flight of ideas. |
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Undifferentiated schizophrenia
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meets the general diagnostic criteria for schizophrenia but does not fit one particular subtype
e.g. thought withdrawal but no other behavioural symptoms |
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common side effects of older typical antipsychotics
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stiffness
restlessness (akithisia) sleepiness anti-SLUD involuntary movmenets of facial and neck muscles (dystonia) |
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common side effects of newer atypical antipsychotics
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cause less EPSEs
weight gain sexual dysfunction diabetes hypertension hypercholesterolaemia neutropaenia |
