Psychotic disorders - an

Question 1

More likely to be schizophrenic? (gender, age, relationship status, geography)

Answer 1

Male, 18-25, single, urban

Question 2

Schizophrenia sx?

Answer 2

Positive: delusion, hallucination, disorganized speech
Negative: social withdrawal, lack of motivation, anhedonia

Question 3

Cardinal feature of schizophrenia?

Answer 3

Cognitive dysfunction: memory loss, poor executive function

Question 4

DSM IV/V for Schizophrenia?

Answer 4

A Criteria: 2+ for 1 mo. of: delusion, hallucination, disorg speech, disorg behavior, negative sx

Social/occupational dysfxn

Continuous signs of disturbance for 6 months

Question 5

Are there any tests, labs or imaging to dx schizophrenia?

Answer 5

NO!

Can image to r/o non-psych etiologies, though, or can use psych testing to establish baseline or track worsening of sx.

Question 6

How do you treat schizophrenia?

Answer 6

Acute: hospitalization + antipsychotics (typical and atypical)

Resistant: lithium, carbamazepine, valproate

Question 7

Besides using antipsychotics, what else is important to treat in schizophrenic patients?

Answer 7

Comorbid depression or substance abuse disorders.

Question 8

Can you cure schizophrenia?

Answer 8

MAYBE!
Only 10% will recover.
1/3 will be relatively stable on meds.
1/3 will have deteriorating course.

Question 9

Sequelae of schizophrenia?

Answer 9

High risk of suicide (10-13% COMPLETION risk)
Substance abuse common.
70-80% heavy chronic smokers.

Question 10

What is “Brief Reactive Psychosis?”

Answer 10

Psychotic symptoms that occur after a significant external stressor for ONE MONTH OR LESS, THEN RESOLVE COMPLETELY.

Question 11

Sx of brief reactive psychosis?

Answer 11

Confusion, agitation or catatonia, emotional lability, psychotic symptoms.

Question 12

DSM IV/V for brief reactive psychosis?

Answer 12

1 + of: delusion, hallucination, disorg speech, disorg behavior.

Duration of at least one day, less than one month.

Disturbance not related to other psych disorder, toxin, etc.

Question 13

Treat brief reactive psychosis?

Answer 13

Relieve sx by INDUCING SLEEP.

Hospitalization + anti psych meds indicated.

Question 14

Brief reactive psychosis needs to completely resolve in less than a month – can it recur?

Answer 14

YES.

If stressors are ongoing, or if comorbid conditions precipitate.

Question 15

What is schizoaffective disorder?

Answer 15

Symptoms consistent with the DSM criteria for schizophrenia, but with superimposed episodes of DEPRESSIVE or MANIC episodes. (Depressive and bipolar variants.)

Question 16

DSM IV/V for schizoaffective disorder?

Answer 16

Period of illness with major depressive or bipolar sx PLUS symptoms consistent with schizophrenia A criteria (delusion, hallucination, disorg speech).

Delusions or hallucinations for two weeks IN THE ABSENCE of mood sx.

Question 17

Tx, Mgt, Prognosis for schizoaffective?

Answer 17

Tx: antipsychotics + antidepressants +/- mood-stabilizers (for bipolar variant)

Mgt: Psychosocial integration

Prognosis: better for bipolar vs depressive type

Question 18

Schizophreniform disorder?

confused yet? it’s not schizophrenia or schizoaffective!

Answer 18

RAPID onset.

Schizophrenia A criteria sx lasting one to six months, negative symptoms.

Question 19

DSM IV/V for schizophreniform?

Answer 19

Episode meeting (most) schizophrenia criteria LASTING 1-6 MONTHS.

**This is basically a middle ground between brief reactive psychosis (1 day to 1 month) and true schizophrenia (6+ months).