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Flashcards in Psychosis Deck (62)
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1

Psychosis—Definition

Broadly defined as a loss of contact with reality

2

Psychotic states are high risk periods of? 4

1. Agitation
2. Aggression
3. Impulsivity (suicide)
4. Other forms of behavioral dysfunction.

3

1. What are Delusions?
-They may be what?

1. Strongly held false beliefs that are not part of the patient’s cultural or religious backgrounds
-They may be bizarre or non-bizzare

4

Types of delusions? 6

1. Persecutory
2. Grandiose
3. Erotomanic
4. Somatic
5. Delusions of reference
6. Delusions of control

5

1. What are Hallucinations?
2. Can involve what?
3. What is the most common?
4. Then in order of prevalence? 4

1. Wakeful experiences of content that is not actually present
2. Any of the 5 senses
3. Auditory most common
4. Followed by
-visual,
-tactile,
-olfactory
-gustatory

6

Thought disorganization—Speech:
Manifests how?
7

1. Alogia/poverty of content

2. Thought blocking—suddenly loosing train of thought

3. Loosening of association—sequences not well connected

4. Tangentiality—answers to questions veering off topic

5. Clanging or clang association—using rhyming words

6. Word salad—real words linked incoherently

7. Perseravation—repeating words or ideas even when topic is changed

7

Psychotic Disorders--Differential
9

1. Schizophrenia
2. Bipolar disorder w/ psychotic features
3. Major depression w/ psychotic features
4. Schizoaffective disorder
5. Schizophreniform disorder
6. Brief psychotic disorder
7. Substance induced psychotic disorder
8. Delusional disorder
9. Psychosis secondary to a medical condition

8

Workup for Psychotic disorders:
First two things you do?

1. Thorough mental status exam—note grooming, mannerisms, reactions

2. PE

9

Labs for workup of Psychotic disorders?

7

1. CBC
2. CMP
3. RPR/VDRL
4. TSH
5. HIV
6. UA
7. Urine drug screen
More as indicated by history

10

What labs are in the Complete metabolic panal?
14

Complete Metabolic Panel (14):
-Electrolytes
1. Sodium
2. Potassium
3. Chloride
4. Carbon Dioxide (CO2)
-Proteins
5. Albumin
6. Total protein
-Kidney Tests
7. Blood urea nitrogen (BUN)
8. Creatinine (Cr)
-Liver Tests
9. Alkaline phosphatase (ALP)
10. ALT (SGPT)
11. AST (SGOT)
12. Total bilirubin
-Other
13. Glucose
14. Calcium

11

Basic Metabolic panal? 8

Basic Metabolic Panel (8):
-Electrolytes
1. Sodium
2. Potassium
3. Chloride
4. Carbon Dioxide (CO2)
-Kidney Tests
5. Blood urea nitrogen (BUN)
6. Creatinine (Cr)
-Other
7. Glucose
8. Calcium

12

Electrolyte Panel (4):

Electrolytes
-Sodium
-Potassium
-Chloride
-Carbon Dioxide (CO2)

13

The diagnosis of schizophrenia is based entirely on what?

the psychiatric history and mental status examination.

14

Peak ages of onset for Schizophrenia:
1. Men?
2. Women?

1. Men: 12-25yo
2. Women: 25-35yo

***Onset of schizophrenia before
age 10 and after age 60
is EXTREMELY rare!

15

Several things make schizophrenia a very difficult issue to deal with:
4

1. For most patients it is highly disabling

2. Generally persists throughout patient’s life

3. Patients and their families often suffer from poor care and social ostracism

4. Only approximately half of all patients with schizophrenia obtain treatment, in spite of the severity of the disorder

16

Diagnosis (DSM-5)
for Schizophrenia?
5


These are considered __________ symptoms

Two (or more) of the following, each present for a significant portion of time during a 1 month period (or less if successfully treated):
1. Delusions
2. Hallucinations
3. Disorganized speech (e.g., frequent derailment or incoherence)
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (e.g., affective flattening or poverty of speech)


“active-phase”

17

Schizophrenia
Only one of these criterion are
necessary if:
3

-Delusions are bizarre
-Hallucinations consist of a voice
keeping up a running commentary,
or
-two or more voices conversing

18

Schizophrenia: Diagnosis (DSM-5)
A couple of other keys?
2

1. Social or occupational dysfunction

2. Continuous signs of the disturbance persisting for at least 6 months and within this at least 1 month of “active-phase” symptoms (see previous slide)

19

Schizophrenia: May include prodromal or residual periods where signs of disturbance may be manifested by only what?

negative symptoms or other symptoms from previous slide in an attenuated form

20

Schizophrenia
1. Positive symptoms? 2
2. Negative symptoms? 7

1. Positive Symptoms
-Delusions
-Hallucinations

2. Negative Symptoms
-Affective flattening
-Poverty of speech (alogia)
-Blocking
-Poor grooming
-Lack of motivation
-Anhedonia
-Social withdrawal

21

Treatment: Why do we care about positive or negative symptoms?

1. Patients that predominantly have positive symptoms?

2. Patients that predominantly have negative symptoms?

1. Patients that predominantly have positive symptoms?
-Relatively good responses to treatments

2. Patients that predominantly have negative symptoms?
-Poor responses to treatments

22

What are the subtypes of Schizophrenia? 3

1. Paranoid type
2. Disorganized type
3. Catatonic type

23

Schizophrenia: Paranoid type
1. Characterized by what? 2
2. Lacks what symptoms? 3

1.
-Preoccupation with one or more delusions or
-frequent auditory hallucinations

2. No
-disorganized speech,
-disorganized or catatonic behavior, or
-flat or inappropriate affect

24

Schizophrenia: Disorganized type. Characterized how?
3

1. Disorganized speech,
2. disorganized behavior,
3. flat or inappropriate affect

25

Schizophrenia: Catatonic type. Characterized how?
5

1. Motoric immobility
2. Excessive purposeless motor activity
3. Extreme negativism or mutism
4. Peculiarities of voluntary movement (e.g. bizarre posturing, stereotyped movements)
5. Echolalia or echopraxia

26

Schizophrenia: Mental Status Examination
1. General Description would include?
-Ranges from?
-Behavior? 3

1. Range from completely disheveled, screaming, and agitated to obsessively groomed, completely silent, and immobile

Behavior?
-May be talkative and exhibit bizarre postures;
-may become agitated or violent in an unprovoked manner or in response to hallucinations;
-may be in a catatonic stupor; tics, echopraxia, etc.

27

Schizophrenia: Mental Status Examination
Mood, feelings, affect:
-Ranges from? 2

1. Reduced emotional responsiveness to
2. overly active and inappropriate emotions such as extremes of rage, happiness, and anxiety

28

Schizophrenia: Mental Status Examination
Perception?
1. All five senses may be affected by what?

2. May have illusions. How are these differentiated from hallucinations?

1. hallucinatory experiences (most common are auditory and visual)

2. Illusions? Differentiated from hallucinations in that illusions are distortions of REAL images

29

Schizophrenia: Mental Status Examination
What is the core symptoms of schizophrenia?

Thought:
The most difficult symptoms to understand

Also… likely the CORE symptoms of schizophrenia
Thought Content
Thought Form and Process

30

Schizophrenia: Thought content includes?

What is the person thinking? (ideas, beliefs, and interpretations of stimuli)