psychotic disorders. archetype schizophrenia phenomenology the mental status exam the mental status...
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Psychotic DisordersPsychotic Disorders
ArchetypeArchetype
SchizophreniaSchizophrenia
PhenomenologyPhenomenology
The mental status examThe mental status exam AppearanceAppearance MoodMood ThoughtThought CognitionCognition Judgment and InsightJudgment and Insight
AppearanceAppearance
Motor disturbancesMotor disturbancesCatatoniaCatatonia
StereotypyStereotypy
MannerismsMannerisms Behavioral problemsBehavioral problems
HygieneHygiene
Social functioningSocial functioning ““Soft signs”Soft signs”
Mood and AffectMood and Affect
Affective flatteningAffective flattening AnhedoniaAnhedonia Inappropriate AffectInappropriate Affect
ThoughtThought
Thought ProcessThought Process ContentContent
Thought ProcessThought Process
Associative disordersAssociative disorders Circumstantial Circumstantial
ThinkingThinking Tangential thinkingTangential thinking
Other associative problemsOther associative problems
PerseverationPerseveration
DistractibilityDistractibility
ClangingClanging
NeologismsNeologisms
Thought ContentThought Content
PhenomenologyPhenomenology
Thought contentThought content
HallucinationsHallucinations
DelusionsDelusions
CognitionsCognitions
Subtle impairmentsSubtle impairments Frontal lobe functionFrontal lobe function
Associative thinkingAssociative thinking
Positive versus Negative SxsPositive versus Negative Sxs
PositivePositive HallucinationsHallucinations DelusionsDelusions Bizarre behaviorBizarre behavior Associative disordersAssociative disorders
Negative SymptomsNegative Symptoms
AlogiaAlogia
Affective flatteningAffective flattening
AnhedoniaAnhedonia
Avolition/apathyAvolition/apathy
EpidemiologyEpidemiology
EpidemiologyEpidemiology
~1% prevalence~1% prevalence
GendersGenders Age of onsetAge of onset
SocioeconomicSocioeconomic
PathologyPathology
AnatomicAnatomic
Widened ventriclesWidened ventricles
Decreased size Decreased size certain regionscertain regions
HistologyHistology
Abnormalities of Abnormalities of cytoarchitecturecytoarchitecture AlignmentAlignment AmountAmount
PathologyPathology
NeurophysiologyNeurophysiology HypofrontalityHypofrontality
More NeurophysiologyMore Neurophysiology
Other neurological changesOther neurological changes Eye movementsEye movements Blink rateBlink rate Sleep disordersSleep disorders
EtiologyEtiology
DopamineDopamine
Dopamine HypothesisDopamine Hypothesis
MetabolitesMetabolites
Dopamine receptor agonistsDopamine receptor agonists
Action of antipsychoticsAction of antipsychotics
Other TransmittersOther Transmitters
GlutamateGlutamate Primary excitatory transmitterPrimary excitatory transmitter May relate to glutaminergic toneMay relate to glutaminergic tone NMDA receptor antagonistsNMDA receptor antagonists
PCP PCP
Neurodegenerative theoriesNeurodegenerative theories
Evidence for cell lossEvidence for cell loss Reduced neuronal Reduced neuronal
densitiesdensities EtiologyEtiology
Neurodevelopmental TheoriesNeurodevelopmental Theories
Abnormalities of Abnormalities of cytoarchitecturecytoarchitecture
Absence of gliosisAbsence of gliosis
GeneticsGenetics
Genetic TheoriesGenetic Theories
Family studiesFamily studies 11oo relatives = 5% relatives = 5% Dizygotic twins = 10%Dizygotic twins = 10% Monozygotic twins = 50%Monozygotic twins = 50%
Adoption studiesAdoption studies Greater riskGreater risk
Possible Environmental CulpritsPossible Environmental Culprits
Bad parentingBad parenting
Social/economicSocial/economic
ViralViral
Allergic/AntibodiesAllergic/Antibodies
EtiologyEtiology
DiagnosisDiagnosis
DiagnosisDiagnosis
Schizophrenia: DSM-IVSchizophrenia: DSM-IV
““A” CriteriaA” Criteria = Psychosis= Psychosis
DurationDuration 6 months6 months
Global CriteriaGlobal Criteria
DiagnosisDiagnosis
““A Criteria”A Criteria” Two or more:Two or more:
DelusionsDelusions
HallucinationsHallucinations
Disorganized speechDisorganized speech
Disorganized behaviorDisorganized behavior
Negative symptomsNegative symptoms
Schizophrenia SubtypesSchizophrenia Subtypes
CatatonicCatatonic MovementMovement
DisorganizedDisorganized ProcessProcess
ParanoidParanoid ContentContent
UndifferentiatedUndifferentiated
ResidualResidual
DifferentialDifferential
DeliriumDelirium
DementiaDementia
Medication-inducedMedication-induced
Other Psychiatric IllnessesOther Psychiatric Illnesses
ComorbidityComorbidity
DepressionDepression
Substance AbuseSubstance Abuse
Course and PrognosisCourse and Prognosis
Course of SchizophreniaCourse of Schizophrenia
PrognosisPrognosis
Usually deterioratesUsually deteriorates
~ exacerbations w/ incomplete recovery~ exacerbations w/ incomplete recovery
Symptoms change over timeSymptoms change over time
OutcomeOutcome
Good Bad Intermediate
Positive PredictorsPositive Predictors
Acute onsetAcute onsetShort durationShort durationGood premorbid functioningGood premorbid functioningAffective symptomsAffective symptomsGood social functioningGood social functioningHigh social classHigh social classNeg fam hx psychoticNeg fam hx psychoticNo structuralNo structural
Poor PredictorsPoor Predictors
Insidious onsetInsidious onsetLong durationLong durationFamily hx of psych illnessFamily hx of psych illnessObsessions/CompulsionsObsessions/CompulsionsAssaultive BehaviorAssaultive BehaviorPoor premorbid functioningPoor premorbid functioningNeurological/anatomic abn.Neurological/anatomic abn.Low social classLow social class
TreatmentTreatment
Antipsychotic MedicationsAntipsychotic Medications
PhenothiazinesPhenothiazines ChlorpromazineChlorpromazine
ButyrophenonesButyrophenones HaloperidolHaloperidol
AtypicalsAtypicals ClozapineClozapine
AntipsychoticsAntipsychotics
Mechanism of actionsMechanism of actions Dopamine blockadeDopamine blockade D-2 and analoguesD-2 and analogues
Antipsychotics: IndicationsAntipsychotics: Indications
Acute psychosisAcute psychosis
Prevention of relapsePrevention of relapse
Also used in other disordersAlso used in other disorders Acute maniaAcute mania Anxiety/insomniaAnxiety/insomnia Aggressive disordersAggressive disorders
Antipsychotics: Side EffectsAntipsychotics: Side Effects
AnticholinergicAnticholinergic
Extrapyramidal (Parkinson’s-like)Extrapyramidal (Parkinson’s-like)
Other effectsOther effects
DopaminergicDopaminergic Tardive dyskinesiaTardive dyskinesia NMSNMS
IdiopathicIdiopathic HematologicHematologic
ClozapineClozapine Rashes, skin pigmentary, temperature Rashes, skin pigmentary, temperature
dysregulationdysregulation
AntipsychoticsAntipsychotics
ApproachApproach Lower doses usually adequateLower doses usually adequate Adjust to side effectsAdjust to side effects Evaluate for TDEvaluate for TD
How long?How long? 11stst episode episode Maintenance Maintenance
Other TreatmentsOther Treatments
ElectroshockElectroshock
Other tranquilizersOther tranquilizers
Psychosocial TreatmentsPsychosocial Treatments
SupportiveSupportive
Social/educativeSocial/educative
FamilyFamily
Other DiagnosisOther Diagnosis
SchizophreniformSchizophreniform
SchizoaffectiveSchizoaffective
Brief PsychoticBrief Psychotic
Delusional DisordersDelusional Disorders
Shared PsychosesShared Psychoses
Psychosis due to somethin’ elsePsychosis due to somethin’ else