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    Psychotic Web

    Uploaded by

    mukhtar abddi

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    © All Rights Reserved
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    Psychotic Web

    Uploaded by

    mukhtar abddi
    8 views49 pages

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    Copyright:

    © All Rights Reserved
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    Download as ppt, pdf, or txt
    8 views49 pages

    Psychotic Web

    Uploaded by

    mukhtar abddi

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    You are on page 1of 49

    Psychotic Disorders

    Archetype
    Schizophrenia
    Phenomenology
    The mental status exam
     Appearance
     Mood
     Thought
     Cognition
     Judgment and Insight
    Appearance
     Motor disturbances
    Catatonia
    Stereotypy
    Mannerisms
     Behavioral problems
    Hygiene
    Social functioning
     “Soft signs”
    Mood and Affect
     Affective flattening
     Anhedonia
     Inappropriate Affect
    Thought
     Thought Process
     Content
    Thought Process
     Associative disorders
     Circumstantial
    Thinking
     Tangential thinking
    Other associative problems
    Perseveration
    Distractibility
    Clanging
    Neologisms
    Thought Content
    Phenomenology
    Thought content
    Hallucinations
    Delusions
    Cognitions
    Subtle impairments
     Frontal lobe function
    Associative thinking
    Positive versus Negative Sxs
    Positive
     Hallucinations
     Delusions
     Bizarre behavior
     Associative disorders
    Negative Symptoms
    Alogia
    Affective flattening
    Anhedonia
    Avolition/apathy
    Epidemiology
    Epidemiology
    ~1% prevalence
    Genders
     Age of onset
    Socioeconomic
    Pathology
    Anatomic
    Widened ventricles
    Decreased size
    certain regions
    Histology
    Abnormalities of
    cytoarchitecture
     Alignment
     Amount
    Pathology
    Neurophysiology
     Hypofrontality
    More Neurophysiology
     Other neurological changes
     Eye movements
     Blink rate
     Sleep disorders
    Etiology
    Dopamine
    Dopamine Hypothesis
    Metabolites
    Dopamine receptor agonists
    Action of antipsychotics
    Other Transmitters
    Glutamate
     Primary excitatory transmitter
     May relate to glutaminergic tone
     NMDA receptor antagonists
    PCP
    Neurodegenerative theories
     Evidence for cell loss
     Reduced neuronal
    densities
     Etiology
    Neurodevelopmental Theories
    Abnormalities of
    cytoarchitecture
    Absence of gliosis
    Genetics
    Genetic Theories
    Family studies
     1o relatives = 5%
     Dizygotic twins = 10%
     Monozygotic twins = 50%
    Adoption studies
     Greater risk
    Possible Environmental Culprits
    Bad parenting
    Social/economic
    Viral
    Allergic/Antibodies
    Etiology
    Diagnosis
    Diagnosis
    Schizophrenia: DSM-IV
    “A” Criteria
     = Psychosis
    Duration
     6 months
    Global Criteria
    Diagnosis
    “A Criteria”
     Two or more:
    Delusions
    Hallucinations
    Disorganized speech
    Disorganized behavior
    Negative symptoms
    Schizophrenia Subtypes
    Catatonic
     Movement
    Disorganized
     Process
    Paranoid
     Content
    Undifferentiated
    Residual
    Differential
    Delirium
    Dementia
    Medication-induced
    Other Psychiatric Illnesses
    Comorbidity
    Depression
    Substance Abuse
    Course and Prognosis
    Course of Schizophrenia
    Prognosis
    Usually deteriorates
    ~ exacerbations w/ incomplete recovery
    Symptoms change over time
    Outcome

    Good Bad Intermediate


    Positive Predictors
    Acute onset
    Short duration
    Good premorbid functioning
    Affective symptoms
    Good social functioning
    High social class
    Neg fam hx psychotic
    No structural
    Poor Predictors
    Insidious onset
    Long duration
    Family hx of psych illness
    Obsessions/Compulsions
    Assaultive Behavior
    Poor premorbid functioning
    Neurological/anatomic abn.
    Low social class
    Treatment
    Antipsychotic Medications
    Phenothiazines
     Chlorpromazine
    Butyrophenones
     Haloperidol
    Atypicals
     Clozapine
    Antipsychotics
    Mechanism of actions
     Dopamine blockade
     D-2 and analogues
    Antipsychotics: Indications
    Acute psychosis
    Prevention of relapse
    Also used in other disorders
     Acute mania
     Anxiety/insomnia
     Aggressive disorders
    Antipsychotics: Side Effects

    Anticholinergic
    Extrapyramidal (Parkinson’s-like)
    Other effects
    Dopaminergic
     Tardive dyskinesia
     NMS
    Idiopathic
     Hematologic
    Clozapine
     Rashes, skin pigmentary, temperature
    dysregulation
    Antipsychotics
    Approach
     Lower doses usually adequate
     Adjust to side effects
     Evaluate for TD
    How long?
     1st episode
     Maintenance
    Other Treatments
    Electroshock
    Other tranquilizers
    Psychosocial Treatments
    Supportive
    Social/educative
    Family
    Other Diagnosis
    Schizophreniform
    Schizoaffective
    Brief Psychotic
    Delusional Disorders
    Shared Psychoses
    Psychosis due to somethin’ else

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