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Psychotic Disorders
PSYCHOTIC DISORDERS
DSM IV Ps
Psychotic
chotic Disorders
Schizophrenia
Schizoaffective D.
Delusional D.
Brief Psychotic
y
D.
Shared Psychotic D.
Psychotic D.
D Due to
General Medical
Condition
Substance-Induced
Psychotic D.
Psychotic D. Not
Otherwise Specified
Note: Affective and
Cognitive Disorders
often
ft also
l exhibit
hibit
psychotic symptoms
SCHIZOPHRENIA
Incidence: 1% Population, 25 %
Hospital
p
Beds
Onset: 15-35 y.o. --- *18-24 most
common
Slow, insidious onset
Prodromal Stage: Daydreaming,
Daydreaming poor
attention, odd thoughts, lack of interest in
self a
se
and
d usua
usual ac
activities
es
Schizophrenia
p
DSM IV Criteria
BLEULERS 4 As
Autism
Associative
Looseness
SCHIZOPHRENIA
Ambivalence
Affective
Indifference
AUTISM
ASSOCIATIVE LOOSENESS
AMBIVALENCE
AFFECTIVE INDIFFERENCE
Flat affect
Inappropriate affect
Blunted affect
Bizarre affect
POSITIVE
Delusions
Hallucinations
Bizarre behavior
Paranoia
NEGATIVE
Apathy
Anhedonia
Poor social function
Povertyy of thought
g
Lack of self
awareness
TYPES OF SCHIZOPHRENIA
SCHIZOAFFECTIVE
DISORDER
Symptoms from
Criterion A in
Schizophrenia
(Thought Disorder)
S
Symptoms
t
off an
Affective Disorder Bipolar Depression
Bipolar,
Depression : 10%
suicide rate
S b t
Substance
Ab
Abuse:
50%
incidence
Aggressive behaviors
Poverty
Loneliness; meager
support system
Cognitive deficits
ETIOLOGY
Dopamine Hypothesis
PCP Hypothesis
Genetic Hypothesis
Neuroanatomy:
Enlargement of lateral
cerebral ventricles
Cortical and Cerebellar
atrophy
Ventricular Assymetry
Impaired
p
Social Interaction R/T
distorted perceptions, mistrust
Common Diagnoses
Disturbed Thought
g Process
R/T anxiety, low self esteem
Antips chotics
Antipsychotics
Mechanism of Action
Traditional
Haldol /decanoate
Prolixin/decanoate
Mellaril
Thorazine
At
Atypical
pical
Risperdal
risperdone (Consta)
S
Seroquell
quetiapine
Zyprexa -olanzapine
olanzapine
Geodon-ziprasidone
Abilify-aripiprazole
Clozaril-clozapine
((requires
q
blood wk))
Anticholinergic
Sedation
Orthostatic Hypotension
Bl d D
Blood
Dyscrasias
i (A
(Agranulocytosis)
l
t i )
Allergies - skin rash, photosensitivity,
allergic jaundice, pigmentary
retinopathy
Parkinsons Disease
T for EPS
Tx
Anticholinergics :
Cogentin, Artane
Benedryl
Symmetrel
y
Other Ad
Adverse
erse Effects
Water Intoxication
Neuroleptic Malignant Syndrome
1% of pts. Taking neuroleptics
15% mortality rate
Hyperpyrexia, muscle rigidity (lead pipe),
altered mental status
status, autonomic instability
Treat symptomatically
Reco er Model
Recovery
Reso rces
Resources