psychotic disorders

what are the general etiologies of psychotic disorders 

• genetics 

• parental risk factors 

• potential environmental triggers 

describe the genetic etiology behinf psychotic disorders 

• identical twins: 1-in-2 chance of developing if twin also has schiz

• non-identical twins: 1-in-7 chance

• non-related individuals: 1-in-100 chance

what are some parental risk factors behind psychotic disorders

• certain maternal viral infections during pregnancy

• nutritional deficits during first 6 months of pregnancy

what are some potential environmental triggers behind psychotic disorders

• psychoactive drugs; LSD, methamphetamine

• marijuana

• typically thought of as inc risk in those already susceptible

briefly describe the neuroanatomical changes seen in pts w schizophrenia

• overall dec in brain volume 

• enlarged lateral and third ventricles 

• smaller medial temporal lobeds 

• dec cortical gray matter 

what are the two types of symptoms a person w schizophrenia experience

positive and negative symptoms

generally what positive symptoms of schizophrenia

added abnormal experiences 

• hallucinations 

• delusions 

• disorganized thinking/speech 

most common hallucinations involved in schizophrenia

auditory and visual; can affect tactile, olfactory, and gustatory but not as common

what are the 5 types of delusions

• grandiose

• referential/reference

• paranoid

• control

• erotomanic

what are grandiose delusion 

you are extremely important, influential, knowledgable

what are referential/reference delusion 

ordinary events have hidden meanings to you only 

what are paranoid delusions

others are out to harm or sabotage you

what are control delusions

others are able to control you

was are erotomanic delusions

others (usually famous) are madly in love w you

what are negative symptoms

loss of normal funx: 

• diminished emotional expression 

• avolition 

• alogia 

• anhedonia 

• asociality 

examples of diminished emotional expression as negative symptoms

• facial expressions

• eye contact

• intonation of speech 

• movement of hands, head, and face 

what is avolition

dec in motivation, self-initatied, purposeful activities

what is alogia

diminished speech output

what is anhedonia

dec pleasure in activities

what is asociality

lack of interest in social interactions

criteria for brief psychotic disorder

presence of one or more of the following symptoms w at least 1 being “*”

• delusions*

• hallucinations*

• disorganized speech*

• grossly disorganized or catatonic behavior 

duration of symptoms to dx brief psychotic disorder

at least 1 days but less than 1 month

in brief psychotic disorder, disturbances are not better explained by what disorders

• major depressive disorder 

• bipolar disorder 

• or another psychotic disorder 

brief psychotic diorder vs schizophrenia

schiz is more chronic

criteria to dx scizophrenia

two or more of the following, each present for a singificant amount of time during a 1-month period, with at least one being “*”

• delusions*

• hallucinations*

• disorganized speech*

• grossly disorganized or catatonic behavior 

• negative symptoms 

duration for schizophrenia symptoms

distubances must persist for at least 6 months

in schizophrenia, the level of functioning is markedly below what is ________ for a person

“normal”

in schizophrenia, it is not attributed to physiological effects of ___________

substances

you must rule out what disorders to dx scizophrenia

• scizoaffective disorder

• major depressive disorder

• bipolar disorder

schizophrenia is NOT…

• multiple/split personality // dissociative identity disorder

• condition that makes people violent (only involved delusions and hallucinations)

• curable (can be tx but not cured) 

what tx options are available for psychotic disorders

• pharmacological 

• non-pharmacological 

generally, what pharacological agents are available to tx schizophrenia

• first generation (typical) antipsychotics (FGA) → neuroleptics

• second generation (atypical) antipsychotics (SGA)

MOA of FGA

block dopamine (D2) receptors, particularly in basal ganglion 

in FGAs, _____________ side effects are common 

extrapyrimidal 

example agents of FGA 

• chlorpromazine (thorazine) 

• haloperidole (haldol)

MOA of SGA

• block serotonin (5HT2) receptors w more potency than FGAs

• block D2 receptors less than FGA 

side effects for SGAs

• fewer extrapyrimidal side-effects than FGA (tardive dyskinesia) 

• linked to more weight gain and type II diabetes 

example agents of SGAs 

• aripiprazole (abilify) 

• olanzapine (zyprexa)

• quetiapine (seroquel)

non-pharacological approaches in tx schizophrenia

• stress reduction 

• family support therapy 

• minimize the use of drugs and alcohol  

dental considerations about tx pts w psychotic disorders

• consider talking to pts PCP or psychiatrist to establish ability to consent for dental tx 

• good if family member/caregiver can be present for familiarity and to reinforce dentist recommendations 

• model oral hygiene rather than just explaining it