Peds Psych Exam 2 (part 1)

19問 • 11ヶ月前

Two Clean Queens

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問題一覧

In Schizophrenia, what brain regions have abnormal development and connectivity?

parietal, temporal, frontal cortex, and hippocampus

Which brain regions are responsible for cognitive dysfunction and psychosis in Schizophrenia?

prefrontal cortex (cognitive dysfunction) and hippocampus (psychosis)

Children with Schizophrenia will display which brain abnormalities?

reduction in cortical and gray matter and larger ventricles

-The presence of at least one delusion lasting 1 month or longer. -Criterion A for schizophrenia has never been met. (Hallucinations may be present but are only related to the delusion). -Functioning is not impaired, and behavior is not bizarre or odd apart from the delusion itself. -If manic or depressive episodes have occurred, they have been brief relative to the duration of the delusion. -The disturbance is not due to substance use or a medical condition and is not better explained by another mental disorder (body dysmorphic disorder or OCD).

Delusional Disorder

Presence of one or more of the following (at least one must be 1, 2, or 3) -Delusions -Hallucinations -Disorganized speech -Grossly disorganized or catatonic behavior Duration of at least 1 day, but less than 1 month, with full return to previous level of function. The disturbance is not better explained by major depression or bipolar disorder with psychotic features, schizophrenia, catatonia, another psychotic disorder, substance use/medication, or another medical condition. Specify if: With marked stressor(s) – symptoms occur in response to events that would be markedly stressful to anyone in similar circumstances Without marked stressors(s) – symptoms do not occur in response to a stressful event With peripartum onset – Onset during pregnancy or within 4 weeks postpartum

Brief Psychotic Disorder

-In the U.S., accounts for 9% of first-onset psychosis cases -More common in females (2:1) and in developing countries -Sudden onset within 2 weeks, usually without prodrome -Do a thorough assessment to rule out other psychotic disorders – include cognition, depression, mania, substance use. -Level of impairment may be severe causing rapid shifts in emotion and confusion -Supervision may be necessary as well as assistance with ADLs -Increased risk of suicidal behavior -Can occur in adolescence and early adulthood – average age of onset is mid 30s -Increased risk in individuals with pre-existing personality traits involving perception, affect, and trust -Evaluate cultural and religious background of the child/adolescent and their families

Brief Psychotic Disorder

2 or more of the following, present for a significant period of time over a 1-month span, or less if successfully treated (at least one must be 1, 2, or 3). -Delusions -Hallucinations -Disorganized speech -Grossly disorganized or catatonic behavior -Negative symptoms -An episode lasts at least 1 month, but less than 6 months. If diagnosis is made without waiting for recovery it should be noted as “provisional”. -Schizoaffective disorder and depressive/bipolar disorders with psychotic features have been ruled out. -Not due to substance/medication use or another medical condition.

Schizophreniform Personality Disorder

Requires the presence of 2 or more of the following: onset of symptoms within 4 weeks of first noticeable change in behavior or functioning; confusion or perplexity; good premorbid social and occupational functioning; absence of blunted or flat affect.

Schizophreniform Disorder with good prognostic features

-Lifetime prevalence 0.3 to 0.7%. -Symptoms of this disorder are identical to schizophrenia, but the total duration of this illness is from 1 to 6 months. -Does not require impaired social and occupational functioning. -strong familial link.

Schizophreniform Disorder

-Lifetime prevalence is 0.2% with persecutory type being the most common -Do a thorough assessment to rule out other psychotic disorders – include cognition, depression, mania, substance use. -Some individuals eventually develop schizophrenia. -There is a significant relationship with family history of schizophrenia and schizotypal personality disorder. -More often seen in older individuals -Evaluate cultural and religious background of the child/adolescent and their families -May cause irritability, anger, dysphoria

Delusional Disorder

A) 2 or more of the following, present for a significant period of time over a 1-month span, or less if successfully treated (at least one must be 1, 2, or 3). -Delusions -Hallucinations -Disorganized speech -Grossly disorganized or catatonic behavior -Negative symptoms -For a significant period of the time since the onset of illness, functioning in academics, work, interpersonal relationships, or self-care is below the level achieved prior to onset or there is a failure to achieve the expected level of functioning. -Continuous signs of disturbance are present for at least 6 months, with 1 month (or less if successfully treated) of symptoms from Criterion A. May include symptoms noted during the prodromal or residual episodes. During the prodromal or residual periods there may only be negative symptoms or mild positive symptoms. -Schizoaffective disorder and depressive/bipolar disorders with psychotic features have been ruled out. -Not due to substance/medication use or another medical condition. -If there is a previous diagnosis of autism spectrum disorder or a communication disorder of childhood onset, this diagnosis is only made if there are prominent delusions or hallucinations, with the other required symptoms for at least 1 month (or less if successfully treated).

Schizophrenia

-Lifetime prevalence 0.3 to 0.7%, but both Early Onset Schizophrenia (EOS) and Childhood Onset Schizophrenia (COS) are rare. -Prevalence is fairly equal between men and women - Onset is usually between 15 to 25 years-old in males; 20 to 30 years-old in females. Onset prior to 10 years-old is rare. -There is a strong familial link and an increased incidence for individuals born in late winter/early spring. -Risk alleles have been noted but contribute only a fraction to the development of this disease as well as other mental disorders. -Some evidence of abnormalities and decreased volume found in the prefrontal cortex, temporal cortex, and hippocampus. -Higher risk associated with prenatal infection, obstetric complications, inadequate nutrition in utero, advanced paternal age, marijuana use, migration, and lack of social support. -Higher incidence in children raised in urban environments and for some minorities. -While there are differences noted in brain volume and architecture, there are no laboratory or psychometric tests specific for this diagnosis.

Schizophrenia

-It is more difficult to make the diagnosis in childhood, though the essential features are the same. Delusions and hallucinations in children may be less elaborate and should be distinguished from normal fantasy play. -Disorganized speech and behaviors occur in many childhood disorders (ASD, ADHD) and must be differentiated. -Alogia is present in up to 25% of individuals diagnosed with this disorder. -Usually, a gradual development of a variety of signs and symptoms, with many individuals complaining of depression. -Most childhood-onset cases have prominent negative symptoms which develop gradually. -In retrospect, children later diagnosed are seen to have nonspecific emotional/behavioral disturbances, altered intelligence, impaired language, and subtle motor delays (DSM-5)

Schizophrenia

-May need to compare the child/adolescent to unaffected siblings when determining expected level of functioning. -Prodromal symptoms may precede the active phase and residual symptoms may follow, with the presence of negative or mild positive symptoms. -Cognitive deficits are common – memory, language, executive function, slower processing speed. These may remain even after other symptoms are in remission. -Lower scores on standardized intelligence measures are seen in children -Poor peer relations, increased social isolation, lone play, and social anxiety sometimes present. -Negative symptoms are more closely tied to overall prognosis and are more persistent.

Schizophrenia

-Do a thorough assessment to rule out other psychotic disorders – include cognition, depression, mania, substance use. -Mood symptoms may be present, but positive symptoms are present in the absence of mood episodes for this diagnosis. -Evaluate cultural and religious background of the child/adolescent and their families -High risk of suicide – 5 to 6% die by suicide and about 20% of individuals with this diagnosis attempt suicide. -High comorbidity with substance use disorders, anxiety disorders, and personality disorders. -Higher incidence of weight gain, diabetes, metabolic syndrome cardiovascular disease, and pulmonary disease compared to the general public

Schizophrenia

-An uninterrupted period of illness during which a major mood episode (major depressive or manic) is concurrent with Criterion A of schizophrenia. -Note: If a major depressive episode, Criterion A1 for MDD (depressed mood) must be included. -Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness. -Symptom meeting criteria for a major mood episode are present during the majority of the active and residual parts of the illness. -Not attributable to substance/medication use or another medical condition.

Schizoaffective Disorder

Specify if: Bipolar type – manic or mixed episode is part of the presentation. Depressive type – only major depressive episode is part of the presentation. Specify if: With catatonia - if comorbid catatonia symptoms are present

Schizoaffective Disorder

Impaired occupational functioning is not required. -Lifetime prevalence 0.3% - 1/3 as common as schizophrenia -Females > males -Typical age of onset is early adulthood – seen in adolescence to later in life -Increased risk in individuals diagnosed with schizophrenia if schizophrenia or bipolar disorder diagnosed in first-degree relative. -Evaluate cultural and religious background of the child/adolescent and their families. -African American and Hispanic populations tend to be incorrectly diagonsed as schizophrenia -Risk of suicide is 5%, with higher risk if depressive symptoms present. -Suicide rates higher in North American populations.

Schizoaffective Disorder

-Consider onset, course, and other factors associated with the psychotic symptoms -Psychotic symptoms start during or soon after exposure to the substance/medication, or during intoxication or withdrawal. -Symptoms can be present for weeks. -Medications that can induce psychotic symptoms include: anesthetics, analgesics, anticholinergics, anticonvulsants, antihistamines, antihypertensives, cardiovascular medications, antimicrobials, antiparkinsonian medications, chemotherapeutics, corticosteroids, gastrointestinal medications, muscle relaxants, NSAIDs, over-the-counter medications, antidepressants, and disulfiram. -Toxins that can induce psychotic symptoms include: anticholinesterase, organophosphate insecticides, sarin, nerve gases, carbon monoxide, carbon dioxide, fuel, and paint. -7 to 25% of individuals with first episode psychosis are reported to have substance/medication-induced psychosis. -Quantitative lab results indicating blood levels for those substances that have a reference can be useful for diagnosis. -Often seen in emergency rooms. -Disability is self-limited and resolves with removal of the causative agent.

Substance/Medication-Induced Psychotic Disorder

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