Day # 6: Week in Review -> Psychotic Disorders

As we discussed on day # 1 of this curriculum, there will always be at least one day per theme that is a review. This may be in the format of a review quiz or a summary of the high yield information. Educational research supports spaced repetition learning and by regularly re-visiting old content we will have a better chance of imprinting what you have learned in your long term memory. Of course, we have only had one week of readings so far, so today we will review the highlights of our first theme of psychotic disorders.

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Day 1: Intro to Psychotic Spectrum Disorders

The core features of psychotic disorders include: (must have at least one of 1, 2, or 3)

1. Delusions

2. Hallucinations

3. Disorganized speech

4. Disorganized or catatonic behavior

5. “Negative symptoms”

**Memory Aid**

The 5 A’s of Negative symptoms in psychotic disorders

1. Anhedonia (decreased interest/pleasure)

2. Affect (flat) - absence or near absence of any sign of affective expression

3. Alogia (poverty of speech) - lack of unprompted content of speech

4. Avolition (apathy)

5. Attention (poor attention)

Optional: Click here to reference full article.

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Day 2: Psychotic Timelines

We discussed the criteria for specific diagnoses within the psychotic spectrum. Highlights include:

•Brief Psychotic disorder: ≥ 1 day, < 1 month

•Schizophreniform disorder: ≥ 1 month, < 6 months

•Schizophrenia: ≥ 6 months

•Schizoaffective disorder: Period of illness during which there is a major mood episode (depression or mania) along with criteria for schizophrenia. There must be delusions or hallucinations for ≥ 2 weeks in the absence of a major mood episode at some time in their life

•Delusional disorder: Aside from delusions, functioning is NOT impaired

•Substance or Medication-induced psychotic disorder

•Psychotic disorder due to another medical condition

Optional: Click here to reference full article.

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Day 3: Schizophrenia - The “who” and the “why”

•Prevelence: 1% of the population at a given time has schizophrenia

•Higher risk of suicide (20x) than the general population

•Known risk factors include: Obstetric complications, late winter or early spring birth, advanced paternal age, strong genetic risk

•Pathogenesis: Discussed future reclassification of psychotic disorders and potential use of biomarkers instead of only symptom clusters

Optional: Click here to reference full article.

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Day 4: Clinical Pearls for Psychotic Disorders

•Clinical interview: Include onset/duration of symptoms; any history of prodromal period; substance use; medical and family history; document number of episodes; risk assessment for suicide and aggression; optional rating scales.

•Be careful to use patient friendly terminology and concepts so as to establish rapport and decrease potential paranoia.

•Quick word on cognition in schizophrenia:

-Speed of Processing

-Memory

-Attention

-Reasoning

-Tact / Social cognition

•Quick word on types of delusions:

-Persecutory

-Erotomania

–Somatic

-Grandiosity

-Being controlled

-Bizarre

-Thought broadcasting

-Thought insertion

-Thought withdrawal

Optional: Click here to reference full article

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Day 5: Intro to the Mental Status Exam

We took a break from psychotic disorders to learn about the mental status exam. As a review, here are the elements.

•Appearance

•Behavior

•Speech/Language

•Mood

•Affect

•Thought process

•Thought content

•Perceptual Disturbances

•Cognition

•Insight

•Judgement

Optional: Click here to reference full article.

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Conclusion

Tune in for our next lesson as we continue our theme of psychotic spectrum disorders. Tomorrow we will cover elements of the mental status exam that are particularly important in psychotic spectrum disorders. In the following days we will discuss medical/lab workup, antipsychotic pharmacology, and supportive psychotherapy.