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Psychotic Disorders

by Phoebe on November 18, 2014

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Schizophrenia 

Things you should know

  • Patient exhibits abnormal behavior and is unable to differentiate real from imaginary.
  • Chronic and debilitating
  • Disruption of the usual balance of emotions and thinking
  • M>F

Signs and Symptoms

  • Positive symptoms – Extra feelings or behaviors which are usually not present
    • Delusions and paranoia
    • Hallucinations
    • Irrational, bizarre or odd statements or beliefs
    • Hostility
    • Disorganized speech
    • Inappropriate laughter
    • Hyperactivity
  • Negative symptoms –  A lack of behaviors or feelings which are usually present
    • Social isolation and withdrawal
    • Becoming more emotionless
    • Lack of motivation
    • Deterioration in their personal appearance and hygiene
    • Catatonic behavior

Diagnosis

  • Thorough Medical and Psychiatric History
  • Diagnostic Criteria
    • DSM-5 – Two diagnostic criteria must be met over most of a month with significant changes in social functioning over the past 6 months.
  • Delusions – False beliefs held in spite of contradictory evidence.
  • Thought broadcasting
  • Paranoid delusions
  • Somatic Delusions
  • Delusions of grandeur
  • Hallucinations – A false perception in any sensory modality
    • Auditory – most common
    • Visual
    • Tactile
    • Olfactory
  • Disorganized speech - incoherence, tangential responses etc. creating difficulty with communication
  • Extremely disorganized behavior
  • Catatonic behavior, which can ranges from a coma-like daze to bizarre, hyperactive behavior
  • Negative symptoms, which relate to reduced ability or lack of ability to function normally
  • Subtypes (No longer in DSM – 5)
    • Paranoid Schizophrenia – Most common.  Auditory hallucinations or delusions of grandiose persecution.  Patient does not have poor thought order or disorganized behavior.
    • Disorganized Schizophrenia – Flattened affect and thought disorder
    • Catatonic Schizophrenia – Either immobile and mute with waxy flexibility or agitated purposeless movements and echolalia (mimicking sound)
    • Undifferentiated schizophrenia – patient has psychotic symptoms but does not fit into the other categories.
    • Residual Type –  Where positive symptoms are present at a low intensity only
  • Two additional subtypes from ICD-10
    • Post-schizophrenic depression: A depressive episode arising in the aftermath of a schizophrenic illness where some low-level schizophrenic symptoms may still be present.
    • Simple schizophrenia: Insidious and progressive development of prominent negative symptoms with no history of psychotic episodes.
  • Treatment

    • Psychosocial Interventions
      • Individual therapy
      • Social skills training
      • Family therapy
      • Vocational rehabilitation and supported employment
    • Medications
      • Atypical Antipsychotics (Second generation)
        • Aripiprazole (Abilify)
        • Clozapine (Clozaril)
        • Iloperidone (Fanapt)
        • Lurasidone (Latuda)
        • Olanzapine (Zyprexa)
        • Quetiapine (Seroquel)
        • Risperidone (Risperdal)
      • Typical Antipsychotics (first generation)
        • Treatment goals for first generation medicines
          • Psychomotor slowing
          • Emotional quieting
          • Affective indifference
        • Side effects include extrapyramidal symptoms (EPS)
          • Tardive dyskinesia – irregular jerky motion
          • Dystonia – Continuous muscle spasms
          • Parkinsonian movement – tremor, bradykinesia, rigidity
        • Chlorpromazine
        • Fluphenazine
        • Haloperidol
        • Perphenazine

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    No show this week

    by Brian Wallace PA-C on November 4, 2014

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    Sorry, but it’s not gonna happen this week.  :(

     

    The kids, my wife and I all have had bronchitis / sinus infection / pnuemonia who knows for about 2 weeks now.  No end in site and I can’t speak long enough without coughing to do the show.

     

    I’ll have one up as soon as I can.  Thanks.

     

     

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