12% Schizophrenia Spectrum and Other Psychotic Disorders

Question 1

(RoshReview)

Which antipsychotic most commonly causes weight gain?

Answer 1

olanzapine

Question 2

(RoshReview)

common SEs of 2nd gen antipsychotics

Answer 2

wt gain/metabolic syndrome
cardiac side effects (think QTc prolongation)
hyperprolactinemia
drowsiness

“While second-generation antipsychotics have fewer EPS, they may lead to weight gain, causing metabolic syndrome, cardiac side effects (including QTc prolongation), hyperprolactinemia, or drowsiness. “

Question 3

(RoshReview)

what labs do we monitor for pts on olanzapine, and how often?

Answer 3

fasting blood glucose & lipids
q 3-6 months

“When a patient is on olanzapine, food intake, hyperglycemia, and hyperlipidemia should be monitored by obtaining fasting blood glucose and lipids every 3–6 months and obtaining a weight at each visit. Metformin has been shown to be effective in treating patients struggling with weight who are on antipsychotic medications.”

Question 4

(RoshReview)

90% of schizophrenic pts use ______

Answer 4

nicotine

(“The most commonly used substances include caffeine, alcohol, and tobacco or nicotine products.” “Alcohol (A), cannabis (B), and cocaine (C) are also substances abused in the schizophrenic population, but to a lesser degree than tobacco.”)

Question 5

(RoshReview)

RF for schizophrenia

Answer 5

advanced paternal age at conception
childhood trauma
CNS infections
cannabis use during adolescence
living further from the equator
immigration
BIRTH DURING THE LATE WINTER OR SPRING - (increased risk of maternal exposure to viruses during pregnancy)

Question 6

(RoshReview)

schizophrenia rarely occurs outside of ages ____ and _____

Answer 6

10 yrs of age and 45 yrs of age

“It begins most often in adolescence or young adulthood, and onset prior to 10 years of age or after age 45 years of age is rare.”

Question 7

(RoshReview)

what type of hallucination is most common in schizophrenia?

Answer 7

auditory

Question 8

(PPP 593)

three components of diagnosing schizophrenia

Answer 8

• 2 or more of following symptoms: positive s/s, negative s/s
  
  • • • for at least 6 months
• at least 1 must be hallucination, delusion or disorganized speech (for 1 month)
• must impair function

Question 9

(PPP 593)

list three positive symptoms of schizophrenia

Answer 9

hallucinations
delusions
disorganized speech

Question 10

(PPP 594)

list 6 A’s of negative symptoms of schizophrenia

Answer 10

Absence of normal cognition
Affect flattening
Alogia:  poverty of speech
Avolition:  lack of will
Anhedonia
Asociality:  failure to engage w/ other socially

Question 11

(PPP 594)

What does PPP say of neuroimaging findings that will be asked on exams?

Answer 11

CT scan shows ventricular enlargement and decreased cortical volume

PET scan shows hypoactive frontal lobes, hyperactivity in basal ganglion

Question 12

(PPP 594)

how do we treat acute psychosis in the ER?

Answer 12

HALOPERIDOL
risperidone
paliperidone (Invega)
---and---
hospitalize pt

if EXTREMELY agitated: IM aripiprazole, olanzapine, or ziprasidone maybe IM haloperidol if you don’t mind the adverse effects

Question 13

(PPP 595)

which antipsychotics more commonly lead to increased prolactin?

Answer 13

first gen antipsychotics

Question 14

(PPP 595)

which of the antipsychotics are least associated with metabolic changes?

Answer 14

aripiprazole and

ziprasidone

Question 15

(PPP 595)

s/s of NMS

Answer 15

AMS
“LEAD-PIPE” MUSCLE RIGIDITY

AUTONOMIC INSTABILITY = tachycardia, tachypnea, hyperthermia, fever, bp changes, hypersalivation, diaphoresis)
INCONTINENCE

LEUKOCYTOSIS
rhabdo (check CPK, LDH, LFTs)

Question 16

(PPP 595)

four EPS effects of antipsychotics, and how we treat them

Answer 16

• ACUTE DYSTONIA // diphenhydramine or benzotropine
• PARKINSONISM //
• TARDIVE DYSKINESIA //
• akathisia // reduction of dose or switch medications; 1st line med mgmt = BB

Question 17

(PPP 595)

what is anti-HAM?

Answer 17

antiHistamine
antiAdrenergic
antiMuscarinic (anticholinergic)
effects of antipsychotics

Question 18

(PPP 595)

what are the cardiac adverse effects of antipsychotics?

Answer 18

QT PROLONGATION

arrhythmias

Question 19

(PPP 595)

how do we fix NMS?

Answer 19

> prompt discontinuation of med
supportive care: cooling blankets, IV fluids
dopamine agonists = bromocriptine or amantadine
dantrolene - for rigidity and fever

Question 20

(PPP 592)

define schizophreniform disorder

Answer 20

s/s of schizophrenia but DURATION

B/W 1-6 MONTHS

Question 21

(PPP 592)

define schizophrenia diagnostic criteria:

Answer 21

2 or more of positive symptoms, negative symptoms, grossly disorganized or catatonic behavior
FOR AT LEAST 6 MONTHS

Question 22

(PPP 592)

define schizoaffective disorder

Answer 22

SCHIZOPHRENIA + MOOD DISORDER (major depressive or manic episode)

Question 23

(PPP 592)

what is the criteria for delusion disorder?

Answer 23

AT LEAST 1 DELUSION
lasting AT LEAST 1 MONTH W/O OTHER PSYCHOTIC SYMPOMS
+
NO SIGNIFICANT IMPAIRMENT IN FUNCTION

Question 24

(PPP 592)

define delusion

Answer 24

a fixed and false belief

“a fixed belief despite evidence to the contrary”

Question 25

(PPP 592)

define NONBIZARRE DELUSION

Answer 25

false + plausible but highly unlikely (i.e. being poisoned)

Question 26

(RoshReview)

what are the two most common subtypes of delusions seen in delusional disorder?

Answer 26

persecutory
jealous
(the spouse who won’t believe spouse is being faithful)

Delusional Disorder = at least one delusion lasting at least one month
MC presents b/w 35-45 yrs of age
RF = FH of paranoid personality disorder