Class 3

Question 1

How to do differential dx psychosis

Answer 1

When evaluating a patient with psychotic symptoms, clinicians should follow the general guidelines for assessing nonpsychiatric conditions. First, clinicians should aggressively pursue an undiagnosed nonpsychiatric medical condition when a patient exhibits any unusual or rare symptoms or any variation in the level of consciousness. Second, clinicians should attempt to obtain a complete family history, including a history of medical, neurological, and psychiatric disorders. Third, clinicians should consider the possibility of a nonpsychiatric medical condition, even in patients with previous diagnoses of schizophrenia. A patient with schizophrenia is just as likely to have a brain tumor that produces psychotic symptoms as is a patient without schizophrenia.

Question 2

Comorbidity schizophrenia and substance misuse

Answer 2

Comorbidity, substance misuse: More than 50%

Nicotine: more than 90%

Question 3

Substance or Rx induced psychotic disorder criteria

Answer 3

A. Presence of one/ both of the following symptoms:
1. Delusions
2. Hallucinations
B. There is evidence from the history, physical examination or lab findings of both 1 and 2:
1. Sx A developed during/ soon after substance intoxication/ withdrawal/ exposure to a Rx/ substance
2. The involved substance/ Rx is capable of producing sx A
C. Not better explained by a psychotic disorder that is not substance/ Rx induced. Sx preceded onset of substance use, sx persist for a substantial period of time after cessation/ withdrawal
D. Not delirium
E. Causes significant distress/ impairment

Question 4

Extrapyramidal rating scale

Answer 4

how the pt walks (shiffling gait, arms aren’t swinging, head looks known, turns slowly 10 sec), hands out to check for tremors, check rapidity of movements (fingures = can procoke dyskinesia), pronation supination dominant hand, puece sur tendon du bicep avec lautre bras est ce que bicep a roue dentée, flexion extensions poignet rotation externe et interne épaule

Question 5

Dystonia

Answer 5

involuntary movements of face, arms, legs, neck. + M less than 25y, prior use of cocaine. (head pulled to the left). Opisthotonus, larygospasm. Rapid onset.

Question 6

Tardive dyskinesia

Answer 6

bizarre facial and tongue movements, stiff neck, difficulty swallowing. Potentially irreversible, + comorbid in cognitive and mood disorders. After use for many years. 1/3 disappears with time. Receptors become too sensitive to dopamine. Block more dopamine with antipsychotics = reduce dyskinesia. Clozapine antidyskinetique

Question 7

Parkinsonism

Answer 7

tremor, shuffling gait, rigidity, drooling, cogwheel. 1-5 days after, +W, dehydrated, elderly

Question 8

Diff dx psychotic disorder

Answer 8

delusional disorder (usually monodelusional, less functional decline), substance/ Rx induced psychotic disorder, psychotic disorder due to another medical condition, brief psychotic disorder, schizophreniform disorder, schizoaffective disorder, autistic disorder, factitious with predominantly psychological signs and symptoms, personality disorder (mild sx, occur throughout pt’s life, no date of onset), malingering, mood disorder, OCD

Question 9

Phase 1: premorbid phase

Answer 9

Social maladjustment, social withdrawal, irritability, antagonistic thoughts and behaviors, being shy, doing poorly in school demonstrating antisocial behavior, passive, no team sports, somatic symptoms, bizarre idea, philosophical interests.

Question 10

Phase 2: Prodromal phase

Answer 10

(2-5 years) Functional impairment, nonspecific sx: sleep disturbance, anxiety, irritability, depression, decreased concentration, fatigue, deterioration in role functioning. + sx: perceptual abnormalities, ideas of reference, suspiciousness late in prodromal phase

Question 11

Phase 3

Answer 11

schizophrenia

Question 12

Phase 4

Answer 12

residual. Sx of the acute phase are absent/ not prominent. Negative symptoms may remain. Residual impairment often increased between active episodes.

Question 13

Onset schizoaffective

Answer 13

young adult

Question 14

schizoaffective epidemiology

Answer 14

0,5-0,8%, M=W for the bipolar subtype, 2W=M depressive subtype, age of onset is later in W. Increasing presence of schizo sx= worse prognosis, resembles more schizo outcomes.

Question 15

Substance or Rx that can induce psychosis

Answer 15

All drugs
Rx: anesthetics and analgesics, anticholinergics, anticonvulsants, antidepressants, antihistamines, antiHTA, cardiovascular Rx, antimicrobial Rx, antoneoplastic Rx, antiparkinsonism, corticosteroids, disulfiram, GI, muscles relaxants, NSAIDS
Toxins: anticholinesterase, organophosphate, insecticides, nerves gases, carbon dioxide, volatile substances, heavy metal poisoning

Question 16

GMC that can cause psychosis

Answer 16

Acute intermittent porphyria, CV disease, CNS infection, CNS trauma, deafness, fluid/ electrolyte imbalance, hepatic disease, hypoadrenocorticocism, hypo/per/para/thyroidism, metabolism condition, migraine, neoplasm, neurosyphilis, normal pressure hydrocephalus, renal disease SLE, temporal lobe epilepsy, vit B12 deficiency, Wilson’s, AIDS, helped encephalitis, Huntingtons, Wernicke, Korsakoff