Day 1 - Psych Part 1 Psychotic

Question 1

Dx criteria of Schizophrenia

Answer 1

At least 2 of following for at least 1 month: Delusions/Hallucinations, Disorg. speech, Grossly disorg. or catatonic behavior, Negative sx w/ social/occupational impairment for 6 mo.

Question 2

Difference bn following disorders: (1) Schizotypal (2) Schizophrenia (3) Schizoaffective (4) Schizoid (5) Schizophreniform (6) Brief psychotic disorder

Answer 2

(1) Personality disorder, odd thoughts/behaviors/appearance (think: may dress like a pickle) (2) Social/occupational impairment, duration for at least 6 mo. (3) Schizophrenia w/ mood disorder, can have psychosis w/o mood disorder but not vice versa (that would be MDD w/ psychotic features) (4) Personality disorder w/ voluntary social isolation (think: schizoids avoid) (5) Schizophrenia sx but duration

Question 3

Neuroimaging of pt w/ schizophrenia

Answer 3

Enlargement of ventricles, both lateral and third; Reduction in cortical volume

Question 4

Schizophrenia v. Delusional disorder

Answer 4

Both delusions; Delusional disorder - non-bizarre delusions, no disorganized speech or behavior

Question 5

Drugs known to cause psychosis

Answer 5

Hallucinogens - LSD, PCP; Stimulants - cocaine, amphetamines; Tactile hallucinations w/ withdrawal from alcohol, barbiturates, or benzos; Steroids - corticosteroids, anabolic steroids

Question 6

2 main extrapyramidal side effects assoc. w/ antipsychotics

Answer 6

(1) Acute dystonia (2) Tardive dyskinesia

Question 7

Pt on antipsychotic p/w neck spasm forcing head in unusual direction - dx & tx

Answer 7

Acute dystonia; Benadryl (diphenhydramine) - add more anticholinergic into system (or Benztropine)

Question 8

Feat. characterize tardive dyskinesia from high-potency traditional antipsychotic

Answer 8

Choreoathetosis (tongue, face, neck, tongue, limb, trunk)

Question 9

Tx tardive dyskinesia

Answer 9

D/c or reduce neuroleptic; Consider switching to antipsychotic with less extrapyramidal side effects (e.g., Atypicals - Risperidone or even Clozapine)

Question 10

Time frame expect to see Parkinsonian side effects in pt taking antipsychotics

Answer 10

4 days to 4 months (i.e., Extrapyramidal side effects)

Question 11

Tx for Parkinsonian side effects from neurolepics

Answer 11

Anticholinergics like benztropine or diphenhydramine; Amantidine (dopamine agonists); Decrease or d/c Neuroleptic

Question 12

S/sx neuroleptic malignant syndrome

Answer 12

Mental status changes - agitated delirium with confusion (not psychosis); Rigidity w/ or w/o tremor, Hyperthermia, Autonomic instability - tachycardia, labile/high fever, tachypnea, diaphoresis, Rhabdomylosis

Question 13

Tx neuroleptic malignant syndrome

Answer 13

Stop offending med; Supportive care in ICU (IVFs, cooling blankets, reducing HTN - clonidine or nitroprusside), DVT prevention, Benzos; Dantrolene (other options - dopamine agonists = Bromocriptine or Amantidine)

Question 14

High potency traditional neuroleptics

Answer 14

Haloperidol, Fluphenazine, Droperidol

Question 15

Low potency traditional neuroleptics

Answer 15

Chlorpromazine, Thioridazine

Question 16

Moderate potency traditional neuroleptics

Answer 16

Molindone, Loxapine, Trifluoperazine, Perphenazine

Question 17

Atypical antipsychotics

Answer 17

Olanzipine, Quetiapine, Clozapine, Risperidone, Ziprasidone, Aripiprazole, Paliperidone