Day 1 - Psych Part 1 Psychotic Flashcards
Dx criteria of Schizophrenia
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.
Difference bn following disorders: (1) Schizotypal (2) Schizophrenia (3) Schizoaffective (4) Schizoid (5) Schizophreniform (6) Brief psychotic disorder
(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
Neuroimaging of pt w/ schizophrenia
Enlargement of ventricles, both lateral and third; Reduction in cortical volume
Schizophrenia v. Delusional disorder
Both delusions; Delusional disorder - non-bizarre delusions, no disorganized speech or behavior
Drugs known to cause psychosis
Hallucinogens - LSD, PCP; Stimulants - cocaine, amphetamines; Tactile hallucinations w/ withdrawal from alcohol, barbiturates, or benzos; Steroids - corticosteroids, anabolic steroids
2 main extrapyramidal side effects assoc. w/ antipsychotics
(1) Acute dystonia (2) Tardive dyskinesia
Pt on antipsychotic p/w neck spasm forcing head in unusual direction - dx & tx
Acute dystonia; Benadryl (diphenhydramine) - add more anticholinergic into system (or Benztropine)
Feat. characterize tardive dyskinesia from high-potency traditional antipsychotic
Choreoathetosis (tongue, face, neck, tongue, limb, trunk)
Tx tardive dyskinesia
D/c or reduce neuroleptic; Consider switching to antipsychotic with less extrapyramidal side effects (e.g., Atypicals - Risperidone or even Clozapine)
Time frame expect to see Parkinsonian side effects in pt taking antipsychotics
4 days to 4 months (i.e., Extrapyramidal side effects)
Tx for Parkinsonian side effects from neurolepics
Anticholinergics like benztropine or diphenhydramine; Amantidine (dopamine agonists); Decrease or d/c Neuroleptic
S/sx neuroleptic malignant syndrome
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
Tx neuroleptic malignant syndrome
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)
High potency traditional neuroleptics
Haloperidol, Fluphenazine, Droperidol
Low potency traditional neuroleptics
Chlorpromazine, Thioridazine
Moderate potency traditional neuroleptics
Molindone, Loxapine, Trifluoperazine, Perphenazine
Atypical antipsychotics
Olanzipine, Quetiapine, Clozapine, Risperidone, Ziprasidone, Aripiprazole, Paliperidone
