Psych Schizo Disorders/AntiPsychotics Flashcards
Patient will present as → a 75-year-old woman has been receiving 24-hour care at home due to a fall risk. She has a history of severe diabetic neuropathy, and as a result, she is unstable on her feet. Two months ago, she began thinking that her daughter was telling her caretakers to steal her money, although both her daughter and the caretakers deny this. She continues to maintain an active social life, and cognitive testing shows no new deficit. She denies auditory and visual hallucinations and feeling like people are “out to get her.”
Delusional DO
Delusional DO
Delusion Disorder:
→ Disease Presentation:
Otherwise normally functioning person with a belief in something that does not exist.
→ DSM-5:
- Non-Bizarre Delusional beliefs for AT LEAST 1 MONTH → WITHOUT ANY schizophrenia symptoms/behavioral changes/impairment
→ Delusion: fixed belief of an external reality despite evidence to the contrary
→ Non-Bizarre Delusion: false belief that is plausible but unlikely
→ Treatment:
1st LINE → SGAS (second gen antipsychotics):
Olanzapine and Risperidone - MC
“Done”, “pine”, rip/pip
Psychotherapy
Antidepressants
TYPES:
- Erotomanic: another person is in love with them
- Grandiose: some great talent or important
- Jealous: unfaithfulness in relationship
- Persecutory: conspired against
- Somatic: Bodily functions or sensations
- Mixed
- Unspecified
- Bizarre: implausible, not understandable
Patient will present as → a 45-year-old truck driver who c/o “hearing things that are not there” for 2 weeks. He reports that he was severely depressed 5 months ago and was placed on Prozac by his PCP. His depression got better and he was “fine” until 2 weeks ago when he started to “hear things.” His work and social life are not impaired by the hallucinations at this time. His friend was diagnosed with schizophrenia a few years ago and he was afraid that he now has schizophrenia.
Schizoaffective DO
Schizoaffective DO
Schizoaffective Disorder:
→ Disease Presentation:
A mental health condition including schizophrenia and mood disorder symptoms.
→ DSM-5:
BOTH schizophrenia + Mood DO: Depression, manic, hypomania + delusions and/or hallucinations
HALLUCINATIONS + DELUSIONS MUST OCCUR AT LEAST 2 WEEKS with the ABSENCE of the mood disorder !!!
→ TYPES:
- Bipolar Type: Manic is present
- Depressive Type: ONLY depression
→ Treatment:
Psychotherapy
Antipsychotics, Anticonvulsants, SSRIs
Patient will present as → a 26-year-old male presents with ‘voices in my head.” The patient was well until 8 months ago when he began to hear voices of two men plotting to kill him. His fear of being killed has resulted in his missing multiple days of work, and he was recently fired. On physical exam, he is disheveled and has incoherent, disorganized speech.
Schizophrenia
Last line for Schizophrenia + S/E?
Clozapine
Causes Agranulocytosis
Schizophrenia
Schizophrenia:
→ Disease Presentation:
Major psychosis for greater than 6 months + difficulty functioning
** TYPICALLY OCCURS in CHILDHOOD **
→ PATHOPHYSIOLOGY: DOPAMINE
Positive Symptoms: TOO MUCH Dopamine in Mesolimbic System
Negative Symptoms: NOT ENOUGH Dopamine in Mesocortical System
→ DSM-5:
>6 Months
PSYCHOSIS: Auditory Hallucinations, Delusions, Hearing Voices, etc.
POSITIVE SYMPTOMS: psychosis: hallucinations, delusions, disorganized speech
NEGATIVE SYMPTOMS: Decreased interest, emotional range, drive
Cognitive symptoms: Neurocognitive: decreased memory, attention, organization, can’t understand interpersonal cues
Mood symptoms: cheerful or sad
→ CT SCAN: Ventricular Enlargement & Decreased cortical volume
→ Before treatment check: EKG
→ Treatment:
Antipsychotics
1st Line for OP = Risperidone, Olanzipine, aripiprazole, quetiapine, etc (NEG. SYMPS)
LAST LINE: CLOZAPINE = Causes Agranulocytosis
1st Line for Agitation = Risperidone, Haldol, Fluphenazine or Chlorpromazine (POS. SYMPS)
Psychotherapy
2nd Gen Atypical Long-acting injectable form –> MC agents used for Schizophrenia –> GREATEST INCIDENT of MOVEMENT DO (also causes increased prolactin = galacterrea)
Risperidone
2nd gen that has the LOWEST incidence of movement do’s
Quetiapine (Seroquel)
2nd gen with highest SE of Wt Gain & DM
Olanzapine
Last line 2nd Gen due to agranulocytosis and myocarditis (even though it treats Schizophrenia the best)
Clozapine
2nd gen that is more weight neutral (less potential for weight gain) but has a high risk of prolonged QT - 500 cals
Ziprasidone (Geodon)
2nd Gen that is a partial dopamine agonist that has a less potential for weight gain. Common SE is akathesia
Aripiprazole
2nd gen - safe with pregnancy - must be taken with food and can be used for BPD (350cals)
Lurasidone (Latuda)
3 First Gen AntiPsychotics + MC SE
Haloperidol
Fluphenazine
Chlorpromazine
Increased risk of Cardiac Symptoms + EPS/TD + Increased Prolactin
