Psychose

Question 1

« continuum » des troubles psychotiques?

Answer 1

tr psychotique bref
schizophréniforme
schizophrénie

tr schizo-affactif

Question 2

durée pour dx schizo?

Answer 2

> 6 mois

Question 3

durée pour dx tr schizophréniforme?

Answer 3

1-6 mois

Question 4

durée pous dx tr psychotique bref ?

Answer 4

1 jour à 1 mois

Question 5

indication utilisation antipsychotique en psychose?

Answer 5

en 2e ligne
ou si antiparkinsonian medications cannot be reduced without sacrificing motor function

si psychose non cassée avec

Question 6

antipsychotique typique?

Answer 6

bloque récepteur D2 de dopamine, aug parkinsonism

Question 7

antipsychotique atypique?

Answer 7

low potential for inducing parkinsonism

ex. clozapine, risperidone, olanzapine, quetiapine, ziprasidone,
aripriprazole)

*seul quétiapine et clozapine sont « consistently » recommandé

Question 8

ssx parkinsonisme?

Answer 8

rigidité
bradykinésie
tremblement

Question 9

gold standard en terme d’antipsychotique?

E2?

Answer 9

Clozapine

E2: sédation, orthostatisme, confusion, hypersalivation
agranulocytose *contrôle sanguin hebdo (risque infectieux)
**hebdo x 6 mois puis q 2 semaines pour les 6 mois suivant

Question 10

[…] is a common first choice becuase it can be used wihtout the risk of agranuocytose, and weekly blood monitoring.

Answer 10

Quétiapine

Question 11

[…]… used to treat agitation or delirium, induce severe parkinsonism.

Answer 11

Haloperidol

ATPsy typique

Question 12

Pt en psychose
dx de schizophrénie très prob
devient agressif à l’urgence

conduite rx?
(avantages et inconvénients, à court et long terme)

Answer 12

+/- BENZO

antipsychotique à haut potentiel:
Haloperidol
Fluphenazine

*sont moins sédatifs, peu E2 anticholinergique, moins hypoTA
*utile en IM pour patient non compliant
*att aux ssx extrapyramidaux:
4h = dystonie aigu
4 jours = akinésie
4 semaines = akathisie
4 mois = dyskinésie tardive

Question 13

The advantage of using […] is that they have a greater effect on negative symptoms (flat affect, poverty of speecj, lack of motivation). They also have little to no risk of extrapyrimydal sx.

Answer 13

antipsycho atypique (clozapine, olanzapine, risperidone, ziprasidone, aripriprazole, quétiapine)

*att agranulocytose avec clozapine

Question 14

The […] are thouht to correct the positive symptoms effectively and to also have a positive impact on the negative symptoms and the cognitive decline associated with SCZ.

Answer 14

the newer generations of antipsychotics (the atypicals), such as Olanzapine

Question 15

Most of the […]¸have been associated with weight gain, some of them producing a significant increase in weight leading to obesity and its comorbidities.

Answer 15

antipsychotique atypique, particulièrement Olanzapine

*les atypiques plus récents (abilyfy et ziprasidone) ont moins d’effet sr le poids

Question 16

un pt SCZ est sous antipsychotique. Il développe de l’anxiété et des sx de l’humeur.
Conduite rx?

Answer 16

anxiété: benzo

humeur: anticonvulsivant comme stabilisateur

Question 17

Pt SCZ x 20 ans, observant,
réfractaire à 2 antipsychotiques dont risperidone.
conduite rx?

Answer 17

si réponse partielle à risperidone, essayer ajout aripiprazole

OU

clozapine seul

Question 18

[…] refers to the combination of hyperthermia, rigidity, and autonomic dysregulation that can occur as a serious complication of the use of antipsychotic drugs.

Answer 18

Syndrome neuroleptique malin

Question 19

conduite si suspicion de syndrome neuroleptique malin?

bilan?

Answer 19

USI
d/c antipsychotique
donner bromocriptine (diminue le blocage de dopamine)
et benzo (dim rigidité)

bilan: aug CK et myoglobinurie

Question 20

[…] classically described as the riad of
mental status changes
autonomic hyperactivity
neuromuscular abnormalities

Answer 20

syndrome sérotoninergique

Question 21

Painful muscle cramps in the head and neck are referred to as […]? and a part of a constellation of advers side effects known as extrapyramidal symptoms that may occur with the use of atypical (1st gen) antipsychotique.

Answer 21

Dystonie

Question 22

[…] is similar to anxiety and consists of feelins of restlessness, uneasem irritability and gysphoria.

Answer 22

Akathisie

*grouille tout le temps

Question 23

[…] presents with involuntary and repetitive tics of the mouth and face (such as chweing, sucking or grimacing) and less commonly rocking and tapping. They may exhibit gasping or fragmented speech dur to diaphragmatic […].

Answer 23

Dyskinésie tardive

Question 24

antipsychotique de 1re ligne pour la SCZ?

Answer 24

risperidone ou
olanzapine ou
quetiapine (+ sédatif)

Question 25

Quand essayer la clozapine?

Answer 25

après 2 essais d’antipsychotiques différents, x 6-8 sem, à dose tx