Psychoses

Question 1

delusional disorder

Answer 1

> 1 delusion lasting >1 MO w/o other psychotic symptoms

no significant impairment in function, no better explanation

Question 2

brief psychotic disorder

Answer 2

> 1 psychotic symptoms with onset and remission in less than 1 month

Question 3

schizophreniform disorder

Answer 3

schizophrenia but <6 mo duration

Question 4

schizoaffective disorder

Answer 4

schizophrenia + mood disturbance (MDD or manic)

Question 5

schizophrenia (general)

Answer 5

> 6 mo duration of illness along with functional decline

Question 6

positive symptoms of schizophrenia

Answer 6

excess dopamine receptors

hallucinations or delusions, disorganized speech, thinking, abnormal behavior

Question 7

sensory perception w.o physical stimuli

Answer 7

hallucinations

Question 8

hallucinations (list) (6)

Answer 8

1. auditory (MC)
2. visual
3. olfactory
4. tactile
5. somatic
6. gustatory

Question 9

fixed belief held with strong conviction despite other evidence

Answer 9

delusions

Question 10

delusion (list) (8)

Answer 10

1. persecutory
2. reference
3. control
4. grandiose
5. nihilism
   6 erotomania
6. jealousy
7. doubles

Question 11

persecutory delusions

Answer 11

person/force interfering with them, observing them or wishing harm

Question 12

delusions of reference

Answer 12

random events take on personal significance (directed at them)

Question 13

grandiose delusions

Answer 13

unrealistic beliefs in one’s powers and abilities

Question 14

nihilism

Answer 14

exaggerated belief in futility of everything/catastrophic events

Question 15

doubles delusions

Answer 15

believes family member or close person replaced by identical double

Question 16

negative symptoms of schizophrenia

Answer 16

dopamine dysfunciton

flat emotional affect, evolution

Question 17

RF of schizophrenia

Answer 17

family history***

Question 18

epidemiology of schizophrenia

Answer 18

MC in men

show in early 20s for men, late 20s for women

Question 19

management of schizophrenia (general)

Answer 19

antispsychotics – 2nd gen preferred

AKA neuroleptics

Question 20

atypical drugs MOA

Answer 20

CNS dopamine D4 receptor and serotonin antagonists

Question 21

why would I give a patient clozapine

Answer 21

resistance developed to other antipsychotics

Question 22

S/E of atypical antipsychotics

Answer 22

extrapyramidal sxs
increased prolactin 
hyperglycemia 
hyperlipidemia 
weight gain 
NMS

Question 23

CIs of atypical antipsychotics

Answer 23

QT prolongation

Question 24

clozapine

Answer 24

atypical given if resistance develops

causes agranulocytosis and myocarditis

less incidence of EPS

Question 25

olanzapine cautions

Answer 25

marked weight gain and DM

Question 26

what are extrapyramidal symptoms?

Answer 26

rigidity bradykinesia tremor akathisia

Question 27

typical/1st gen antipsychotics MOA

Answer 27

dopamine antagonists *decreased dopamine activity causes all SEs

Question 28

typical/1st gen antipsychotics S/es

Answer 28

``` extrapyramitdal symptoms dyskinesia parkonsonism tardive dyskinesia NMS ```

Question 29

list of 3 EPS symptoms

Answer 29

1. dyskinesia/dystonic reaction 2. tardive dyskinesia 3. Parkinsonism

Question 30

dystonic reactions definition and cause

Answer 30

reversible EPS, hours to days after initiation of typical neuroleptics caused by disruption of dopamine/ach balance = excessive AcH

Question 31

symptoms dyskinesia

Answer 31

``` trismus protrusion of tongue facial grimacing torticollis difficulty speaking ```

Question 32

tx of dyskinesia

Answer 32

IV Diphenhydramine add anticholinergic agent (I.e. Benztropine)

Question 33

tardive dyskinesia

Answer 33

repetitive involuntary movements mostly involving extremities and face I.e. lip smacking, teeth grinding, rolling of tongue seen with LONG TERM use

Question 34

life threatening disorder due to D2 inhibitor

Answer 34

NMS

Question 35

NMS symptoms

Answer 35

mental status changes extreme muscle rigidity tremor autonomic instability (tachycardia, hyperthermia, fever)

Question 36

tx of NMS

Answer 36

``` d/c offending agent dopamine agonists (bromocriptine) ```

Question 37

C/I for haldol

Answer 37

Parkinson disease anticoagulant use severe cardiac disorder