Psychosis Flashcards
What is the definition of psychosis?
Impaired mental function which INTERFERES with an individual’s ability to meet ordinary life demands
What are the symptoms of psychosis similar to?
those of depression
What the 2 KEYS to psychosis symptoms?
A form of mental illness that produces:
- bizarre behavior
- deterioration of personality
What is a common type of psychosis?
Schizoprenia
What sex is psychosis more common in?
Males
How much of the US population suffer?
1-2%
What are the symptoms and how many do you have to have and for how long?
2 of the following 7 symptoms for more than 4 weeks:
- Disorganized Speech/Behavior
- Delusions
- Impaired Sense of Reality
- Thought or emotional disturbances
- Confusion
- Hallucinations (auditory and/or visual)
- Negative Symptoms (5 A’s)
What are the 5 negative symptoms and what are they?
- Alogia: poverty of speech/verbal expression
- Avolition: lack of motivation
- Anhedonia: lack of interest in normal activities
- Affective Blunting: lack of emotional expression/flat face
- Attention Impairment: lack of focus or easily distracted
What is the typical age of onset for psychosis?
late teens - early 20’s
What are the 3 prodromal (early) symptoms?
- social withdrawal
- loss of interest in work/school
- deterioration in hygiene
Which of the 3 prodromal symptoms is the most telling?
deterioration in hygiene
NOT ON MIDTERM 2
What are the 2 typical courses of psychosis?
- periods of exacerbation and remission
2. chronic illness
NOT ON MIDTERM 2
What is common with chronic illness?
an incomplete recovery from an acute episode with persistent dysfunction & deterioration
NOT ON MIDTERM 2
What is effective treatment for psychoses?
- immediate acute treatment
- maintenance drugs
- psychotherapy
What is the physical cause of psychosis?
EXCESSIVE dopamine transmission
What are the 2 MOA’s for psychosis drugs?
- Blockade of dopamine receptors
2. Blockade of serotonin and catecholamine receptors
What are the 2 dopamine receptors?
- D1 - blockade results in partial antipsychotic activity
2. D2 - blockade results in FULL antipsychotic activity
Which blockade is most effective?
D2
Which blockade causes EPS?
D1
What is EPS?
Extra-pyramidal Syndrome, aka pseudoparkinsonism
What 2 things do we evaluate when choosing an antipsychotic drug?
- patient profile (age, current disease, symptoms)
2. drug profile (therapeutic and side effects)
What are the 3 classes of anti-psychotic drugs?
- Phenothiazines
- Non-phenothiazines
- Atypical Antipsychotics
NOT ON MIDTERM 2
What are the general side effects of all 3 categories?
- Photosensitivity
- Orthostatic hypotension/impotence
- Weight Gain
- Dry mouth/constipation/urinary retention
NOT ON MIDTERM 2
What are the OTHER 5 SE known?
- EPS
- TD
- Dystonia
- Akathisia
- Tourette’s Syndrome
What is the 1 large ADVERSE affect?
NMS - Neurolyptic Malignant Syndrome Rare but lethal and involves 1. muscle rigidty 2. fever 3. delirium
What is EPS?
extra-pyramidal syndrome, aka pseudoparkisonism
- Bradykinesia (slow movement)
- Rigidity
- Abnormal reflexes
- Tremors at Rest
- Drooling
What is TD?
Tardive Dyskinesia
- Eye rolling
- Lip Smacking
- Uncontrollable tongue movement
Which drug is TD uncontrollable tongue movement common with?
Thioridazine
What is dystonia?
Constant neck and back muscle spasms
What is Akathisia?
feeling of intense restlessness
- pacing
- agitation
- fidgeting
What is Tourette’s Syndrome?
uncontrollable
- noises
- obscenities/foul words
What are the 3 phenothiazine drugs to know?
- Chloropromazine
- Thioridazine
- Trifluoperazine
What is the MOA of phenothiazines?
Block D2 receptors (full block) and some
serotonin, NE and EPI
What are low doses of phenothiazines used for?
- HIccups
- Nausea
- Vomiting
What are high doses of phenothiazines used for?
- Anxiety
- Agitation
- Psychosis
What are the non-phenothiazines common to in structure?
phenothiazines
What is a common serious SE of non-phenothiazines?
EPS
Why is EPS a side effect of non-phenothiazines?
Because the MOA of non-phenothiazines is to block D1 receptors (partial antipsychotic activity)
What are the 2 non-phenothiazine drugs?
- Thiothixene
2. Haloperidol
Which of the 2 non-phenothiazine drugs causes low to no sedation?
Thiothixene
What are the 4 atypical antipsychotics to know?
- Clozapine
- Olanzapine
- Risperidone
- Quetiapine
What is commonly NOT a SE of atypical antipsychotics?
EPS
If a patient has WHAT set of symptoms does Quetiapine seem to work best for?
Negative Symptoms (5 A's): alogia avolition anhedonia affective blunting attention impariment
In what age group do atypical antipsychotics work best and why?
late teen - early 20’s
less SE’s
What is a particular SE of clozapine?
aggranulocytosis - low WBC
What is a particular SE olanzapine?
weight gain
What is a particular SE of risperidone?
increased suicide ideation
Which of the 4 drugs are SISTER drugs?
olanzapine
risperidone
quetiapine
