Psychosis

Question 1

What is the definition of psychosis?

Answer 1

Impaired mental function which INTERFERES with an individual’s ability to meet ordinary life demands

Question 2

What are the symptoms of psychosis similar to?

Answer 2

those of depression

Question 3

What the 2 KEYS to psychosis symptoms?

Answer 3

A form of mental illness that produces:

1. bizarre behavior
2. deterioration of personality

Question 4

What is a common type of psychosis?

Answer 4

Schizoprenia

Question 5

What sex is psychosis more common in?

Answer 5

Males

Question 6

How much of the US population suffer?

Answer 6

1-2%

Question 7

What are the symptoms and how many do you have to have and for how long?

Answer 7

2 of the following 7 symptoms for more than 4 weeks:

1. Disorganized Speech/Behavior
2. Delusions
3. Impaired Sense of Reality
4. Thought or emotional disturbances
5. Confusion
6. Hallucinations (auditory and/or visual)
7. Negative Symptoms (5 A’s)

Question 8

What are the 5 negative symptoms and what are they?

Answer 8

1. Alogia: poverty of speech/verbal expression
2. Avolition: lack of motivation
3. Anhedonia: lack of interest in normal activities
4. Affective Blunting: lack of emotional expression/flat face
5. Attention Impairment: lack of focus or easily distracted

Question 9

What is the typical age of onset for psychosis?

Answer 9

late teens - early 20’s

Question 10

What are the 3 prodromal (early) symptoms?

Answer 10

1. social withdrawal
2. loss of interest in work/school
3. deterioration in hygiene

Question 11

Which of the 3 prodromal symptoms is the most telling?

Answer 11

deterioration in hygiene

Question 12

NOT ON MIDTERM 2

What are the 2 typical courses of psychosis?

Answer 12

1. periods of exacerbation and remission

2. chronic illness

Question 13

NOT ON MIDTERM 2

What is common with chronic illness?

Answer 13

an incomplete recovery from an acute episode with persistent dysfunction & deterioration

Question 14

NOT ON MIDTERM 2

What is effective treatment for psychoses?

Answer 14

1. immediate acute treatment
2. maintenance drugs
3. psychotherapy

Question 15

What is the physical cause of psychosis?

Answer 15

EXCESSIVE dopamine transmission

Question 16

What are the 2 MOA’s for psychosis drugs?

Answer 16

1. Blockade of dopamine receptors

2. Blockade of serotonin and catecholamine receptors

Question 17

What are the 2 dopamine receptors?

Answer 17

1. D1 - blockade results in partial antipsychotic activity

2. D2 - blockade results in FULL antipsychotic activity

Question 18

Which blockade is most effective?

Answer 18

D2

Question 19

Which blockade causes EPS?

Answer 19

D1

Question 20

What is EPS?

Answer 20

Extra-pyramidal Syndrome, aka pseudoparkinsonism

Question 21

What 2 things do we evaluate when choosing an antipsychotic drug?

Answer 21

1. patient profile (age, current disease, symptoms)

2. drug profile (therapeutic and side effects)

Question 22

What are the 3 classes of anti-psychotic drugs?

Answer 22

1. Phenothiazines
2. Non-phenothiazines
3. Atypical Antipsychotics

Question 23

NOT ON MIDTERM 2

What are the general side effects of all 3 categories?

Answer 23

1. Photosensitivity
2. Orthostatic hypotension/impotence
3. Weight Gain
4. Dry mouth/constipation/urinary retention

Question 24

NOT ON MIDTERM 2

What are the OTHER 5 SE known?

Answer 24

1. EPS
2. TD
3. Dystonia
4. Akathisia
5. Tourette’s Syndrome

Question 25

What is the 1 large ADVERSE affect?

Answer 25

``` NMS - Neurolyptic Malignant Syndrome Rare but lethal and involves 1. muscle rigidty 2. fever 3. delirium ```

Question 26

What is EPS?

Answer 26

extra-pyramidal syndrome, aka pseudoparkisonism 1. Bradykinesia (slow movement) 2. Rigidity 3. Abnormal reflexes 4. Tremors at Rest 5. Drooling

Question 27

What is TD?

Answer 27

Tardive Dyskinesia 1. Eye rolling 2. Lip Smacking 3. Uncontrollable tongue movement

Question 28

Which drug is TD uncontrollable tongue movement common with?

Answer 28

Thioridazine

Question 29

What is dystonia?

Answer 29

Constant neck and back muscle spasms

Question 30

What is Akathisia?

Answer 30

feeling of intense restlessness 1. pacing 2. agitation 3. fidgeting

Question 31

What is Tourette's Syndrome?

Answer 31

uncontrollable 1. noises 2. obscenities/foul words

Question 32

What are the 3 phenothiazine drugs to know?

Answer 32

1. Chloropromazine 2. Thioridazine 3. Trifluoperazine

Question 33

What is the MOA of phenothiazines?

Answer 33

Block D2 receptors (full block) and some | serotonin, NE and EPI

Question 34

What are low doses of phenothiazines used for?

Answer 34

1. HIccups 2. Nausea 3. Vomiting

Question 35

What are high doses of phenothiazines used for?

Answer 35

1. Anxiety 2. Agitation 3. Psychosis

Question 36

What are the non-phenothiazines common to in structure?

Answer 36

phenothiazines

Question 37

What is a common serious SE of non-phenothiazines?

Answer 37

EPS

Question 38

Why is EPS a side effect of non-phenothiazines?

Answer 38

Because the MOA of non-phenothiazines is to block D1 receptors (partial antipsychotic activity)

Question 39

What are the 2 non-phenothiazine drugs?

Answer 39

1. Thiothixene | 2. Haloperidol

Question 40

Which of the 2 non-phenothiazine drugs causes low to no sedation?

Answer 40

Thiothixene

Question 41

What are the 4 atypical antipsychotics to know?

Answer 41

1. Clozapine 2. Olanzapine 3. Risperidone 4. Quetiapine

Question 42

What is commonly NOT a SE of atypical antipsychotics?

Answer 42

EPS

Question 43

If a patient has WHAT set of symptoms does Quetiapine seem to work best for?

Answer 43

``` Negative Symptoms (5 A's): alogia avolition anhedonia affective blunting attention impariment ```

Question 44

In what age group do atypical antipsychotics work best and why?

Answer 44

late teen - early 20's | less SE's

Question 45

What is a particular SE of clozapine?

Answer 45

aggranulocytosis - low WBC

Question 46

What is a particular SE olanzapine?

Answer 46

weight gain

Question 47

What is a particular SE of risperidone?

Answer 47

increased suicide ideation

Question 48

Which of the 4 drugs are SISTER drugs?

Answer 48

olanzapine risperidone quetiapine