Psychosis Flashcards

0
Q

Who is more likely to have schizophrenia?

A

Men = Women

Disorders pop up in 20s and 30s.

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1
Q

What is psychosis?

A

A disturbance in the perception of reality (hallucinatoins, delusions, or thought disorganization) and periods of high risk for agitation, aggression, impulsivity, and other forms of behavior dysfunction.

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2
Q

What may you see with psychotic disorders?

A

Hallucinations - false sensory perceptions.

Delusions - false beliefs versus evidence to the contrary (bizarre or nonbizarre)

Thought disorganization - disruption of the logical process of thought.

Agitation - acute state of anxiety, heightened emotional arousal, and increased motor activity.

Aggression - acts or threats of violence.

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3
Q

Negative symptoms for schizophrenics

A

negative affect - lessened personality

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5
Q

Psychotic disorders

A

schizophrenia

schizoaffective disorder

affective disorders with psychotic features - psychotic features of bipolar mania, bipolar depression, and unipolar depression

delirium

brief psychotic disorder - resolves quickly with treatment or removal of stressor.

delusional disorder

psychosis secondary to a medical condition

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5
Q

Acute disturbance of consciousness and cognition

A

Delirium

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6
Q

Periods of active psychosis and persistent deterioration in social, occupational, scholastic, and personal functioning

A

Schizophrenia

Severe, chronic disorder

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7
Q

What are examples of psychosis secondary to a medical condition?

A

Neurologic problems; CNS infection, neoplasms, vascular events, cognitive disorders and seizures.

Endocrine dysfunction; thyroid, parathyroid or adrenal abnormalities.

Metabolic issues: hypoxia………..

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8
Q

Psychotic disorders seen in Alzheimers

A

Delusions

Visual hallucinations

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9
Q

Psychotic issues seen with substance induction

A

Ingestion or withdrawal from prescription medications, alcohol or illicit drugs

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10
Q

What do you use when diagnosing for psychotic disorders?

A

Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

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12
Q

Schizophrenia - characteristic symptoms of DSM-IV

A
Delusions
Hallucinations
Disorganized speech
Catatonic behavior
Negative symptoms

DSM-5 requires at least one of the following regardless of the presence of other characteristic symptoms
delusions
hallucinations
disorganized speech

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12
Q

What is the MOA of psychosis?

A

Too much dopamine.

Glutamate and seratonin also involved.

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13
Q

Isolated delusions in an otherwise high-functioning person

A

Delusional Disorder

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14
Q

Typical Antipsychotics - First Generation (FGA)

A
Chlorpromazine (Thorazine)
Mesoridazine (Serentil)
Fluphenazine (Prolixin)
Thiothixene (Navane)
Loxapine (Loxitane)
Molindone (Moban)
Thioridazine (Mellaril)
Trifluoperazine (Stelazine)
Perphenazine (Trilfon)
Haloperidol (Haldol)
Pimozide (Orap)
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15
Q

Do all first generations have same effect?

A

YES!! Same effect and side effects!

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16
Q

Which dopamine receptors are good?

A

D-2 (D-1 Bad!) Look for drugs specific to D-2 receptor.

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17
Q

Which antipsychotic is the class drug?

A

Haloperidol (Haldol)

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18
Q

Approved indications for Haldol

A

Management of schizophrenia.

Control of tics and vocal utterances of Tourette’s disorder in children and adults.

Severe behavioral problems in children.

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19
Q

Unapproved indications for Haldol

A

Treatment of nonschizophrenia psychosis.

Emergency sedation of severely-agitated or delirious patients.

Treatment of ICU delirium.

Adjunctive treatment of ethanol dependence.

Postoperative nausea vomiting.

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20
Q

Dopamine blockade for Haloperidol

A

D2>1>D4>5-HT2a>D1>H1

21
Q

Which antipsychotic is the high potency drug?

A

Haldol - reduced sedation and reduced anticholinergic effects versus low potency.

Clinical effect is exactly the same.

22
Q

Kinetics of typical antipsychotics

A

Lipophilic
High binding
Large volume of distribution

23
Q

Cardiac class effect for phenothiazines

A

Q-T Prolongation

24
What must you get before patients are prescribed antipsychotics?
EKG!! QTc cannot be greater than 0.44 miliseconds
25
What is a risk of typical antipsychotics in elderly patients with dementia?
Risk of death!
26
ADRs of Haldol
``` Tachycardia Dizziness Hypotension Impotence Hypoprolactinemia / gynecomastia ``` Weight gain seen in kids. Risk of death.
27
What movement disorders can develop when on typical antipsychotics?
Extrapyramidal Symptoms Tardive dyskinesias
28
Types of extrapyrmidial symptoms
Akathisia Parkinsonian Syndrome Dystonias
29
Motor restlessness
Akathisia
30
Mask-like facial expression, resting tremor, cogwheel rigidity, shuffling gait, and psychomotor retardation.
Parkinsonion Syndrome
31
Haloperidol
Haloperidol 5 mg twice a day
32
Haloperidol IV
Haloperidol IV 5 mg Can go up to 10 mg (2.5 - 10 mg)
33
How many doses of Haldol can you Rx?
One dose! Must then move on to discover the underlying cause. These should only be used on an as needed basis until you can get a psych consult.
34
In psychosis you may see disturbances in the:
Perception of reality - evidenced by hallucinations, delusions or thought disorganization. Periods of high risk for aggression, impulsiveness, and other forms of behavioral dysfunction.
35
Major mood disorder | Prominent psychotic symptoms, but patient also experiences psychosis in the absence of mood symptoms
Schizoaffective disorder
36
Psychosis secondary to a medical condition
Neurologic problems; central nervous system infection, neoplasms, vascular events, cognitive disorders and seizures Endocrine dysfunction; thyroid, parathyroid or adrenal abnormalities Metabolic issues; hypoxia, hypoglycemia, fluid or electrolyte abnormalities Hepatic and renal disorders Autoimmune disorders; systemic lupus erythematosus
37
Alzheimer’s dementia Delusions, and visual hallucinations Substance induced psychotic disorder Ingestion or or withdrawal from prescription medications, alcohol or illicit drugs
Psychotic disorders
38
How do typical antipsychotics work?
Block the D-1 and D-2 receptors.
39
Atypical Antipsychotics
``` Aripiprazole (Abilify) Clozapine (Clozaril) Lucrasidone (Latuda) Paliperidone (Invega) Risperidone (Risperdal) Asenapine (Asendin) Iloperidone (Fanapt) Olanzapine (Zyprexa) Quetiapine (Seroquel) Ziprasidone (Geodon) ```
40
MOA atypical antipsychotics
Block the D-2 receptors
41
Atypical antipsychotics differences in dopamine blockade
Clozapine - D4=a1>5-HT2A > D2 = D1 Olanzapine 5-HT2a>H1>D4>D2>1>D1 Aripiprazole D2=5-HT2A>D4>a1=H1>>D1 Quetiapine H1>a1>M1,3>5-HT2A
42
Are atypicals superior to typicals?
No evidence of superiority in acute schizophrenia Side effect profile (depending) may favor atypicals Numerous long-acting injectable dosage form
43
Is there an increased risk of death in the elderly seen with the atypical antipsychotics?
Yes :-(
44
Metabolic effects of atypical antipsychotics
Weight gain Hyperlipidemia Hyperglycemia
45
ADRs of atypical antipsychotics
``` Prolactin elevation Seizure risk Orthostatic hypotension Neuroleptic malignant syndrome QT prolongation And then there’s … ```
46
Atypical Antipsycotics class drug
Abilify
47
Abilify
Abilify 15 mg once a day
48
Adherence of anti psychotics are improved by use of
Sustained action injectable products Haloperidol decanoate Oil-based intramuscular given every 2 to 4 weeks Abilify® Maintena Once monthly Invega® Sustenna Ramped up to eventually once a month Risperdal® Consta Every two weeks