Psychosis

Question 1

What is psychosis

Answer 1

major emotional disorder associated with perceptual and functional impairment

Question 2

how to choose antipsychotics: schizophrenia

Answer 2

ziprasidone/Geodon or aripiprazole/Abilify. 2nd gen, less EPS, less metabolic SEs

Question 3

what may psychosis be associated with

Answer 3

meds (especially anticholinergics), depression, dementia, schizophrenia, traumatic event (functional psychosis). organic related to infection (delerium), poisoning, tumor, hypoxia, injury. toxic: drug/ETOH withdrawal

Question 4

schizophrenia negative symptoms

Answer 4

diminished socialization, restricted effect, poverty of speech. amotivation, anhedonia, flat affect, apathy, emotional withdrawal, poor rapport

Question 5

what is the most common psychosis?

Answer 5

schizophrenia

Question 6

olanzapine action and considerations

Answer 6

2nd gen/atypical. most weight gain/metabolic effects, not reccomended. Block D4, D1, muscarinic, alpha1, histamine1 receptors.

Question 7

schizophrenia positive symptoms

Answer 7

`hallucinations, delusions, formal thought disorders. agitation, feelings of unreality, racing thoughts, paranoia, hyperactivity

Question 8

what are the effects of typical antipsychotics in the basal ganglia

Answer 8

extrapyramidal symptoms. This includes movement disorders: acute dystonia (involuntary muscle spasms), parkinsonism, perioral tremor, neuroleptic malignancy syndrome, tardive dyskinesia (involuntary movements of mouth, tongue, extremeties), akathisia (restlessness)

Question 9

treatment of agitated dementia in elders

Answer 9

avoid antipsychotics, use mood stabilizers

Question 10

schizophrenia treatment

Answer 10

multimodal: case management, behavioral counseling, meds also helpful

Question 11

extrapyrimadal syndrome (EPS)

Answer 11

most common and troublesome side effect of antipsychotic, pseudoparkinsonism-shuffling, drooling, pill-rolling, akathisia, restlessness, dystonia, tardive dyskinesia.

Question 12

what are antipsychotics used for besides psychosis, schizophrenia

Answer 12

acute agitation, dementia, bipolar. thorazine: acute n/v, hiccups, preop sedation

Question 13

schizophrenia onset

Answer 13

often adolescence

Question 14

antipsychotics: managing SEs and EPS

Answer 14

BBs may be helpful for akathisia. Parkonsoniian s/s: benztropine/Cogentin, Benadryl (antihistamine with anticholinergic properties), amantidine/Symmetrel (dopamine agonist), d/c medication.

Question 15

typical (1st gen) antipsychotics drugs available

Answer 15

PHENOTHIAZINE: chlorpromazine/Thorazine, fluphenazine, perphenazine, prochlorperazine, thioridazine, trifluoperazine
NON PHENOTHIAZINES: haloperidol/Haldol, chlorprothixene, molindone, pimozide, theothixene

thioridazine/Mellaril, thiothixene/Navane,

Question 16

what is EPS treated with

Answer 16

anti parkinson, antihistamine, and anticholinergics

Question 17

why do people with schizophrenia have positive symptoms?

Answer 17

thought to be because increased dopaminergic (D2) activity in mesolimbic region

Question 18

clozapine consideration

Answer 18

use should be reserved for severe schizophrenia.

high agranulocytosis risk (fatal within 24-72h). Weekly CBC, stop if WBC <3500. baseline CBC + after d/c up to 4 weeks after as well. Assess for leukopenia, fever, chills, lethargy.

both patient and provider need to be registered

Question 19

typical antipsychotic drug/drug interactions

Answer 19

wide range, include antihypertensives (potentiate effects), anticholinergics (potentiate effects)

Question 20

typical (1st gen) antipsychotics action

Answer 20

block post-synaptic dopamine D2 receptors. In mesolimbic area, reduce positive schizophrenia symptoms. In medulla and GI tract, anti-emesis. In basal ganglia, EPS. Block ACh receptors, anticholinergic effects (dry mouth, orthostasis, sedation, weight gain). Block alpha adrenergic receptors, orthostatic hypotension. Block histamine receptors, sedation, weight gain

Question 21

typical antipsychotic side effects

Answer 21

neuroleptic malignant syndrome, EPS, weight gain, photosensitivity, decreased seizure threshold, orthostatic hypotension, sexual dysfunction, galactorrhea, amenhorrea

Question 22

psychotic (schizophrenic) disorders

Answer 22

massive disruption: mood, thinking, overall behavior; poor filtering of stimuli. causes multifactorial: genetic, environmental, neurotransmitters, may have familial trait

Question 23

schizophrenia cognitive symptoms

Answer 23

attention deficits, memory deficits, lack of judgement, lack of insight, slowed thought processing, word salad

Question 24

atypical antipsychotics (2nd gen) available

Answer 24

risperdone/RISPERDAL (used in peds too), aripiprazole/Abilify (used in peds too), clozapine/Clozaril (not used much), olanzapine/Zyprexa (not used much), olanzapine-fluoxetine/Symbax, quetapine/Seroquel, ziprasidone/Geodon, asenapine/Saphris, paliperdone/Invega

Question 25

which antipsychotics can be used in children

Answer 25

risperidone/Risperdal, ariPiprazole/Abilify (both 2nd gen)

Question 26

typical antipsychotic drugs - efficacy

Answer 26

more effective in treating positive symptoms than negative, more effective in treating severe psychosis patients who are agitated, dangerous

Question 27

schizophrenia patho

Answer 27

unclear. genetic part, probably mutation. dopamine theory: too much in limbic system or limbic system hyperresponsive to it. Possible decreased D1 dopamine activity (?other neurotransmitter issues: GABA, serotonin, glutamate). Brain structual abnormalities related to birth trauma, fetal environment, drugs?

Question 28

neuroleptic malignant syndrome NMS

Answer 28

side effect of antipsychotics; life threatening, fever as high as 107, diaphoresis, rigidity, stupor, coma, ARF, tremor, catatonia, labile pulse and BP, hyperthermia, elevated CK, myoglobinemia, mortality about 10%

Question 29

what do most schizophrenia drugs do?

Answer 29

block D2 receptor; some also regulate glutamate neurotransmitter. Used to quiet symptoms and permit improved functioning.

Question 30

EPS risk

Answer 30

higher risk with typical anti-psychotics than atypical

Question 31

how to choose antipsychotics: mania

Answer 31

consult for aripiprazole/Abilify and mood stabilizer (lithium or valproic acid)

Question 32

other types of schizophrenia symptoms

Answer 32

catatonia, paranoid

Question 33

atypical/2nd gen antipsychotic ADRs

Answer 33

less EPS risk, more hematologic risks (agranulocytosis), sedation, caution with elders (increase mortality), all prego cat C (except clozapine cat B), olanzapine anticholinergic effects, clozapine high agranulocytosis risk

Question 34

schizophrenia negative symptoms cause

Answer 34

thought to be related to decrease in dopaminergic (D3) in the mesocortical system

Question 35

schizophrenia prodrome

Answer 35

almost a year long, subtle changes (mood, inattention, affects day to day functioning related to fragmented thoughts)

Question 36

antipsychotic dosing

Answer 36

use a high dose to decrease agitation, then taper down. Patients respond differently, not one size fits all. Need maintenance dose, high relapse rate if discontinued.

Question 37

how to choose antipsychotics: elders

Answer 37

1st gen greater EPS risks, 2nd gen increased CV events and death

Question 38

monitoring considerations for antipsychotics

Answer 38

baseline CBC, LTF, EKG (weekly WBC clozapine). stigma of MH, ADEs, risk for acute dystonia if on s/t for treatment of vomiting. education: risk/ben, SEs. Always forewarn pt/fam of potential SEs to maintain trust.

Question 39

withdrawal effects of antipsychotics

Answer 39

HA, n/v, salivation, diarrhea, insomnia

Question 40

how to choose antipsychotics: agitated dementia (off label)

Answer 40

risperidone 0.5-1.5mg/day

Question 41

clozapine action and considerations

Answer 41

2nd gen/atypical. used for treatment resistance. block D4, S2, and alpha2 receptors.

Question 42

other adverse effects of antipsychotics

Answer 42

allergic dermatitis (macular/papular rash, urticaria), photosensitivity, neuroendocrine effects (amennhorea, rare gynecomastia), hematologic effects (more common with atypicals, leukopenia, agranulocytosis, leukocytosis), CV (arrhythmias). all have prego concerns (EPS in newborns)

Question 43

how to choose antipsychotics: delerium

Answer 43

haloperidol, risperidone. start low

Question 44

Risperdol receptor action

Answer 44

block D2, S2, alpha1, alpha2, H1 receptors. 2nd gen/atypical

Question 45

atypicial antipsychotics (as opposed to typical)

Answer 45

no evidence better than typicals. aid in controlling negative as well as pos (typical only pos), have indirect effect on serotonin as well as dopamine. less EPS.

Question 46

pharmacokinetics, pharmacodynamics of antipsychotics

Answer 46

block dopamine receptors in basal ganglia, hypothalamus, lymbic system, medulla. absorbed rapidly, wide distribution in adipose tissue. Concern: concurrent therapy with anticholinergic. SE: Parkinsonism, prolactin elevation, EPS symptoms. Risperdol (atypical) may have less D2 activity.