Psychosis Flashcards
Good prognostic indicators for schizophreniform
1) onset of prominent psychotic symptoms within 4 weeks of first noticeable bheavioral change.
2) Confusion at height of psychotic episode
3) Good premorbid social and occupational functioning
4) Absence of blunted or flat affect .
What is not present in brief psychotic disorder?
Presence of negative symptoms. Otherwise still have delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior.
APA practice guidelines: how many months do the acute and stabilization phases last after first psychotic episode?
6 months
What is a safer antipsychotic to use in the elderly?
seroquel based off a nursing home study. It did the best vs risperidone.
Which FGA can cause photosensitivity?
Thorazine.
Which SGA is associated with higher EPS?
Risperidone/paliperiodone
What’s the big side effect of iloperidone (fanapt)?
Orthostatic hypotension
Causes of death from clozaril:
Agranulocytosis, myocarditis/cardiomyopathy, PE/DVT.
Clozaril and seizures
At >600mg per day, the risk of seizures on clozapine increases to 5%. This is why you titrate up slowly.h
How often to check AIMS in the young/elderly on typicals? Atypicals?
Typicals: 6 mo/3 mo
Atypicals 12 mo/6 mo
After discharge during stabilization phase, how long should one continue the current dose of antipsychotic?
6 months
If prolactin sensitive, which antipsychotic should one prescribe for least amount of risk?
seroquel
What does CBT work on for psychosis during the stable phase?
Delusions
How many sx of catatonia do you need for the diagnosis?
3 out of the 11 ( stupor, catlepsy, waxy flexibility, mutism, negativism, posturing, mannerism, stereotypy, agittaion, grimacing, and echolalia or echopraxia.)
Treatment for delusionsal disorder?
Start with a SGA. If not helpful, stop it. Limited data that it will be helpful.
Jealous Spouse psychosis- what is the diagnosis?
Delusional Disorder, Paranoid Type. (not paranoid personality disorder)
First thing to do for clozapine-induced drooling?
Behavioral measures (more pillows, lateral decubitus) then meds
Which antipsychotic drugs can cause pancreatitis ?
Clozapine, risperidone, olanzapine. Even depakote. Lithium will not.
Nongenetic Risk factors for schizophrenia
- Hypoxia at birth
- Season of birth (winter)
- Urban environment
- Pregnancy and birth complications
- Greater paternal age
- Prenatal and perinatal infections
Schizophrenia positive prognostic indicators
- Female
- rapid onset of symptoms
- Older age of first episode
- predominantly positive symptoms
- Brief presentation.
- Confusion at height of episode (schizophreniform)
Most common diagnosis associated with catatonia?
Bipolar disorder
Which schizophrenia subtype increases risk of impuslive behavior?
Persecutory
Concordance rate for monozygotic twins with schizophrenia
45%
How often do you check AIMS?
eveyr year in young, every 6 months in the elderly
How long are the acute and stabilization phases of schizophrenia/Brief psychotic?
6 months
How long should a schizophrenic remain asymptomatic before you lower the dose?
2 years
What is the risk of developing schizophrenia in a first-degree biological relative of an individual with schizophrenia as compared to the general population?
10 x
Brief Psychotic Disorder and Immigrants
The data regarding the increase in risk differs across the studies but the brief psychotic disorder is consistently reported to occur more frequently in immigrants than in people who were born in a given country. A recent compilation of meta-analyses which included 55 studies found that first-generation immigrants have a 2 times increased risk of a brief psychotic disorder.
Which antipsychotic is least associated with prolactin elevation?
quetiapine
TD in elderly vs young
remission rates are much lower in the elderly population than in their younger cohorts. Older patients also are at a much greater risk of developing TD.
For SGA monitoring, do they want the glucose or the A1c?
first start with the fasting glucose.
What’s happenign to the brain in child onset schizophrenia?
Enlargement of the ventricles, and decreased grey matter volume.
In parkinson’s psychosis, what can you use besides pimavanserin?
clozapine , but be careful
Cognitive impairment in schizophrenia is due to which neurotransmitter?
Acetylcholine
What is the mortality rate of suicide in schizophrenic patients?
5%, thought 20% will attempt
which antipsychotic cannot be used with carbamazepine?
clozapine
TCAs and Schizotypals
Tricyclic antidepressants are contraindicated in patients with a schizotypal personality disorder because these drugs can exacerbate psychosis.
The 2 markers of schizophrenia.. high one and low one?
The above case describes a patient with the most likely diagnosis of schizophrenia. γ-aminobutyric acid A receptor subunit α2 (GABRα2) is a marker of GABAnergic neurotransmission during neurodevelopment and is found in high levels in lateral cerebellum of patients with schizophrenia.
High GABRa2,
Low BDNF, GAD1, GAD67
