Psychosis

Question 1

Good prognostic indicators for schizophreniform

Answer 1

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 .

Question 2

What is not present in brief psychotic disorder?

Answer 2

Presence of negative symptoms. Otherwise still have delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior.

Question 3

APA practice guidelines: how many months do the acute and stabilization phases last after first psychotic episode?

Answer 3

6 months

Question 4

What is a safer antipsychotic to use in the elderly?

Answer 4

seroquel based off a nursing home study. It did the best vs risperidone.

Question 5

Which FGA can cause photosensitivity?

Answer 5

Thorazine.

Question 6

Which SGA is associated with higher EPS?

Answer 6

Risperidone/paliperiodone

Question 7

What’s the big side effect of iloperidone (fanapt)?

Answer 7

Orthostatic hypotension

Question 8

Causes of death from clozaril:

Answer 8

Agranulocytosis, myocarditis/cardiomyopathy, PE/DVT.

Question 9

Clozaril and seizures

Answer 9

At >600mg per day, the risk of seizures on clozapine increases to 5%. This is why you titrate up slowly.h

Question 10

How often to check AIMS in the young/elderly on typicals? Atypicals?

Answer 10

Typicals: 6 mo/3 mo

Atypicals 12 mo/6 mo

Question 11

After discharge during stabilization phase, how long should one continue the current dose of antipsychotic?

Answer 11

6 months

Question 12

If prolactin sensitive, which antipsychotic should one prescribe for least amount of risk?

Answer 12

seroquel

Question 13

What does CBT work on for psychosis during the stable phase?

Answer 13

Delusions

Question 14

How many sx of catatonia do you need for the diagnosis?

Answer 14

3 out of the 11 ( stupor, catlepsy, waxy flexibility, mutism, negativism, posturing, mannerism, stereotypy, agittaion, grimacing, and echolalia or echopraxia.)

Question 15

Treatment for delusionsal disorder?

Answer 15

Start with a SGA. If not helpful, stop it. Limited data that it will be helpful.

Question 16

Jealous Spouse psychosis- what is the diagnosis?

Answer 16

Delusional Disorder, Paranoid Type. (not paranoid personality disorder)

Question 17

First thing to do for clozapine-induced drooling?

Answer 17

Behavioral measures (more pillows, lateral decubitus) then meds

Question 18

Which antipsychotic drugs can cause pancreatitis ?

Answer 18

Clozapine, risperidone, olanzapine. Even depakote. Lithium will not.

Question 19

Nongenetic Risk factors for schizophrenia

Answer 19

• Hypoxia at birth
• Season of birth (winter)
• Urban environment
• Pregnancy and birth complications
• Greater paternal age
• Prenatal and perinatal infections

Question 20

Schizophrenia positive prognostic indicators

Answer 20

• Female
• rapid onset of symptoms
• Older age of first episode
• predominantly positive symptoms
• Brief presentation.
• Confusion at height of episode (schizophreniform)

Question 21

Most common diagnosis associated with catatonia?

Answer 21

Bipolar disorder

Question 22

Which schizophrenia subtype increases risk of impuslive behavior?

Answer 22

Persecutory

Question 23

Concordance rate for monozygotic twins with schizophrenia

Answer 23

45%

Question 24

How often do you check AIMS?

Answer 24

eveyr year in young, every 6 months in the elderly

Question 25

How long are the acute and stabilization phases of schizophrenia/Brief psychotic?

Answer 25

6 months

Question 26

How long should a schizophrenic remain asymptomatic before you lower the dose?

Answer 26

2 years

Question 27

What is the risk of developing schizophrenia in a first-degree biological relative of an individual with schizophrenia as compared to the general population?

Answer 27

10 x

Question 28

Brief Psychotic Disorder and Immigrants

Answer 28

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.

Question 29

Which antipsychotic is least associated with prolactin elevation?

Answer 29

quetiapine

Question 30

TD in elderly vs young

Answer 30

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.

Question 31

For SGA monitoring, do they want the glucose or the A1c?

Answer 31

first start with the fasting glucose.

Question 32

What’s happenign to the brain in child onset schizophrenia?

Answer 32

Enlargement of the ventricles, and decreased grey matter volume.

Question 33

In parkinson’s psychosis, what can you use besides pimavanserin?

Answer 33

clozapine , but be careful

Question 34

Cognitive impairment in schizophrenia is due to which neurotransmitter?

Answer 34

Acetylcholine

Question 35

What is the mortality rate of suicide in schizophrenic patients?

Answer 35

5%, thought 20% will attempt

Question 36

which antipsychotic cannot be used with carbamazepine?

Answer 36

clozapine

Question 37

TCAs and Schizotypals

Answer 37

Tricyclic antidepressants are contraindicated in patients with a schizotypal personality disorder because these drugs can exacerbate psychosis.

Question 38

The 2 markers of schizophrenia.. high one and low one?

Answer 38

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