Psychosis and Bipolar

Question 1

Schizophrenia

Answer 1

-Auditory hallucinations
-Delusions
-Disorganized speech
-Disorganized behavior
-Flat affect
-Social withdrawal
-Lack of motivation
-Lack of speech or thought

Question 2

Dopaminergic theory of psychosis

Answer 2

Increased activity of the mesocortical and mesolimbic projections from the ventral tegmental area

Question 3

First-generation Antipsychotics

Answer 3

D GOT TRIPLE A HOES

Haloperidol, “zines”

MOA: D2-receptor blockade

AE:
-Antipsychotic
-Extrapyramidal (dystonia, akathisia, park, tardive dyskinesia, nero malignant)
-Hyperprolactinemia
-Antiemetic
-Orthostatic hypotension
-Anticholinergic (DM, BV, UR, cons)
-Sedation, increase weight/appetite

Question 4

First-generation Antipsychotics Caution

Answer 4

Risk in elderly
-carry BBW to ↑mortality in these patients

Question 5

Second generation Antipsychotics

Answer 5

PIA got an HD tv for MEN

Quetia”pine” and Aripiprazole, “idones”

MOA: D2-receptor and 5-HT2A-receptor blockade

– Decrease risk of EPS
– Effective against negative symptoms
– Can cause metabolic syndrome

Question 6

Clozapine, “the best and the worst”

Answer 6

AE - ASS
* Agranulocytosis (BBW)
* Seizures (BBW)
* Salivation (wet pillow syndrome)

Question 7

Olanzapine AE

Answer 7

• Most problematic for weight gain and metabolic changes

Question 8

Ziprasidone AE

Answer 8

• Causes QT prolongation

Question 9

Risperidone AE

Answer 9

REP

• Worse than other 2nd generation antipsychotics in terms of increasing prolactin secretion and causing EPS

Question 10

Quetiapine and Aripiprazole AE

Answer 10

• Less AE than other 2nd generation antipsychotics

Question 11

Major Depressive Disorder

Answer 11

– Symptoms for at least 2 weeks
– May be associated with:
* Depressed mood
* Anhedonia
* Increase weight or decrease weight
* Increase sleep or decrease sleep
* Fatigue or low energy
* Decreased concentration
* Feelings of worthlessness or guilt
* Psychomotor agitation or retardation
* Recurrent thoughts of death or suicide

Question 12

Lithium

Answer 12

MOA:
-Inhibits multiple enzymes involved in generation of second messengers; poorly understood mechanism

Indications:
-Bipolar disease

AE: NMN HK
-Nephrogenic diabetes insipidus
-Movement problems = tremor
-Hypothyroidism
-Nausea, vomiting
-Kidney dysfunction long term

Contra:
-Pregnancy
-Renal disease
-Thyroid dysfunction

Question 13

Lithium Monitoring

Answer 13

-Serum lithium concentration monitoring (BBW)
-Renal and thyroid function need to be checked