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Psychiatry > Psychotic D/O > Flashcards

Psychotic D/O Flashcards

1
Q

Epilepsy in which lobe causes psychosis

A

Temporal

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2
Q

CNS Causes of Psychosis

A 
Cerebrovascular dx
multiple sclerosis
cancer
Alz Dx
Parkinsons Dx
Huntington's chorea
tertiary syphillis
Temporal lobe epilepsy
encephalitis
prior disease
Neurosarcoidosis***
AIDS
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3
Q

Endocrinopathies causing Psychosis

A

Addision/Cushings dx
hypo or hyper thyroid
hyper or hypo Ca
HYPO - pituitarism

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4
Q

Nutritional/Vitalim def causing psychosis

A

B12
Folate
Niacin

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5
Q

DSM criteria for Psychosis SECONDARY TO GMC

A

prominent hallucinations/delusions
sx do NOT only occur during an episode of delerium
evidence to support medical cause from labs/h&P/etc

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6
Q

Meds that Cause psychosis

A 
corticosteroids
anti-Parkinsons drugs
Anticonvulsants
Anti-Histamines
Anti-Ach
Anti-HTN (beta-block)
digitalis
methylphenidate
Fluroquinolones (levofloxacin)
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7
Q

Drugs of Abuse that cause psychosis

A 
EtOH
Cocaine
LSD
Ecstasy
PCP
BZD
Barbituates
Weed
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8
Q

Work-up for young adult with new onset psychosis in Schizophrenia

A

check TSH, RPR and brain imaging

will likely start anti-psychotics

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9
Q

DSM for Schizophrenia

A 
***2+ for at least 1 month***
delusions
hallucinations
disorg. speech
GROSSLY disorg. behavior or catatonia
negative sx

*** ONLY ONE of the above needed if delussions are BIZARRE…OR….if hallucinations are running comentary….OR if hallucinations are 2+ people conversing in the pt’s head

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10
Q

Subtypes of Schizo

Paranoid Type

A

Paranoid Type - most common, dominated by delusions

  • delusions of grandeur or persecution
  • higher fxn, older onset,
  • NO predom. of disorg speech/behavior or catatonia
  • NO inappropriate affect
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11
Q

Catatonia subtype of Schizo

A

rigid posture
inapp. or repetitive and purposeless movements
echolalia
echopraxia

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12
Q

Thought blocking

A

stop talking mid sentence/mid thought

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13
Q

What is INTACT in schizophrenia

A

Memory and Orientation

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14
Q

Schizophrenia gen facts

A 
look for only CONCRETE understanding of provers/similarities
LACK insight
memory/orientation is INTACT
disorg thought process
Men and Women get it equally
Men present in 20's, women in 30's
look for neologisms (new language)
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15
Q

genetics of schizo

A

50% concordance in monozygote twins
40% risk if BOTH parents have it
12% risk if ONE FIRST-DEGREE relative has it

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16
Q

Schizo and Dopamine

A

DA involved b/c anti-pscyhotics work and drugs that inc. DA (cocaine and amphetatmines) increase schizo-sx

17
Q

Effects of Antipsychotic on Nigrostriatal

A

EPS - tremor, slurred speech, akathisia, dystonia

18
Q

CT findings in schizo

A

enlarged ventricles and diffuse cortical atrophy

19
Q

GOOD Prognostic factors of schizo

A

later onset
females
good pre-morbid fxn

20
Q

POOR prognostic factors of schizo

A 
early onset
gradual onset
family hx
males
comorbid  substance abuse
21
Q

when to use clozapine

A

when both atypical and typical antipsychotics fail

22
Q

decline in functioning, socially withdrawn, irritable,

new found interest in religion or occult= signs of —>

A

prodromal phase of schizo

23
Q

Pyschotic Phase of schizo

A

perceptual disturbances
dellsions
disorg thought process/content

24
Q

5 A’s of Schizo Phrenia

A 
Anhedonia
Affect (FLAT)
Alogia (poverty of speech)
Avolition (apathy)
Attention (poor)
25
Q

First rule out in Schizophrenia type presentation

A

Rule OUT cocaine

26
Q

Schizophrenia - Disorganized Type

A

Disorganized Type - WORST TYPE

  • poor fxn, earlier onset
  • Disorg speech
  • disorg. behavior
  • flat or inapp. affect
27
Q

Schizophrenia - Catatonic Type

A

Catatonic Type

  • RARE; needs 2+ of following***
  • immobility/waxy flexibility
  • extremely purposeless motor activity
  • extreme negativism or mutism**
  • peculiar voluntary movements or posturing
  • ECHOLALIA or ECHOPRAXIA***
28
Q

Schizophrenia - Undifferentiated and Residual Type

A

Unidff Type: traits of more than 1 subtype

Residual Type
mostly negative sx w/ min. + sx (less hallucinations/delusions)

29
Q

Schizophrenia tx

A

for all subtypes tx with Typical or Atypical Antipsychotics

EXCEPT use BZD in the ACUTE catatonic state then move on to anti-psychotics

30
Q

Schizoaffective

A

Schizophrenia + MOOD SYMPTOMS

Tx delusions first! Then tx the mood concerns

31
Q

If patient has acute psychotic disorder

A

watch and wait until 1 month

if it progresses to schizophreniform –> tx for 3-6wk

32
Q

Delusional Disorder

A

Beleiveable, Logical

Rational Thought process

33
Q

Schizophrenia Good Prognostic Factors

A
  • late onset (ages 20-25??)
  • obvious precipitating factor/stressor
  • acute onset
  • good premorbid fxn
  • presence of mood d/o symptoms
  • Fhx of mood d/o
  • good support sys
  • pt is married
  • positive sx (vs negative sx)
  • stable occupational record
  • mid-high SES
34
Q

patient who is not compliant on antipsychotics give –>

A

Haloperidol/fluphenazine DECANOATE

- IM injections that last longer and dont require compliance

35
Q

drugs that look like schizo

A

LSD, PCP, and Amphetamines (inc cocaine)

drugs might have less thought blocking etc compared to schizo but not a hard rule

36
Q

Schizo w/ family that is over controlling/hostile

A

INCR relapse rate

37
Q

one schizo episode and sx free on meds:

NEXT STEP –>

A

DECR DOSE GRADUALLY
- while doing this, INCR the # of psych viisits
Eventually stop med all together if pt stays sx free

Psychiatry (13 decks)

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