Psychotic D/O Flashcards by Ravi Patel

Epilepsy in which lobe causes psychosis

Temporal

How well did you know this?

Not at all

Perfectly

CNS Causes of Psychosis

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

How well did you know this?

Not at all

Perfectly

Endocrinopathies causing Psychosis

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

How well did you know this?

Not at all

Perfectly

Nutritional/Vitalim def causing psychosis

B12
Folate
Niacin

How well did you know this?

Not at all

Perfectly

DSM criteria for Psychosis SECONDARY TO GMC

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

How well did you know this?

Not at all

Perfectly

Meds that Cause psychosis

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

How well did you know this?

Not at all

Perfectly

Drugs of Abuse that cause psychosis

EtOH
Cocaine
LSD
Ecstasy
PCP
BZD
Barbituates
Weed

How well did you know this?

Not at all

Perfectly

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

check TSH, RPR and brain imaging

will likely start anti-psychotics

How well did you know this?

Not at all

Perfectly

DSM for Schizophrenia

***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

How well did you know this?

Not at all

Perfectly

Subtypes of Schizo

Paranoid Type

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

How well did you know this?

Not at all

Perfectly

Catatonia subtype of Schizo

rigid posture
inapp. or repetitive and purposeless movements
echolalia
echopraxia

How well did you know this?

Not at all

Perfectly

Thought blocking

stop talking mid sentence/mid thought

How well did you know this?

Not at all

Perfectly

What is INTACT in schizophrenia

Memory and Orientation

How well did you know this?

Not at all

Perfectly

Schizophrenia gen facts

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)

How well did you know this?

Not at all

Perfectly

genetics of schizo

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

How well did you know this?

Not at all

Perfectly

Schizo and Dopamine

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

Effects of Antipsychotic on Nigrostriatal

EPS - tremor, slurred speech, akathisia, dystonia

CT findings in schizo

enlarged ventricles and diffuse cortical atrophy

GOOD Prognostic factors of schizo

later onset
females
good pre-morbid fxn

POOR prognostic factors of schizo

early onset
gradual onset
family hx
males
comorbid  substance abuse

when to use clozapine

when both atypical and typical antipsychotics fail

decline in functioning, socially withdrawn, irritable,

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

prodromal phase of schizo

Pyschotic Phase of schizo

perceptual disturbances
dellsions
disorg thought process/content

5 A’s of Schizo Phrenia

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

First rule out in Schizophrenia type presentation

Rule OUT cocaine

Schizophrenia - Disorganized Type

Disorganized Type - WORST TYPE - poor fxn, earlier onset - Disorg speech - disorg. behavior - flat or inapp. affect

Schizophrenia - Catatonic Type

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***

Schizophrenia - Undifferentiated and Residual Type

Unidff Type: traits of more than 1 subtype Residual Type mostly negative sx w/ min. + sx (less hallucinations/delusions)

Schizophrenia tx

for all subtypes tx with Typical or Atypical Antipsychotics EXCEPT use BZD in the ACUTE catatonic state then move on to anti-psychotics

Schizoaffective

Schizophrenia + MOOD SYMPTOMS | Tx delusions first! Then tx the mood concerns

If patient has acute psychotic disorder

watch and wait until 1 month if it progresses to schizophreniform --> tx for 3-6wk

Delusional Disorder

Beleiveable, Logical | Rational Thought process

Schizophrenia Good Prognostic Factors

- 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

patient who is not compliant on antipsychotics give -->

Haloperidol/fluphenazine DECANOATE | - IM injections that last longer and dont require compliance

drugs that look like schizo

LSD, PCP, and Amphetamines (inc cocaine) | drugs might have less thought blocking etc compared to schizo but not a hard rule

Schizo w/ family that is over controlling/hostile

INCR relapse rate

one schizo episode and sx free on meds: | NEXT STEP -->

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