Psychotic Disorders Flashcards
Responsible for negative sxs?
Low dopamine activity in prefrontal cortical pathway
Responsible for positive sxs?
Excessive dopamine activity in mesolimbic pathway
Causes hyperprolactinemia?
Tuberoinfundibular pathway
Cases EPS?
Nigrostriatal pathway
Serotonin?
Elevated
NE?
Elevated
GABA?
Decreased EZ necessary to make GABA in hippocampus
Glutamate receptors?
Decreased NDMA receptors (why ketamine can cause psychosis)
Brain changes?
1) Enlarged lateral ventricles
2) Diffuse cortical atrophy
Deafness?
Predisposing factor to paranoid psychosis
Prognosis?
1) 70% improve with meds
2) 40-50% remain impaired
3) 20-30% function in society with meds
4) 50% attempt suicide
How long does it take for atypicals to work?
> 4 weeks
Reserved for pts who failed multiple trials?
Clozapine
Improves pt’s ability to function in society?
Behavioral therapy
Causes EPS?
High potency typicals
Causes anticholinergic sxs?
Low potency typicals and atypicals
Causes metabolic syndrome?
Atypicals
Causes tardive dyskinesia?
High potency typicals
Causes NMS?
High potency typicals
Tx for EPS?
1) Benztropine
2) Diphenhydramine
3) BZDs
4) Beta blockers (esp for akathisia)
Tx for anticholinergic sxs?
As per symptom
Tx for metabolic syndrome?
1) Switch to typical or a more “weight neutral” atypical such as aripiprazole or ziprasidone
2) Monitor lipids and glucose
3) Refer to primary care and diet/exercise
Tx for tardive dyskinesia?
1) D/C or reduce offending agent
2) Switch to atypical
3) BZDs, B-blockers, or cholinomimetics for short term
Tx for NMS?
D/C drug and tx the sxs
2 heart drugs that exacerbate psychosis in predisposed pts?
1) B-blockers
2) Digoxin
