Psychotic Disorders

Question 1

Responsible for negative sxs?

Answer 1

Low dopamine activity in prefrontal cortical pathway

Question 2

Responsible for positive sxs?

Answer 2

Excessive dopamine activity in mesolimbic pathway

Question 3

Causes hyperprolactinemia?

Answer 3

Tuberoinfundibular pathway

Question 4

Cases EPS?

Answer 4

Nigrostriatal pathway

Question 5

Serotonin?

Answer 5

Elevated

Question 6

NE?

Answer 6

Elevated

Question 7

GABA?

Answer 7

Decreased EZ necessary to make GABA in hippocampus

Question 8

Glutamate receptors?

Answer 8

Decreased NDMA receptors (why ketamine can cause psychosis)

Question 9

Brain changes?

Answer 9

1) Enlarged lateral ventricles

2) Diffuse cortical atrophy

Question 10

Deafness?

Answer 10

Predisposing factor to paranoid psychosis

Question 11

Prognosis?

Answer 11

1) 70% improve with meds
2) 40-50% remain impaired
3) 20-30% function in society with meds
4) 50% attempt suicide

Question 12

How long does it take for atypicals to work?

Answer 12

> 4 weeks

Question 13

Reserved for pts who failed multiple trials?

Answer 13

Clozapine

Question 14

Improves pt’s ability to function in society?

Answer 14

Behavioral therapy

Question 15

Causes EPS?

Answer 15

High potency typicals

Question 16

Causes anticholinergic sxs?

Answer 16

Low potency typicals and atypicals

Question 17

Causes metabolic syndrome?

Answer 17

Atypicals

Question 18

Causes tardive dyskinesia?

Answer 18

High potency typicals

Question 19

Causes NMS?

Answer 19

High potency typicals

Question 20

Tx for EPS?

Answer 20

1) Benztropine
2) Diphenhydramine
3) BZDs
4) Beta blockers (esp for akathisia)

Question 21

Tx for anticholinergic sxs?

Answer 21

As per symptom

Question 22

Tx for metabolic syndrome?

Answer 22

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

Question 23

Tx for tardive dyskinesia?

Answer 23

1) D/C or reduce offending agent
2) Switch to atypical
3) BZDs, B-blockers, or cholinomimetics for short term

Question 24

Tx for NMS?

Answer 24

D/C drug and tx the sxs

Question 25

2 heart drugs that exacerbate psychosis in predisposed pts?

Answer 25

1) B-blockers

2) Digoxin