Psychotic Disorders Flashcards
How do I differentiate various psychotic disorders on exam day?
Duration of symptoms
positive symptoms in psychotic disorders is associated with which receptors?
Dopamine receptors
Negative symptoms in psychotic disorders are associated with which receptors?
Muscarinic receptors
Bizarre Delusions, Disorganized speech/behavior and hallucinations are what type of symptoms? Negative for positive?
Positive
Flattened affect, social withdrawal, anhedonia, apathy, poverty of thought are what type of symptoms?
Negative symptoms
Psychotic symptoms have been present for at least 1 month, there has been a significant impact on social or occupational functioning for at east 6 months. Pt has delusions, hallucinations & disorganized speech. Dx?
Shizophrenia
Psychotic symptoms: delusions, hallucinations and disorganized speech for less than 6 months but over 1 month. Dx?
Schizophreniform
Most effective antipsychotic to treat negative symptoms? (Neg symptoms are associated with muscarinic receptors)
Atypical Antipsychotics
Meaning of phrenia
> 6 months
Meaning of phreniform
> 1 month but <6 months
A stressful life event that precipitates psychotic disorder and symptoms occur for < 1 month and patient returns to basleine. Dx
Brief psychotic disorder
When a patient has had symptoms for years with no impairment of baseline functioning, what 2 dx should i be thinking of on test day?
non-bizzare delusional disorder, personality disorders
Perform these tests for patients with psychosis that are not schizophrenia.
Drug screen first!!!!!
TSH, basic electrolytes, calcium, HIV, VDRL, EEG (temporal lobe epilepsy)
The greatest risk of factor for progression to schizophrenia?
Schizophreniform disorder
The time when schizophreniform patients are at greatest risk of depression and suicide?
After episode of psychosis resolves
What to do with a patient with bizarre or paranoid symptoms?
Hospitalize
Treatment of patients psychotic patient with agitation?
Benzodiazepines & Antipsychotics x 6 months unless history of repeat episodes then plan ofr long-term antipsychotics. Must initiate long-term psychotheraphy
2 disorders that you can treat with antipsychotics
Huntington and Tourette syndrome
What to do when a patient on a low potency antipsychotic causes orthostatic hypotension, acute urinary retention, dry mouth, blurry vision and delirium?
Change to an Atypical antipsychotic
AntIpsychotic associated with prolonged QT, arrhythmias, chest pain, dyspnea, palpitations etc
Thioridazine
Patients on this antipsychotic need routine eye exam while on the medication because it causes abnormal retinal pigmentation.
Thioridazine
side effects that cause noncompliance in females on antipsychotics.
Weight gain due to hyperprolactinemia. May also have galactorrhea and amenorrhea.
Antipschotic associated with agranulocytosis which requires CBC with diff before start of therapy and weekly after that?
Clozapine/Clozaril/versacloz
Side effects that cause noncompliance in males on antipsyhotics?
Impotence and inhibition of ejaculation (alpha blocker effect).
Antipsychotic with the greatest weight gain?
Olanzepine
High potency antipsychotics like Haloperidol and Fluphenazine have the disadvantage of being associated with ?
EPS (Extrapyramidal systems)
This Atypical antipsychotic is reserved for treatment- resistant patients because of Agranulocytosis?
Clozapine
These drugs have little or no risk of EPS so they are the drug of choice for initial therapy in psychosis:
Atypical antipsychotics: Quetiapine ( Seroquel ), Risperidone ( Risperdal ), Olanzepine ( Zyprexa ), Clozapine ( clozaril)
Atypical antipsychotics end with what word? except for which one?
Pine
Except for Risperidone
First choice antipsychotics when insomnia is a problem?
Olanzepine, quetiapine, ziprazidone and aripiprazole
First choice for schizophrenia when sedation is a problem?
Risperidone
6 receptors affected by Risperidone?
5HT, D1, D2, alpha 1, alpha 2 and H1
