Psychotic Disorders Flashcards
T/F: Schizophrenia is the same as split personality
F
T/F: Schizophrenic patients are unable to differentiate reality from fantasy
T
Diagnosis of schizophrenia is based entirely on:
Psychiatric history and mental status examination
T/F: CT scan or Pet scan can be used to differentiate a normal bran and a brain with schizophrenia
T
Males usually present (negative/positive) symptoms of schizophrenia
Negative
Females usually present (negative/positive) symptoms of schizophrenia
Positive
First degree biological relatives of schizophrenics are ____ times as likely to develop the disorder as members of the general population
10x
There is a ___% chance of getting schizophrenia if both of your parents have it, while ___% chance if one of the parents has it
47%; 13%
There is a ___% chance of getting schizophrenia if your identical twin has it, while ___% chance if your non-identical twin has it
50%; 18%
There is a ___% chance of getting schizophrenia if one of your siblings has it, while ___% chance if one of your paternal cousins has it
9%; 2%
T/F: the age of the mother has a direct correlation with the development of schizophrenia, where mothers older than 60 yo were vulnerable to developing the disorder
F
it’s the father
Nine linkage sites associated with schizophrenia:
1q, 5q, 6p, 6q, 8p, 10p, 13q, 15q, 22q
Specific genes associated with schizophrenia:
Alpha-7 nicotinic receptor, DISC 1, GRM 3, COMT, NRG1, RGS 4, G 72
Mutation (negative symptoms) associated with schizophrenia:
dystrobrevin (DTNBP1), neureglin 1
The yellowish fingers of patients with schizophrenia associates the disease with abnormal levels of ____
nicotine (among smokers)
Neural changes in a schizophrenic brain include:
(Increased/Decreased) lateral and third ventricle size
(Increased/Decreased) cortical and thalamic volume
(Increased/Decreased) symmetry in temporal, frontal, parietal lobes
(Increased/Decreased) size of amygdala, hippocampus, parahippocampal gyrus
(Increased/Decreased) volume of globus pallidus and substantia nigra
(Increased/Decreased) number of D2 receptors in the caudate, putamen, and nucleus accumbens
Increased
Decreased
Decreased
Decreased
Decreased
Increased
Dysfunction in anterior cingulate basal ganglia thalamocortical circuit causes (negative/positive) psychotic symptoms
Positive
Dysfunction in dorsolateral prefrontal circuit causes (negative/positive) psychotic symptoms
Negative
DSMV Criteria for schizophrenia includes 2 or more of the following being present for 6 months or more:
Happy Days, Sad Nights, Dark Days
H = Hallucinations
D = Delusions
S = Speech (Disorganized)
N = Negative symptoms
D = Disorganized or catatonic behavior
T/F: Males have more frequent relapses, more severe disease course and worse outcomes
T
Brief psychotic disorder is the presence of one or more following symptoms:
Happy Days, Sad and Dark Days
Hallucinations
Delusions
Speech (disorganized)
Disorganized or catatonic behavior
T/F: The duration of Brief psychotic disorder is at least 1 month but less than 6 months, with eventual full return to premorbid level of functioning
F
at least one day but less than 1 month
T/F: In schizophrenia, patient declines
T
Criteria of schizophreniform disorder include having ___ or more ff symptoms:
Happy Days, Sad Days, Dark days
Hallucinations
Delusions
Speech (disorganized)
Disorganized or catatonic behavior
1 or more
recall: in schizophrenia, it’s 2 or more of the same set of symptoms
Duration of schizophreniform disorder
at least 1 month but less than 6 months, with eventual full return to premorbid level of functioning
recall:
Schizophrenia: at least 6 months and progressively declines
Brief psychotic disorder: at least 1 day to 1 month with eventual full return to premorbid level of functioning
considered as a basket case diagnosis
Schizoaffective Disorder
Mood symptoms + schizophrenia symptoms = what disorder?
Schizoaffective Disorder
T/F: Schizoaffective disorder is a better prognosis than schizophrenia and worse than mood disorder
T
T/F: Delusions are bizarre only
F
they can be bizarre or non-bizarre
T/F Delusional disorders are nonbizarre delusions of at least ___ month/s in duration, with slight preponderance of (male/female) patients
1 month; female
This type of delusional disorder refers to delusions that another person, usually of higher status, is in love with the individual (women predominant)
Erotomaniac/ De Clerambault/ Psychose Passionelle
3 subtypes of Monosymptomatic Hypochondriacal Psychosis
Infestation
Dysmorphophobia
Olfactory
This unspecified type of delusional disorder refers to delusions where a familiar person has been replaced by an impostor
Capgras (Illusion of Doubles)
This unspecified type of delusional disorder refers to delusions where a familiar person can assume the guise of strangers
Fergoli’s
This unspecified type of delusional disorder refers to delusions where a familiar person can change into another person at will
Intermetamorphosis
T/F Vocational and psychosocial rehabilitation of patients with psychotic disorders cannot be done outpatient
F
it can be done outpatient
T/F: It is necessary that a patient experiencing exacerbation of psychotic symptoms be hospitalized
F
not necessarily, if there are adequate community alternatives that are available like support from the family
T/F First episodes of psychosis and unusual presentations of psychotic conditions are indications of hospitalization
T
T/F: Patients experiencing extreme fear and significant confusion require long term hospital care
F
short term only
T/F: Patients with suicidal risk and command hallucinations require long term hospital care
F
short term only
T/F Treatment of significant comorbidity from med illness, substance abuse, and med complications require long term hospital care
T
T/F: Protection from self-inflicted harm or danger to others require short-term hospital care
F
long term
First generation antipsychotics
Dopamine Receptor Antagonist
T/F: First generation antipsychotics are effective in positive symptoms
T
T/F: First generation antipsychotics include chlorpromazine
T
T/F: Typical neuroleptics are completely absorbed after oral administration, with low protein binding, volume of distribution, and lipid solubilities
F
they are INCOMPLETELY ABSORBED; with HIGH protein binding, etc
Typical neuroleptics
Peak plasma concentration : ____ hours
Half life: _____ hours
Metabolized in the liver with steady state in ____ days
Peak plasma concentration : 1-4 hours
Half life: 10-20 hours
Metabolized in the liver with steady state in 5-10 days
T/F: Typical neuroleptic aliphatics such as Chlorpromazine and Levomepromazine are already phased out
T
This drug comes in handy especially when there is an agitated patient in the ER, due to its fast sedation and de-escalation of violence or aggression
Haloperidol
Class Butyrophenone
This very good antipsychotic but behaves like an atypical psychotic is used at low doses as adjunct for negative thoughts if a person is depressed
Amisulpride
Class Benzamide
These three medications are injectables good for 1 month. Ideal for patients who are noncompliant and find it hassle to take medicine everyday
Fluphenazine
Flupenthixol
Haloperidol
T/F: Oral forms of therapy are necessary for patients who are too agitated or incapacitated to comply with treatment
F
Parenteral forms
This adverse effect results from the blockade of dopamine receptors in the basal ganglia, and occurs upon intake of high-potency neuroleptics like ____________
Extrapyramidal Syndromes; haloperidol
This EPS syndrome occurs immediately after intake of neuroleptic, and involve sudden tonic contractions of the muscles of the tongue, neck, ,back, mouth and eyes
Usual affected population:
Drug to alleviate this EPS:_______________
Acute dystonia
Young males
Diphenhydramine
This EPS syndrome occurs after 1 week o f intake of medication causing motor restlessness, inability to keep legs and feet still
Commonly affected population:
Common in patients taking this atypical antipsychotic:
Akathisia
Middle-aged Women
Aripiprazole
T/F: Parkinsonism as an EPS may occur in the first months of treatment
F
first weeks
Some of the manifestations of this EPS is drooling, mask-like facies, loss of postural reflexes
Parkinsonism
Other manifestations: cogwheel rigidity, bradykinesia, tremor
What happens in patients with Tardive dyskinesia as EPS?
fasciculations of the tongue, choreoathetotic movements of the extremities and trunk
occurs among chronic patients
T/F: Tardive dyskinesia is a late-onset movement disorder due to a disturbance in dopamine-acetylcholine balance in the basal ganglia
T
Best remedy for Tardive dyskinesia
Clozapine
4 discussed examples of EPS as a side effect of neuroleptics
Acute dystonia
Parkinsonism
Akathisia
Tardive Dyskinesia
This is the most dreaded adverse effect of neuroleptic therapy, which causes rapid onset of muscular rigidity, fever, autonomic instability and altered levels of consciousness
Can possibly treated with ____ and ___
Neuroleptic Malignant Syndrome
Dantrolene and Bromocriptine
T/F: CV effects are associated with high potency neuroleptics like Levomepromazine and Chlorpromazine
CV Effects are very common with the atypical antipsychotic _______
F
Must be low-potency
- Quetiapine
Hypothalamic effects cause (increased/decreased) libido and (increased/decreased) appetite; hypersecretion of prolactin is also common in drugs ________ and _________
Decreased Libido
Increased Appetite
Risperidone and Amisulpride
Agranulocytosis is usually associated with this neuroleptic ______
Clozapine
T/F: Dermatologic effects may be observed in patients with schizophrenia
T
Aripriprazole is a (typical/atypical) antipsychotic
Dose range: _____
Peak plasma:
Half life:
Atypical
5-30 mg
Peak plasma: 3-5 hours
Half life: 75 hours
Clozapine is a (typical/atypical) antipsychotic
Lowest and highest doses__
Peak plasma:
Half life:
Atypical
Lowest dose: 25 mg
highest: 800 mg
Peak plasma: 2 hours
Half life: 12 hours
Risperidone and paliperidone can cause prolactin changes and can cause ______ at high doses
Parkinsonism
Risperidone is a (typical/atypical) antipsychotic
Dose range: _____
Peak Plasma:
Half life
Atypical
0.5-6 mg
Peak plasma: 1 hour
Half life: 20 hours -> once daily
Paliperidone is a (typical/atypical) antipsychotic
T/F: Available in oral form
Atypical
F- available as long acting injection
Olanzapine is a (typical/atypical) antipsychotic
Dose range: _____
Peak Plasma:
Half Life:
Atypical
10-20 mg
Peak plasma: 5 hours
Half life:31 hours
this atypical neuroleptic is for treatment-resistant schizophrenia
Clozapine
Risperidone is the first line treatment for: (SAPA)
Schizophrenia
Aggression
Psychotic Depression
Acute Mania
same as olanzapine, quetiapine, aripiprazole
T/F: risperidone is notorious for weight gain
F
Olanzapine
Quetiapine Peak plasma:
Half life:
peak plasma: 1-2 hours
Half life: 7 hours
Quetiapine
25 (low dose) can be used for ________
75-150 (mid dose) mg can be used for ____
300-600 mg can be used for __________
400-800 and above can be used for _________
Insomnia
Anxiety
Psychotic Disorders
Bipolar Disorder
Cleanest neuroleptic
Aripiprazole
but worst effect is akathisia
What is electroconvulsive therapy?
This is reserved for patients with severe psychotic symptoms, suicidal/homicidal patients, to also treat treatment-resistant schizophrenia
It is done once daily, with 2 more administrations if significant improvement is observed. add 2 more if significant improvement after 4 days
what are the other biological therapies for faster recovery of patient who just relapsed?
Electroconvulsive Therapy
Vagus Nerve Stimulation
Transcranial MAgnetic Stimulation
Psychosurgery
