Psychotic Disorders

Question 1

Hypnagogic Hallucination

Answer 1

Hallucination experienced only before falling asleep

Question 2

Hypnopompic Hallucination

Answer 2

Hallucination experienced only upon awakening

Question 3

Labile affect

Answer 3

Patient rapidly goes from one emotion to the next: “laughing one second and crying the next”

Question 4

In order to diagnose Schizophrenia, symptoms must be present for….

Answer 4

Symptoms must be present for at least 6 months

Question 5

Positive Symptoms in Schizophrenia include:

Answer 5

Hallucinations
Delusions
Bizarre Behavior
Disorganized Speech

**These symptoms are responsive to antipsychotic medications

Question 6

Negative Symptoms in Schizophrenia include:

Answer 6

Blunted Affect
Anhedonia
Apathy
Alogia
Lack of Interest in Socialization

**These symptoms are not responsive to medications

Question 7

Alogia

Answer 7

Poverty of speech and/or speech content, blocking, or latency of response

Question 8

If a schizophrenic patient fails both typical and atypical antipsychotics, this medication should be considered

Answer 8

Clozapine

Question 9

The 5 A’s of Schizophrenia describe negative symptoms:

Answer 9

Anhedonia
Affect =flat
alogia
apathy(avolition)
attention= poor

Question 10

Echolalia

Answer 10

Repeats words or phrases they hear someone else say

Question 11

Echopraxia

Answer 11

Mimics behavior of another person

Question 12

For the diagnosis of Brief Psychotic Disorder, the disorder lasts….

Answer 12

Psychotic Symptoms are present for less than one month

Question 13

For the diagnosis of Schizophreniform Disorder, the symptoms are present

Answer 13

Psychotic symptoms are present between 1 month and 6 months

Question 14

Akathisia

Answer 14

unpleasant, subjective sense of restlessness often manifested by the inability to sit still

Question 15

Head CTs of Patients with Schizophrenia may show

Answer 15

Enlarged Ventricles

Diffuse Cortical Atrophy

Question 16

What is a predisposing factor to paranoid psychosis?

Answer 16

Deafness

Question 17

Negativism

Answer 17

Patient refuses to cooperate with simple requests for no apparent reson

Question 18

1st Generation Antipsychotics include

Answer 18

Haloperidol
Chlorpromazine
Thioridazine
Trifluoperazine

*Mostly D2 Antagonists

Question 19

Antipsychotics are effective against which type of Symptoms in Schizophrenia Spectrum Disorders?

Answer 19

Positive Symptoms

Question 20

Common Side Effects of 1st Generation Antipsychotics

Answer 20

Extrapyramidal Side Effects
Neuroleptic Malignant Syndrome
Tardive Dyskinesia

Question 21

2nd Generation Antipsychotics include

Answer 21

Aripriprazole
Clozapine
Olanzapine
Quetiapine
Risperidone
Ziprosidone

*These are Serotonin and Dopamine Receptor Antagonists

Question 22

2nd Generation Antipsychotics have an increased risk of ________, but decreased incidence of ________.

Answer 22

Increased risk of metabolic syndrome

Decreased Incidence of extrpyramidal side effects

Question 23

Why is clozapine reserved for multi-drug failure (i.e. a last resort)?

Answer 23

Has increased risk of agranulocytosis, this requires frequent CBC monitoring

Question 24

What are the more weight neutral antipsychotics?

Answer 24

Aripriprazole

Ziprasidone

Question 25

Which antipsychotic is associated with the most weight gain?

Answer 25

Olanazapine

Question 26

Extrpyramidal Side Effects include:

Answer 26

Dystonia (spasms) of face, neck, tongue
Parkinsonism: resting tremor, rigidity, bradykinesia
Akathisia (Treat this with Beta Blockers)

Question 27

Tardive Dyskinesia

Answer 27

Darting or writhing movements of face, tongue, head

Question 28

High Potency 1st Gen. Antipsychotics include_______ and tend to cause ____(side effects)_____.

Answer 28

Haloperidol and Trifluoperaznie

Tend to cause extrapyramidal side effects and tardive dyskinesia

Question 29

Low Potency 2nd Gen Antipsychotics include ________ and tend to cause ____(side effects)_____.

Answer 29

Chlorpromazine and Thioridazine

Tend to cause anticholinergic symptoms (dry mouth/eyes, constipation, blurred vision, etc.) along with the atypicals.

Question 30

Neurloeptic Malignant Syndrome

Answer 30

MEDICAL EMERGENCY

Need to withdraw antipsychotic meds immediately

A/W: mental status change, autonomic changes (high fever, high BP, tachycardia), lead-pipe rigidity, sweating, increased CPK, leukocytosis, and metabolic acidosis

Question 31

Potential Side Effect of Thioridazine

Answer 31

At high doses: irreversible retinal pigmentation

Question 32

Potential Side Effect of Chlorpromazine

Answer 32

Deposits in lens and Cornea

Question 33

Additional Side Effects from Antipsychotics include

Answer 33

Prolonged QT and other ECG changes
Hyperprolactinemia –> gynecomastia, galactorrhea, amenhorrhea, decreased libido, impotence
Dermatologic Conditions: Rashes and Photosensitivity

Question 34

Treatment for Extrapyramidal Side Effects

Answer 34

Antiparkinsonian Agents: benztropine (cogentin) and diphenhydramine (benadryl)
Benzodiazepines
Beta Blockers for akathisia