Psychotic Disorders Flashcards
Schizophrenia and receptors:
Positive sx?
Negative sx?
Positive sx: Dopamine receptors
Negative sx: Muscarinic receptors
__________ = most effective med for treatment-resistant psychosis
Clozapine
Adverse Effects of Atypical Antipsychotic Medications
- Olanzapine
Greater incidence of diabetes and weight gain
AVOID IN DIABETIC AND OBESE PTS
Adverse Effects of Atypical Antipsychotic Medications
- Risperidone
- Quetiapine
R: Greater incident of movement disorders
Q: Lower incidence of movement disorders; appropriate for use in pts with existing movement disorders
Adverse Effects of Atypical Antipsychotic Medications
- Ziprasidone
Increased risk of QT interval prolongation
AVOID IN PTS WITH CONDUCTION DEFECTS
Adverse Effects of Atypical Antipsychotic Medications
- Clozapine
- Aripiprazole
- Lurasidone
- C: High risk of agranulocytosis; need to monitor CBC on regular basis; never used as first-line tx given side-effect profile
- A: Partial dopamine agonist, approved as adjunct tx for MDD
- L: safer for use in pregnant pts
Which two antipsychotic medications are LEAST likely to cause weight gain, diabetes, and metabolic syndrome?
Aripiprazole and ziprasidone
Delusional Disorder
Nonbizarre delusions (false but plausible) for more than one month and NO impairment in level of functioning
(e.g., the patient may believe the country is about to be invaded, but he or she still obeys the law, goes to work, etc…)
30 yo man brought to ER after he was found wandering on the streets with no shoes in middle of. winter. He is admitted to inpatient psych. unit and stabilized on antipsychotic meds. Past. records show he is repeatedly noncompliant with. his meds, and each time relapses within 6 mo. Which of the following meds is the best one on which to maintain this pt?
a. Clozapine
b. Haloperidol decanoate
c. Chlorpromazine
d. Thioridazine
e. Quetiapine
b. Haloperidol decanoate
Injectable is better than oral for noncompliance/long term
22 yo man brought to ER after he became exceedingly anxious in his college dorm room, stating that he is sure the college administration was sending a “hit squad” to kill him. He also notes that he can see “visions” of men dressed in black who are carrying guns and stalking him. His thought process is relatively intact, without thought. blocking or loos associations. Urine tox screen is positive for one of the following drugs.
a. Barbiturates
b. Heroin
c. Benzos
d. Amphetamines
e. MDMA
d. Amphetamines
Amphetamine intoxication can result in psychosis very closely resembling acute paranoid schizophrenia, with sx including paranoid delusions and visual hallucinations.
62 yo man with chronic schizophrenia brought to ER after he is found wandering around his halfway. house, confused and disoriented. Serum sodium concentration is 123 meq/L and urine sodium concentration is 5 meq/L. The pt has been treated with risperidone 4 mg/day for past 3 years with good sx control. His roommate reports that the pt often complains of feeling thirsty. Which of the following is the most likely cause of this pt’s sx?
a. Renal failure
b. Inappropriate ADH secretion
c. Addison disease
d. Psychogenic polydipsia
e. Nephrotic syndrome
d. Psychogenic polydipsia
Self-induced water intoxication should always be considered in the differential dx of confusional states and seizures in schizophrenic pts. As many as 20% of pts with dx of schizophrenia drink excessive amounts of water. At least 4% of these pts suffer from chronic hyponatremia and recurrent acute water intoxication.
Meds that cause excessive water retention, such as lithium and carbamazepine, can aggravate the sx.
21 yo man brought to psychiatrist. For previous year, he has been withdrawn, apathetic, and somewhat suspicious of his friends. For past week, he has isolated himself in his room because he states that there are voices telling him that his friends are going to hurt him.
Dx?
a. Brief psychotic disorder
b. Schizophreniform disorder
c. Schizophrenia
d. Schizoaffective disorder
e. MDD with pyschosis
f. Schizoid personality
g. Schizotypal personality
c. Schizophrenia
He h as had a prodromal period lasting a year.
26 yo woman presents to the ER accompanied by fiancee. He notes that she has been acting increasingly strangely over past 3 weeks. She states that the TV is beaming messages directly. into her brain, and that she can’t understand why he can’t hear the messages too. Her hygiene has also gotten poorer, and she has not taken a shower in the past week b/c the water might “turn into acid”
Dx?
a. Brief psychotic disorder
b. Schizophreniform disorder
c. Schizophrenia
d. Schizoaffective disorder
e. MDD with pyschosis
f. Schizoid personality
g. Schizotypal personality
b. Schizophreniform
