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Psychiatry > Psychotic Disorders > Flashcards

Psychotic Disorders Flashcards

1
Q

What is the DSM V Criteria for diagnosis of schizophrenia?

A

At least 2

  • Delusions
  • Hallucinations (mainly auditory)
  • Disorganised speech
  • Catatonic behaviour
  • Emotional blunting, alogia, avolition (negative symptoms)

Deterioration of level of function at work, socially or with regard to self-care

Duration of at least 6 months, including 1 month of active illness with/without prodromal or residual phase

Full mood syndromes (depression or mania)

Not the result of medical condition or effects of a substance

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2
Q

What are the CT brain findings of a patient with schizophrenia?

A

Ventriculomegaly

Hypofrontallity

Changes in medial temporal lobe

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3
Q

What are the positive symptoms of schizophrenia?

A

Delusions

Hallucinations

Disorganised speech

Disorganised/catatonic behaviour

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4
Q

What are the negative symptoms of schizophrenia?

A

Alogia

Avolition

Ambivalence

Affective changes

Apathy

Abulia

Asociality

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5
Q

What is the treatment for a first episode psychosis?

A

Bio

  • Admit
  • Initiate treatment with atypical AP as early as possible
  • Always be careful of dosing
  • Start low and up-titrate slowly
  • Aim for the least impact on functioning
  • sedation with Diazepam if aggressive

Psychosocial

  • Multidisciplinary team
  • Psychoeducate
  • Psychotherapy (CBT)
  • Sociotherapeutic programs
  • OT
  • Family and community support
  • Social worker
  • Goal is to place patient back into community at highest level of functioning
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6
Q

What is the MOA of typical antipsychotic agents?

A

Blocks D2 receptors - EPSE

Blocks tubero-infundibular pathways - Increases prolactin

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7
Q

What is MOA of Atypical antipsychotic agents?

A

Blocks D2 receptors with decreased affinity than typicals

Blocks serotonin and other receptors

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8
Q

What are the side-effects of typical antipsychotics?

A

EPSE

  • Acute dystonia
  • Parkinsonism
  • Akathisia
  • Tardive dyskinesis
  • Neuroleptic malignant syndrome
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9
Q

What are the side-effects of haloperidol?

A

EPSE
prolactin elevation
hypotention
sedation

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10
Q

What are the side-effects of chlorpromazine?

A 
sedation
anticholinergic effects
EPSE but less
weight gain
hypotension
prolactin elevation
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11
Q

What are the side-effects of risperidone?

A

weight gain
less EPSE
prolactin elevation
hypotension

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12
Q

What are the side-effects of olazepine?

A 
Sedation
Weight gain
Glucose abn
Lipid abn
Anticholinergic effects
Hypotension
Prolactin elevation
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13
Q

What are the side-effects of amisulpride?

A 
Prolactin elevation
Anticholinergic effects
EPSE
Weight gain
Glucose abn
Lipid abn
Sedation
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14
Q

What are the life-threatening side-effects of clozapine?

A 
Myocarditis
Toxic megacolon
Seizures
Metabolic syndrome
Orthostatic hypotension
Angranulocytosis
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15
Q

What are the common side-effects of clozapine?

A

Sedation
Weight gain
hypersalivation

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16
Q

What are the guidelines for use of clozapine?

A

x3 normal WCC prior to initiation

Start at 12.5mg/25mg
up-titrrate by 25mg every 2-3 days until 150mg p/day (new) or 100mg p/day (prev)

Monitor WCC weekly for first 18 weeks

Monitor WCC monthly for as long as on clozapine

Don’t interrupt doses- if >2 doses missed - restart from initial dose

17
Q

What long acting injectable antipsychotics are available and what are the doses?

A

Fluphenazine 12.5-25mg every 3-4 weeks

Flupenthixol 10-40mg every 2-4 weeks

Zuclopethixol 50-100mg every 2-4 weeks

Respiradone LA injectable 25-50mg every 2-4 weeks

Paliperidone palmitate 75mg every 4 weeks

18
Q

What is the diagnostic criteria for schizophreniform disorder?

A

Symptoms of schizophrenia that last less than 6 months, with the patient returning back to baseline functioning

19
Q

What is the diagnostic criteria for Schizoaffective disorder?

A

Characteristics of both schizophrenia and a mood disorder not meeting the criteria for either

20
Q

What is the diagnostic criteria for a brief psychotic episode?

A

A condition following an immediate psychosocial stressor and is accompanied by subjective emtional turmoil, and resolves within 1 month

21
Q

How is Neuroleptic malignant syndrome diagnosed?

A

Clinical Features: FEVER

Fever

Elevated creatinine kinase, LFTs, urea and electrolytes, leucocytosis and myoglobinuria

Vitals signs fluctuate – autonomic instability

Encephalopathy – confusion and altered LOC

Rigidity

22
Q

What are the consequences of elevated prolactin?

A

Galactorrhoea

Sexual dysfunction

Osteoperosis

Psychiatry (9 decks)

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