Psychotic Disorders Flashcards
What is the DSM V Criteria for diagnosis of schizophrenia?
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
What are the CT brain findings of a patient with schizophrenia?
Ventriculomegaly
Hypofrontallity
Changes in medial temporal lobe
What are the positive symptoms of schizophrenia?
Delusions
Hallucinations
Disorganised speech
Disorganised/catatonic behaviour
What are the negative symptoms of schizophrenia?
Alogia
Avolition
Ambivalence
Affective changes
Apathy
Abulia
Asociality
What is the treatment for a first episode psychosis?
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
What is the MOA of typical antipsychotic agents?
Blocks D2 receptors - EPSE
Blocks tubero-infundibular pathways - Increases prolactin
What is MOA of Atypical antipsychotic agents?
Blocks D2 receptors with decreased affinity than typicals
Blocks serotonin and other receptors
What are the side-effects of typical antipsychotics?
EPSE
- Acute dystonia
- Parkinsonism
- Akathisia
- Tardive dyskinesis
- Neuroleptic malignant syndrome
What are the side-effects of haloperidol?
EPSE
prolactin elevation
hypotention
sedation
What are the side-effects of chlorpromazine?
sedation anticholinergic effects EPSE but less weight gain hypotension prolactin elevation
What are the side-effects of risperidone?
weight gain
less EPSE
prolactin elevation
hypotension
What are the side-effects of olazepine?
Sedation Weight gain Glucose abn Lipid abn Anticholinergic effects Hypotension Prolactin elevation
What are the side-effects of amisulpride?
Prolactin elevation Anticholinergic effects EPSE Weight gain Glucose abn Lipid abn Sedation
What are the life-threatening side-effects of clozapine?
Myocarditis Toxic megacolon Seizures Metabolic syndrome Orthostatic hypotension Angranulocytosis
What are the common side-effects of clozapine?
Sedation
Weight gain
hypersalivation
What are the guidelines for use of clozapine?
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
What long acting injectable antipsychotics are available and what are the doses?
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
What is the diagnostic criteria for schizophreniform disorder?
Symptoms of schizophrenia that last less than 6 months, with the patient returning back to baseline functioning
What is the diagnostic criteria for Schizoaffective disorder?
Characteristics of both schizophrenia and a mood disorder not meeting the criteria for either
What is the diagnostic criteria for a brief psychotic episode?
A condition following an immediate psychosocial stressor and is accompanied by subjective emtional turmoil, and resolves within 1 month
How is Neuroleptic malignant syndrome diagnosed?
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
What are the consequences of elevated prolactin?
Galactorrhoea
Sexual dysfunction
Osteoperosis
