Psychotic Disorders and Antipsychotics

Question 0

Specific features if schizophrenias:

1. Paranoid
2. Catatonic
3. Disorganized
4. Residual
5. Undifferentiated

Answer 0

1. delusions or hallucinations
2. Psychomotor (stupor, rigidity, posturing, mute)
3. Disinhibited, disheveled, bizzare emotional responses
4. Lack of positive symptoms, but presence of negative symptoms
5. Everything else

Question 1

Timeline of psychotic disorders?

Answer 1

#Brief psychotic disorder – less than one month
#Schizophreniform disorder – one month to six months
#Schizophrenia – over six months

Question 2

Most common type of schizophrenia? Relative age of onset?

Type of schizophrenia with the worst prognosis? Relative age of onset?

Answer 2

Paranoid – later age

Disorganized – earliest age

Question 3

Treatment for schizophrenia?

Answer 3

Atypical antipsychotics

(It's atypical for OLd CLOSets to QUIETly RISPER from A-Z)
#Olanzapine
#Clozapine
#Quetiapine
#Risperidone
#Aripiprazole
#Ziprasidone

#Paliperidone
#Asenapine
#iloperidone
#lurasidone

Question 4

In emergencies situation with schizophrenic – use which IM medication?

Answer 4

Olanzapine/Ziprasidone >haloperidol

Question 5

Schizophrenic patient noncompliant with medication – try?

Answer 5

Long acting injectable antipsychotics

Question 6

When to use clozapine?

Answer 6

Patient does not respond to trial of typical or atypical antipsychotics (never use as first-line treatment because need to do serial CBCs, drooling yet Anticholinergic symptoms, myocarditis)

Question 7

Side effects of:

1. Olanzapine
2. Clozapine
3. Quetiapine
4. Risperidone
5. Ziprasidone

Answer 7

1. Diabetes and weight gain (“O” is fat)
2. Agranulocytosis; need to monitor CBC (C-lozapine needs C-BC)
3. Minor incidence of movement disorders (quieter)
4. Major incidence of movement disorders (R-igid)
5. QT prolongation; avoid in patients with conduction abnormalities (Z-apping)

Question 8

Schizophrenia medications least likely to cause weight gain, diabetes or metabolic syndrome ?

Answer 8

Aripiprazole; Ziprasidone

Question 9

Patient on new antipsychotic medications develops muscle spasms, torticollis, laryngeal spasms – diagnosis? Treatment?

Answer 9

Acute dystonia

Benztropine, trihexyphenidyl, diphenhydramine

Question 10

Patient on long-term antipsychotic medications develops restlessness, pacing, inability to relax – diagnosis? Treatment?

Answer 10

Akathisia

#Reduce dose
#Beta blockers

Question 11

Patient on antipsychotic medications develops Involuntary movements of head, limbs, trunk – diagnosis? Treatment?

Answer 11

Switch to clozapine (least risk)

Tardive dyskinesia

Question 12

Patient on antipsychotic medications develops muscular rigidity, fever, agitation, obtundation – diagnosis? Treatment?

Answer 12

Neuroleptic malignant syndrome

Dantrolene or Bromocriptine

Question 14

Delusional disorder?

Answer 14

#Non-bizarre delusions
#No impairment in functioning (obeys law, goes to work, pays bills)

#Atypical antipychotics
#Psychotherapy

Question 15

Bipolar I vs II?

Answer 15

Mania vs hypomania

Question 16

adjustment syndrome with depressive features vs Depression?

Answer 16

within 3 months of an incident vs any other time

Question 17

Atypicals a vs typicals

Answer 17

1. More QT prolongation (Ziprasidone)
2. Less pyramidal symptoms, tardive dyskinesia, NMS
3. More weight gain (Olanzapine)
4. Better with negative symptoms of schizophrenia
5. More likely to cause metabolic syndrome

Question 18

Side effects of clozapine?

Answer 18

#Agranulocytosis
#drooling yet Anticholinergic symptoms
#tachycarditis and myocarditis
#sedation
#orthostatic hypotension 
#myoclonic jerks
#weight gain 

#no EPS
#seizures if over 600 mg/day

Question 19

Olanzapine - before giving, get?

Answer 19

#fasting glucose
#lipid panel
#BMI and waist circumference

Question 20

Quetiapine has a unique FDA approval for?

Also will cause a patient to?

Black box warning?

Answer 20

Bipolar depression

Sleep

Death from all causes

Question 21

Aripipazole MoA?

Half life?

Side effects?

Answer 21

Partial agonist AND antagonist to DA

100 hrs

Restlessness

Question 22

Drug least likely to cause weight gain?

Answer 22

Ziprasidone

Question 23

Side effects of first generation antipsychotics?

Answer 23

Parkinsonian (rigidity, flat facies, broad based small steppage gait, cogwheeling)

(Stiffness can be asymmetrical)

Question 24

Dystonic patient with torticolis - tx?

Answer 24

#benztropine
#diphenhydramine

Question 25

Who gets dystonia? When?

Prevent how? (Do not give that drug to?)

Answer 25

Young men

1-4 days later

Cotreatment with benztropine (old preple - can give Anticholinergic delirium)

Question 26

Potentially Permanent dystonia? Who is more likely to get it?

Treatment?

Answer 26

Tardive dyskinesia;

Old white women

Switch to Quetiapine or Clozapine

Question 27

Neuroleptic malignant syndrome (NMS) treatment?

Answer 27

#stop meds
#ICU hydration
#after stable Danteolene or benztropine