Psychotic Disorders and Antipsychotics Flashcards

0
Q

Specific features if schizophrenias:

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

Timeline of psychotic disorders?

A
#Brief psychotic disorder – less than one month
#Schizophreniform disorder – one month to six months
#Schizophrenia – over six months
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2
Q

Most common type of schizophrenia? Relative age of onset?

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

A

Paranoid – later age

Disorganized – earliest age

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3
Q

Treatment for schizophrenia?

A

Atypical antipsychotics

(It's atypical for OLd CLOSets to QUIETly RISPER from A-Z)
#Olanzapine
#Clozapine
#Quetiapine
#Risperidone
#Aripiprazole
#Ziprasidone
#Paliperidone
#Asenapine
#iloperidone
#lurasidone
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4
Q

In emergencies situation with schizophrenic – use which IM medication?

A

Olanzapine/Ziprasidone >haloperidol

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5
Q

Schizophrenic patient noncompliant with medication – try?

A

Long acting injectable antipsychotics

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6
Q

When to use clozapine?

A

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)

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7
Q

Side effects of:

  1. Olanzapine
  2. Clozapine
  3. Quetiapine
  4. Risperidone
  5. Ziprasidone
A
  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)
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8
Q

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

A

Aripiprazole; Ziprasidone

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9
Q

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

A

Acute dystonia

Benztropine, trihexyphenidyl, diphenhydramine

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10
Q

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

A

Akathisia

#Reduce dose
#Beta blockers
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11
Q

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

A

Switch to clozapine (least risk)

Tardive dyskinesia

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12
Q

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

A

Neuroleptic malignant syndrome

Dantrolene or Bromocriptine

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14
Q

Delusional disorder?

A
#Non-bizarre delusions
#No impairment in functioning (obeys law, goes to work, pays bills)
#Atypical antipychotics
#Psychotherapy
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15
Q

Bipolar I vs II?

A

Mania vs hypomania

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16
Q

adjustment syndrome with depressive features vs Depression?

A

within 3 months of an incident vs any other time

17
Q

Atypicals a vs typicals

A
  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
18
Q

Side effects of clozapine?

A
#Agranulocytosis
#drooling yet Anticholinergic symptoms
#tachycarditis and myocarditis
#sedation
#orthostatic hypotension 
#myoclonic jerks
#weight gain 
#no EPS
#seizures if over 600 mg/day
19
Q

Olanzapine - before giving, get?

A
#fasting glucose
#lipid panel
#BMI and waist circumference
20
Q

Quetiapine has a unique FDA approval for?

Also will cause a patient to?

Black box warning?

A

Bipolar depression

Sleep

Death from all causes

21
Q

Aripipazole MoA?

Half life?

Side effects?

A

Partial agonist AND antagonist to DA

100 hrs

Restlessness

22
Q

Drug least likely to cause weight gain?

A

Ziprasidone

23
Q

Side effects of first generation antipsychotics?

A

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

(Stiffness can be asymmetrical)

24
Q

Dystonic patient with torticolis - tx?

A
#benztropine
#diphenhydramine
25
Q

Who gets dystonia? When?

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

A

Young men

1-4 days later

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

26
Q

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

Treatment?

A

Tardive dyskinesia;

Old white women

Switch to Quetiapine or Clozapine

27
Q

Neuroleptic malignant syndrome (NMS) treatment?

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