Psychotic Disorders and Antipsychotics Flashcards
Specific features if schizophrenias:
- Paranoid
- Catatonic
- Disorganized
- Residual
- Undifferentiated
- delusions or hallucinations
- Psychomotor (stupor, rigidity, posturing, mute)
- Disinhibited, disheveled, bizzare emotional responses
- Lack of positive symptoms, but presence of negative symptoms
- Everything else
Timeline of psychotic disorders?
#Brief psychotic disorder – less than one month #Schizophreniform disorder – one month to six months #Schizophrenia – over six months
Most common type of schizophrenia? Relative age of onset?
Type of schizophrenia with the worst prognosis? Relative age of onset?
Paranoid – later age
Disorganized – earliest age
Treatment for schizophrenia?
Atypical antipsychotics
(It's atypical for OLd CLOSets to QUIETly RISPER from A-Z) #Olanzapine #Clozapine #Quetiapine #Risperidone #Aripiprazole #Ziprasidone
#Paliperidone #Asenapine #iloperidone #lurasidone
In emergencies situation with schizophrenic – use which IM medication?
Olanzapine/Ziprasidone >haloperidol
Schizophrenic patient noncompliant with medication – try?
Long acting injectable antipsychotics
When to use clozapine?
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)
Side effects of:
- Olanzapine
- Clozapine
- Quetiapine
- Risperidone
- Ziprasidone
- Diabetes and weight gain (“O” is fat)
- Agranulocytosis; need to monitor CBC (C-lozapine needs C-BC)
- Minor incidence of movement disorders (quieter)
- Major incidence of movement disorders (R-igid)
- QT prolongation; avoid in patients with conduction abnormalities (Z-apping)
Schizophrenia medications least likely to cause weight gain, diabetes or metabolic syndrome ?
Aripiprazole; Ziprasidone
Patient on new antipsychotic medications develops muscle spasms, torticollis, laryngeal spasms – diagnosis? Treatment?
Acute dystonia
Benztropine, trihexyphenidyl, diphenhydramine
Patient on long-term antipsychotic medications develops restlessness, pacing, inability to relax – diagnosis? Treatment?
Akathisia
#Reduce dose #Beta blockers
Patient on antipsychotic medications develops Involuntary movements of head, limbs, trunk – diagnosis? Treatment?
Switch to clozapine (least risk)
Tardive dyskinesia
Patient on antipsychotic medications develops muscular rigidity, fever, agitation, obtundation – diagnosis? Treatment?
Neuroleptic malignant syndrome
Dantrolene or Bromocriptine
Delusional disorder?
#Non-bizarre delusions #No impairment in functioning (obeys law, goes to work, pays bills)
#Atypical antipychotics #Psychotherapy
Bipolar I vs II?
Mania vs hypomania