Psychotic disorders (F2) Flashcards
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Define Psychosis
Components of psychosis
Delusion
Hallucination
Disorganization
No insight
Differentiate psychiatric vs medical cause of psychosis
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Ddx psychotic disorders
Schizophrenia
Schizoaffective disorder
ATPD (<2w), Brief psychotic disorder (<1m), Schizophreniform disorder (1-6m)
Delusional disorder (>3m or 1m)
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Ddx mood disorders with psychotic features
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Secondary causes of psychosis
Medical: CNS, Endocrine, Metabolic
Delirium
Dementia/ LBD
Substance abuse
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Schizophrenia
DSM-5 criteria
Hallucinations
Questions for auditory hallucination
Hallucinations
Questions for non-auditory hallucinations
Delusuions
Questions for different types of delusions
Thought disorganization
Questions for assessment
Negative symptoms of psychosis
Questions for assessment
Risk assessment of psychosis
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Psychosis
Investigations
CBC
LRFT for metabolic encephalopathy
Other metabolic: TFT, B12
Urine toxicology
Infection: VDRL, HIV
Scans: ECG before TCA, EEC/ CT brain
Schizophrenia
Demographics
Mortality rate
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Schizophrenia
Symptom spectrum
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Schizophrenia
First rank symptoms
SPECTRA
Schizophrenia
Positive symptoms
Schizophrenia
Negative symptoms
Schizophrenia
Thought, affective symptoms
Schizophrenia
Cognitive and motor symptoms
Motor – Catatonia
- Retarded, Excited, Malignant
Cognitive
- Sustained attention, executive function, memory, social cognition…etc
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Subtypes of schizeophrenia
Clinical features
Paranoid - +ve symptoms, most common
Hebephrenic - -ve symptoms, thought disorder, poor prognosis
Catatonic – motor symptoms: wavy flexibility, automatism, rigidity, stupor, posturing…
(Simple)
Schizophrenia
Clinical course
First episode psychosis = golden window for intervention
Cycloid psychosis
Criteria
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Schizoaffective disorder
Criteria
Clinical presentation
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Schizotypal disorder
Clinical features
Associated disorders
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Delusion disorder
Criteria
Clinical features
Additional notes:
- Must screen for schizophrenic and bipolar disorder, could be manic episode
- Likely to have poor adherence to medications and followup
- Unlikely to have complete remission
- Higher risk of suicide compared to schizophrenia due to higher level of functioning
- Does not progress into schizophrenia
- Collateral history must be taken to ascertain delusions
- Likely to cause family violence
Non-bizarre, Systemized, Single theme
Schizophrenia
Genetic risk factors
Schizophrenia
Environmental risk factors
Schizophrenia
Neurobiological risk factors
Schizophrenia
Familial and developmental risk factors
EE = Critical, hostile, over involvement attitude
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Schizophrenia
Treatment phases
FEP = Hospitalize
Acute = Anti-psychotics
Maintenance = Antipsychotics, psychosocial interventions
Late/ resistant = Clozapine
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Antipsychotics
MoA
Efficacy
Examples
S/E
FGA:
Chlorpromazine
Flupenthixol
Haloperidol
SGA:
Sulpiride
Clozapine/ Olanzapine
Quetiapine
S/E: Anti-HAM + Dopaminergic S/E
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Antipsychotic prescription
Preparation
Onset of action
Choice
Dosing
Regimen
RoA
Monitoring
Start: CBC, LRFT, Metabolic profile, ECG
Choice: Clozapine/ SGA first
Dose: Start minimal effective dose, regular never prn
Regimen: Monotherapy first, change dose/ combo/ drug if needed
RoA: Oral or depot
Monitor: Metabolic profile, mental state, physical health
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Treatment resistant schizophrenia
Definition
Treatment
Monitoring
Clozapine:
- Deadly: Agranulocytosis, Functional IO, Liver failure
- Not deadly: Seizure, Pancreatitis, Carditis
Monitor: Neutrophil count Q1w for 18 weeks, Q2 weeks until 1 year, Q4w until end
Fail: Add antipsychotics, ECT, Lamotrigine
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Non- pharmocological treatment of schizophrenia
Indications
Modalities
Schizophrenia
Early intervention paradigm: effect, procedure, efficacy
Schizophrenia
Clinical course and prognosis
30% resistant
20% remission
10% suicide
50% poor outcome
