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Case Files Psychiatry > Schizophrenia spectrum and other psychotic disorders > Flashcards

Schizophrenia spectrum and other psychotic disorders Flashcards

1
Q

What is the best therapy for schizoaffective disorder?

A
  1. Antipsychotic

2. Antipsychotic + antidepressant

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2
Q

Why is important to establish the presence of mania in a schizoaffective patient?

A

Mania would change the treatment plan

- Adding mood stabilizer instead of an antidepressant

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3
Q

What anatomical abnormalities are seen on MRI in patient with schizophrenia?

A

Frontotemporal dysfunction

Left-hemisphere lateralization

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4
Q

Lack of energy

A

Anergia

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5
Q

What substances/medications can induce mood symptoms?

A

Cocaine/Amphetamines- Maina
Cocaine withdrawal- Depression
Sterods
Antiparkinsonian medications

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6
Q

What part of the history can help differentiate bipolar or MDD with psychotic features from schizoaffective?

A

In both MDD and bipolar the mood symptoms would be present long before the psychosis

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7
Q

What are some concerning side effects of typical antipsychotics?

A

Tardive dyskinesia
EPS
Neuroleptic malignant syndrome
Anticholinergic effects

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8
Q

Which mood stabilzers are used to treat manic symptoms of schizoaffective disorder?

A

Lithium
Carbamazepine
Valproic acid

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9
Q

What kind of psychotherapy can be used to help schizoaffective disorder?

A

Psychosocial rehabilitation

  • Social isolation
  • Apathy
  • Disturbed interpersonal relationships
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10
Q

What is a reasonable step in an adolescent patient with mood symptoms that are resistant to treatment?

A

Order a urine or serum toxicology for substance abuse

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11
Q

How do young patients with schizoaffective disorder present differently than older patients?

A

Symptoms are usually worse

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12
Q

What are the two main diagnostic critera for schizophrenia?

A

Delusions (persecutory)

Hallucinations

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13
Q

How long do symptoms need to be present to dx schizophrenia?

A

6+ months

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14
Q

When is psychiatric admission warranted?

A

SI+
HI+
Patient cannot care for themselves

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15
Q

What are the symptoms of psychosis and how many need to be present for schizophrenia?

A 
Delusions
Hallucinations
Disorganized speech
Disorganized or catatonic behavior
Negative symptoms

2+

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16
Q

What 3 disorders must be ruled out before schizophrenia can be dx?

A

Schizoaffective
Mood disorder with psychotic features
Substance or medical condition

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17
Q

Phase of schizophrenia with postitive and negative symptoms

A

Active-phase

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18
Q

Neuropsychiatric syndreom occurring in psychiatric or medical disorders that present with three or more psychomotor symptoms.

  • Stupor
  • Catalepsy
  • Waxy flexibility
  • Mutism
  • Negativism
  • Posturing
  • Grimacing
  • Mannerism
  • Stereotypy
  • Agitation
  • Echopraxia
  • Echolalia
A

Catatonia

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19
Q

Thoughts lacking logical connections between ideas (loose associations) or between the individual words (word salad)

A

Disorganized speech

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20
Q

Misinterpretation of aspects of the external environment as having a particular significance for the individual.

A

Ideas of reference

21
Q

Negative symptoms

A

Lack of emotional responses and thought processes

  • Decreased expression of emotion
  • Flattening of affect
  • Alogia- decreased spontaneous speech
  • Avolition- decreased motivation
22
Q

How long does the active-phase (2+: dellusions, hallucinations, or disorganized speech) of schizophrenia need to be?

A

1+ month

23
Q

What are the risk factors for aggression?

A 
Positive history - Violence or impulsiveness
Substance abuse
Young age
Male
Lack of treatment
24
Q

What percentage of schizophrenic pateints attemp suicide? Complete?

A

20%

5%

25
Q

What are the risk factors for suicide in a schizophrenic patient?

A 
AH to harm oneself
Depressive symptoms
Substance abuse
Unemployment
Recent psychotic episode or hospital discharge
Young age
Male
26
Q

What are major medications that can induce psychosis?

A

Dopaminergic agents
Steroids
Anticholinergics

27
Q

What is the proper diagnosis of a patient that has delusions, but no other psychotic features?

A

Delusion disorder- requires 1 month timeframe

28
Q

What is key about making a diagnosis of some mood disorder with psychotic features?

A

The psychotic features are only present with the mood disturbance and never by themselves

29
Q

What has the best prognosis?

A
  1. Mood disturbance with psychosis
  2. Schizoaffective
  3. Schizophrenia
30
Q

What should be the first line treatment for schizophrenia? Why?

A

Atypical antipsychotics
Less side effects
Better at treating negative symptoms

31
Q

Which atypicals have the worst metabolic side effects? The best?

A

Clozapine
Olanzapine

Ziprasidone
Aripiprazole

32
Q

What is the most effective antipsychotic medication in treating schizophrenia?

A

Clozapine

33
Q

Why is clozapine not used very often?

A

Risk of agranulocytosis

34
Q

What are EPS?

A

Akathisia
Dystonia
Parkinsonism

35
Q

What other side effects can typical antipsychotics cause?

A

Hyperprolactinemia

Tardive dyskinesia

36
Q

What can be used to treat dystonias?

A

Anticholinergics

  • Benztropine
  • Diphenhydramine
37
Q

Sensation of inner restlessness

A

Akathisia

38
Q

What can be used to treat akathisia?

A

Benzos

Beta-blocker- Propranolol

39
Q

Bradykinesia and muscle rigidity (cogwheeling)

A

Parkinsonian

40
Q

What can be used to treat parkinsonian symptoms?

A

Benztropine

41
Q

Characteristic involuntary movements with long-term antipsychotic use

A

Tardive dyskinesia

42
Q

Altered mental status, fever, dysautonomia, and muscle rigidity

A

Neuroleptic malignant syndrome

43
Q

What can be used to treat severe cases of neuroleptic malignant syndrome?

A

Dantrolene or bromocriptine

44
Q

What antipsychotic can reduce suicide attempts in schizophrenia and schizoaffective disorder?

A

Clozapine

45
Q

What is the most frequently used substance by schizophrenics?

A

Nicotine- 75% to 90%

46
Q

How does smoking lead to worsening psychosis in a schizophrenic patient?

A

Induction of cytochrome P450 1A2

- Lowers clozapine concentrations

47
Q

What is the work-up algorithm for psychiatric disorders?

A
  1. Rule out substances or medications
  2. Rule out medical conditions
  3. Characterize the disorder
48
Q

Hallucination vs Hallucinosis

A

Lack of insight vs insight intact

49
Q

What are the key components of diagnosis schizoaffective disorder?

A
  1. Psychosis and prominent mood symptoms
  2. Must have a 2+ wk period with only psychosis

i.e. Psychotic episodes occur during the mood episodes, but mood symptoms do not always occur during the psychotic episodes

Case Files Psychiatry (10 decks)

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