EM Psych 7: Psychoses

Question 1

psychotic disorders include abnormalities in ____ or more of 5 domains:

Answer 1

one or more:
hallucinations
delusions
disorganized or abnormal motor behavior
disorganized thinking
negative symptoms

Question 2

symptoms that can be the most chronically impairing features of psychoses

Answer 2

negative symptoms
- avolition (decreased motivation)
- diminished emotional expression
- anhedonia (decreased ability to experience pleasure
- asociality (decreased interest in social interaction)
- alogia (decreased speech)

Question 3

common drugs that cause psychosis

Answer 3

Atropine
Benzodiazepine (withdrawal)
Corticosteroids
Dextromethorphan
Ethanol (withdrawal)
Fluoroquinolones

Question 4

most common side effect of antipsychotic medications seen in the ED

Answer 4

acute dystonias
- more common in younger patients and those who have never taken antipsychotic drugs before
- m/c dystonias: muscle spasms of the neck, face, and back

Question 5

treatment of dystonia

Answer 5

benztropine, 1-2 mg IV or IM
diphenhydramine 25-50 mg IV
both rapidly corrects the dystonia

Question 6

risk of anti-psychotic-induced parkinson’s syndrome is greatest in what population?

Answer 6

elderly, with development in the first month after initiation of the antipsychotic agent

Question 7

atypical antipsychotic that can cause seizures

Answer 7

clozapine
- may also cause agranulocytosis

Question 8

remarks on neuroleptic malignant syndrome

Answer 8

Although high-potency antipsychotics may be more likely to cause the disorder, all antipsychotics are potential offenders

NMS is a medical emergency and has a mortality rate as high as 20%

Question 9

sometimes used to relieve the rigidity in NMS

Answer 9

dantrolone sodium
or bromocriptine

Question 10

most common form of psychosis

Answer 10

schizophrenia
- diagnosed more in men than in women

bipolar - equal between men and women

Question 11

diagnosis of schizophrenia

Answer 11

signs of disturbance must be present for at least 6 months

must have 2 or more criteria, and at least one must be delusions or disorganized speech

others:
- hallucinations
- negative symptoms
- grossly disorganized or catatonic behavior

Question 12

remarks on delusional disroder

Answer 12

diagnosed in the absence of schizophrenia and involves the presence of one or more delusions for at least 1 month

Question 13

remarks on schizoaffective disorder

Answer 13

characterized by criteria of schizophrenia occurring concurrently with a major mood episode (major depressive or manic)

Question 14

remarks on catatonia

Answer 14

Medical conditions associated with catatonia include Trauma head), Hepatic encephalopathy, Encephalitis, and Neooplasms

the acute presentation of catatonia often includes STUPOR, and therefore, patients often have their first clinical contact in the ED.
It is therefore important to recognize that catatonia is frequently associated with an organic cause.