Flashcards in MTB - Psychiatry Deck (19):
what two causes are important to rule out in a patient presenting with psychosis (before dx. schizophrenia)
1. drug screen
2. temporal lobe epilepsy
greatest RF for progression to schizophrenia
what form of schizophrenia is most responsive to treatment?
poor prognostic factors in schizophrenia
early age of onset
poor premorbid functioning
treatment approach to patient with schizophrenia
if at risk of harm to self or others - hospitalize
for agitation - give BDZ
start antipsychotics - continue for 6 months
who should be on long term antipsychotics?
usually given for 6 months --> long term only if recurrent episodes of psychosis
indications for antipsychotics
1. acute psychotic attacks
3. Huntington's dz, Tourette syndrome
S/e: high potency antipsychotics (fluphenazine, haloperidol)
less anticholinergic, less sedating, less hypotension
s/e: low potency antipsychotics (chlorpromazine, thioridazine)
greater anticholinergic, more sedating, more postural hypotension
less EPS symptoms
BDZ - lorazepam and/or ECT
can do lorazepam challenge test to verify the disorder
1. OT prolongation, arrhythmias --> always get EKG if chest pain or SOB develops
2. abnormal retinal pigmentation --> routine eye exam
greatest risk of weight gain (what antipsychotic)
choice of antipsychotic when insomnia is also a problem?
atypicals --> olanzapine, quetiapine, ziprasidone, aripiprazole
choice of antipsychotic when sedation is a problem?
what tests should be ordered if starting on olanzapine?
- get baseline measure and reassess in 12 weeks
Tx. acute dystonia
reduce antipsychotic dose
Anticholinergic therapy --> benztropine, diphenhydramine, trihexyphenidyl
add BDZ or BB
switch to newer antipsychotics i.e. risperidone
tx. tardive dyskinesia
stop older antipsychotics, switch to new gen. i.e. clozapine
** symptoms usually get worse after medication discontinuation