MTB - Psychiatry Flashcards Preview

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Flashcards in MTB - Psychiatry Deck (19):
1

what two causes are important to rule out in a patient presenting with psychosis (before dx. schizophrenia)

1. drug screen
2. temporal lobe epilepsy

2

greatest RF for progression to schizophrenia

schizophreniform disorder

3

what form of schizophrenia is most responsive to treatment?

paranoid type

4

poor prognostic factors in schizophrenia

family history
early age of onset
poor premorbid functioning
disorganized/deficit type

5

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

6

who should be on long term antipsychotics?

usually given for 6 months --> long term only if recurrent episodes of psychosis

7

indications for antipsychotics

1. acute psychotic attacks
2. sedation
3. Huntington's dz, Tourette syndrome

8

S/e: high potency antipsychotics (fluphenazine, haloperidol)

EPS symptoms
less anticholinergic, less sedating, less hypotension

9

s/e: low potency antipsychotics (chlorpromazine, thioridazine)

greater anticholinergic, more sedating, more postural hypotension
less EPS symptoms

10

Tx. catatonia

BDZ - lorazepam and/or ECT
can do lorazepam challenge test to verify the disorder

11

s/e: THIORIDAZINE

1. OT prolongation, arrhythmias --> always get EKG if chest pain or SOB develops
2. abnormal retinal pigmentation --> routine eye exam

12

greatest risk of weight gain (what antipsychotic)

olanzapine

13

choice of antipsychotic when insomnia is also a problem?

atypicals --> olanzapine, quetiapine, ziprasidone, aripiprazole

14

choice of antipsychotic when sedation is a problem?

risperidone

15

what tests should be ordered if starting on olanzapine?

LFTs
glucose
lipid profile
- get baseline measure and reassess in 12 weeks

16

Tx. acute dystonia

reduce antipsychotic dose
Anticholinergic therapy --> benztropine, diphenhydramine, trihexyphenidyl

17

Tx. akathisia

reduce dose
add BDZ or BB
switch to newer antipsychotics i.e. risperidone

18

tx. tardive dyskinesia

stop older antipsychotics, switch to new gen. i.e. clozapine
** symptoms usually get worse after medication discontinuation

19

predictors of antidepressant treatment response

1. personal history of response
2. family history of response