MTB - Psychiatry Flashcards
what two causes are important to rule out in a patient presenting with psychosis (before dx. schizophrenia)
- drug screen
2. temporal lobe epilepsy
greatest RF for progression to schizophrenia
schizophreniform disorder
what form of schizophrenia is most responsive to treatment?
paranoid type
poor prognostic factors in schizophrenia
family history
early age of onset
poor premorbid functioning
disorganized/deficit type
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
- acute psychotic attacks
- sedation
- Huntington’s dz, Tourette syndrome
S/e: high potency antipsychotics (fluphenazine, haloperidol)
EPS symptoms
less anticholinergic, less sedating, less hypotension
s/e: low potency antipsychotics (chlorpromazine, thioridazine)
greater anticholinergic, more sedating, more postural hypotension
less EPS symptoms
Tx. catatonia
BDZ - lorazepam and/or ECT
can do lorazepam challenge test to verify the disorder
s/e: THIORIDAZINE
- OT prolongation, arrhythmias –> always get EKG if chest pain or SOB develops
- abnormal retinal pigmentation –> routine eye exam
greatest risk of weight gain (what antipsychotic)
olanzapine
choice of antipsychotic when insomnia is also a problem?
atypicals –> olanzapine, quetiapine, ziprasidone, aripiprazole
choice of antipsychotic when sedation is a problem?
risperidone
what tests should be ordered if starting on olanzapine?
LFTs
glucose
lipid profile
- get baseline measure and reassess in 12 weeks
