delusional disorder
> 1 delusion lasting >1 MO w/o other psychotic symptoms
no significant impairment in function, no better explanation
brief psychotic disorder
> 1 psychotic symptoms with onset and remission in less than 1 month
schizophreniform disorder
schizophrenia but <6 mo duration
schizoaffective disorder
schizophrenia + mood disturbance (MDD or manic)
schizophrenia (general)
> 6 mo duration of illness along with functional decline
positive symptoms of schizophrenia
excess dopamine receptors
hallucinations or delusions, disorganized speech, thinking, abnormal behavior
sensory perception w.o physical stimuli
hallucinations
hallucinations (list) (6)
- auditory (MC)
- visual
- olfactory
- tactile
- somatic
- gustatory
fixed belief held with strong conviction despite other evidence
delusions
delusion (list) (8)
- persecutory
- reference
- control
- grandiose
- nihilism
6 erotomania - jealousy
- doubles
persecutory delusions
person/force interfering with them, observing them or wishing harm
delusions of reference
random events take on personal significance (directed at them)
grandiose delusions
unrealistic beliefs in one’s powers and abilities
nihilism
exaggerated belief in futility of everything/catastrophic events
doubles delusions
believes family member or close person replaced by identical double
negative symptoms of schizophrenia
dopamine dysfunciton
flat emotional affect, evolution
RF of schizophrenia
family history***
epidemiology of schizophrenia
MC in men
show in early 20s for men, late 20s for women
management of schizophrenia (general)
antispsychotics – 2nd gen preferred
AKA neuroleptics
atypical drugs MOA
CNS dopamine D4 receptor and serotonin antagonists
why would I give a patient clozapine
resistance developed to other antipsychotics
S/E of atypical antipsychotics
extrapyramidal sxs increased prolactin hyperglycemia hyperlipidemia weight gain NMS
CIs of atypical antipsychotics
QT prolongation
clozapine
atypical given if resistance develops
causes agranulocytosis and myocarditis
less incidence of EPS
olanzapine cautions
marked weight gain and DM
what are extrapyramidal symptoms?
rigidity
bradykinesia
tremor
akathisia
typical/1st gen antipsychotics MOA
dopamine antagonists
*decreased dopamine activity causes all SEs
typical/1st gen antipsychotics S/es
extrapyramitdal symptoms dyskinesia parkonsonism tardive dyskinesia NMS
list of 3 EPS symptoms
- dyskinesia/dystonic reaction
- tardive dyskinesia
- Parkinsonism
dystonic reactions definition and cause
reversible EPS, hours to days after initiation of typical neuroleptics
caused by disruption of dopamine/ach balance = excessive AcH
symptoms dyskinesia
trismus protrusion of tongue facial grimacing torticollis difficulty speaking
tx of dyskinesia
IV Diphenhydramine
add anticholinergic agent (I.e. Benztropine)
tardive dyskinesia
repetitive involuntary movements
mostly involving extremities and face
I.e. lip smacking, teeth grinding, rolling of tongue
seen with LONG TERM use
life threatening disorder due to D2 inhibitor
NMS
NMS symptoms
mental status changes
extreme muscle rigidity
tremor
autonomic instability (tachycardia, hyperthermia, fever)
tx of NMS
d/c offending agent dopamine agonists (bromocriptine)
C/I for haldol
Parkinson disease
anticoagulant use
severe cardiac disorder