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Flashcards in Psychotic D/O Deck (37):
1

Epilepsy in which lobe causes psychosis

Temporal

2

CNS Causes of Psychosis

Cerebrovascular dx
multiple sclerosis
cancer
Alz Dx
Parkinsons Dx
Huntington's chorea
tertiary syphillis
Temporal lobe epilepsy
encephalitis
prior disease
Neurosarcoidosis***
AIDS

3

Endocrinopathies causing Psychosis

Addision/Cushings dx
hypo or hyper thyroid
hyper or hypo Ca
HYPO - pituitarism

4

Nutritional/Vitalim def causing psychosis

B12
Folate
Niacin

5

DSM criteria for Psychosis SECONDARY TO GMC

prominent hallucinations/delusions
sx do NOT only occur during an episode of delerium
evidence to support medical cause from labs/h&P/etc

6

Meds that Cause psychosis

corticosteroids
anti-Parkinsons drugs
Anticonvulsants
Anti-Histamines
Anti-Ach
Anti-HTN (beta-block)
digitalis
methylphenidate
Fluroquinolones (levofloxacin)

7

Drugs of Abuse that cause psychosis

EtOH
Cocaine
LSD
Ecstasy
PCP
BZD
Barbituates
Weed

8

Work-up for young adult with new onset psychosis in Schizophrenia

check TSH, RPR and brain imaging
will likely start anti-psychotics

9

DSM for Schizophrenia

***2+ for at least 1 month***
delusions
hallucinations
disorg. speech
GROSSLY disorg. behavior or catatonia
negative sx

*** ONLY ONE of the above needed if delussions are BIZARRE...OR....if hallucinations are running comentary....OR if hallucinations are 2+ people conversing in the pt's head

10

Subtypes of Schizo
Paranoid Type

Paranoid Type - most common, dominated by delusions
- delusions of grandeur or persecution
- higher fxn, older onset,
- NO predom. of disorg speech/behavior or catatonia
- NO inappropriate affect

11

Catatonia subtype of Schizo

rigid posture
inapp. or repetitive and purposeless movements
echolalia
echopraxia

12

Thought blocking

stop talking mid sentence/mid thought

13

What is INTACT in schizophrenia

Memory and Orientation

14

Schizophrenia gen facts

look for only CONCRETE understanding of provers/similarities
LACK insight
memory/orientation is INTACT
disorg thought process
Men and Women get it equally
Men present in 20's, women in 30's
look for neologisms (new language)

15

genetics of schizo

50% concordance in monozygote twins
40% risk if BOTH parents have it
12% risk if ONE FIRST-DEGREE relative has it

16

Schizo and Dopamine

DA involved b/c anti-pscyhotics work and drugs that inc. DA (cocaine and amphetatmines) increase schizo-sx

17

Effects of Antipsychotic on Nigrostriatal

EPS - tremor, slurred speech, akathisia, dystonia

18

CT findings in schizo

enlarged ventricles and diffuse cortical atrophy

19

GOOD Prognostic factors of schizo

later onset
females
good pre-morbid fxn

20

POOR prognostic factors of schizo

early onset
gradual onset
family hx
males
comorbid substance abuse

21

when to use clozapine

when both atypical and typical antipsychotics fail

22

decline in functioning, socially withdrawn, irritable,
new found interest in religion or occult= signs of --->

prodromal phase of schizo

23

Pyschotic Phase of schizo

perceptual disturbances
dellsions
disorg thought process/content

24

5 A's of Schizo Phrenia

Anhedonia
Affect (FLAT)
Alogia (poverty of speech)
Avolition (apathy)
Attention (poor)

25

First rule out in Schizophrenia type presentation

Rule OUT cocaine

26

Schizophrenia - Disorganized Type

Disorganized Type - WORST TYPE
- poor fxn, earlier onset
- Disorg speech
- disorg. behavior
- flat or inapp. affect

27

Schizophrenia - Catatonic Type

Catatonic Type
- RARE; needs 2+ of following***
- immobility/waxy flexibility
- extremely purposeless motor activity
- extreme negativism or mutism****
- peculiar voluntary movements or posturing
- ECHOLALIA or ECHOPRAXIA***

28

Schizophrenia - Undifferentiated and Residual Type

Unidff Type: traits of more than 1 subtype

Residual Type
mostly negative sx w/ min. + sx (less hallucinations/delusions)

29

Schizophrenia tx

for all subtypes tx with Typical or Atypical Antipsychotics

EXCEPT use BZD in the ACUTE catatonic state then move on to anti-psychotics

30

Schizoaffective

Schizophrenia + MOOD SYMPTOMS
Tx delusions first! Then tx the mood concerns

31

If patient has acute psychotic disorder

watch and wait until 1 month

if it progresses to schizophreniform --> tx for 3-6wk

32

Delusional Disorder

Beleiveable, Logical
Rational Thought process

33

Schizophrenia Good Prognostic Factors

- late onset (ages 20-25??)
- obvious precipitating factor/stressor
- acute onset
- good premorbid fxn
- presence of mood d/o symptoms
- Fhx of mood d/o
- good support sys
- pt is married
- positive sx (vs negative sx)
- stable occupational record
- mid-high SES

34

patient who is not compliant on antipsychotics give -->

Haloperidol/fluphenazine DECANOATE
- IM injections that last longer and dont require compliance

35

drugs that look like schizo

LSD, PCP, and Amphetamines (inc cocaine)
drugs might have less thought blocking etc compared to schizo but not a hard rule

36

Schizo w/ family that is over controlling/hostile

INCR relapse rate

37

one schizo episode and sx free on meds:
NEXT STEP -->

DECR DOSE GRADUALLY
- while doing this, INCR the # of psych viisits
Eventually stop med all together if pt stays sx free