Psychotic Disorders Flashcards by Marianne Gwyneth Monsalud

T/F: Schizophrenia is the same as split personality

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T/F: Schizophrenic patients are unable to differentiate reality from fantasy

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Diagnosis of schizophrenia is based entirely on:

Psychiatric history and mental status examination

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T/F: CT scan or Pet scan can be used to differentiate a normal bran and a brain with schizophrenia

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Males usually present (negative/positive) symptoms of schizophrenia

Negative

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Females usually present (negative/positive) symptoms of schizophrenia

Positive

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First degree biological relatives of schizophrenics are ____ times as likely to develop the disorder as members of the general population

10x

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There is a ___% chance of getting schizophrenia if both of your parents have it, while ___% chance if one of the parents has it

47%; 13%

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There is a ___% chance of getting schizophrenia if your identical twin has it, while ___% chance if your non-identical twin has it

50%; 18%

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There is a ___% chance of getting schizophrenia if one of your siblings has it, while ___% chance if one of your paternal cousins has it

9%; 2%

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T/F: the age of the mother has a direct correlation with the development of schizophrenia, where mothers older than 60 yo were vulnerable to developing the disorder

F
it’s the father

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Nine linkage sites associated with schizophrenia:

1q, 5q, 6p, 6q, 8p, 10p, 13q, 15q, 22q

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Specific genes associated with schizophrenia:

Alpha-7 nicotinic receptor, DISC 1, GRM 3, COMT, NRG1, RGS 4, G 72

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Mutation (negative symptoms) associated with schizophrenia:

dystrobrevin (DTNBP1), neureglin 1

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The yellowish fingers of patients with schizophrenia associates the disease with abnormal levels of ____

nicotine (among smokers)

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Neural changes in a schizophrenic brain include:

(Increased/Decreased) lateral and third ventricle size
(Increased/Decreased) cortical and thalamic volume
(Increased/Decreased) symmetry in temporal, frontal, parietal lobes
(Increased/Decreased) size of amygdala, hippocampus, parahippocampal gyrus
(Increased/Decreased) volume of globus pallidus and substantia nigra
(Increased/Decreased) number of D2 receptors in the caudate, putamen, and nucleus accumbens

Increased
Decreased
Decreased
Decreased
Decreased
Increased

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Dysfunction in anterior cingulate basal ganglia thalamocortical circuit causes (negative/positive) psychotic symptoms

Positive

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Dysfunction in dorsolateral prefrontal circuit causes (negative/positive) psychotic symptoms

Negative

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DSMV Criteria for schizophrenia includes 2 or more of the following being present for 6 months or more:

Happy Days, Sad Nights, Dark Days

H = Hallucinations
D = Delusions
S = Speech (Disorganized)
N = Negative symptoms
D = Disorganized or catatonic behavior

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T/F: Males have more frequent relapses, more severe disease course and worse outcomes

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Brief psychotic disorder is the presence of one or more following symptoms:

Happy Days, Sad and Dark Days

Hallucinations
Delusions
Speech (disorganized)
Disorganized or catatonic behavior

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T/F: The duration of Brief psychotic disorder is at least 1 month but less than 6 months, with eventual full return to premorbid level of functioning

F
at least one day but less than 1 month

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T/F: In schizophrenia, patient declines

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Criteria of schizophreniform disorder include having ___ or more ff symptoms:

Happy Days, Sad Days, Dark days
Hallucinations
Delusions
Speech (disorganized)
Disorganized or catatonic behavior

1 or more

recall: in schizophrenia, it’s 2 or more of the same set of symptoms

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Duration of schizophreniform disorder

at least 1 month but less than 6 months, with eventual full return to premorbid level of functioning recall: Schizophrenia: at least 6 months and progressively declines Brief psychotic disorder: at least 1 day to 1 month with eventual full return to premorbid level of functioning

considered as a basket case diagnosis

Schizoaffective Disorder

Mood symptoms + schizophrenia symptoms = what disorder?

Schizoaffective Disorder

T/F: Schizoaffective disorder is a better prognosis than schizophrenia and worse than mood disorder

T/F: Delusions are bizarre only

F they can be bizarre or non-bizarre

T/F Delusional disorders are nonbizarre delusions of at least ___ month/s in duration, with slight preponderance of (male/female) patients

1 month; female

This type of delusional disorder refers to delusions that another person, usually of higher status, is in love with the individual (women predominant)

Erotomaniac/ De Clerambault/ Psychose Passionelle

3 subtypes of Monosymptomatic Hypochondriacal Psychosis

Infestation Dysmorphophobia Olfactory

This unspecified type of delusional disorder refers to delusions where a familiar person has been replaced by an impostor

Capgras (Illusion of Doubles)

This unspecified type of delusional disorder refers to delusions where a familiar person can assume the guise of strangers

Fergoli's

This unspecified type of delusional disorder refers to delusions where a familiar person can change into another person at will

Intermetamorphosis

T/F Vocational and psychosocial rehabilitation of patients with psychotic disorders cannot be done outpatient

F it can be done outpatient

T/F: It is necessary that a patient experiencing exacerbation of psychotic symptoms be hospitalized

F not necessarily, if there are adequate community alternatives that are available like support from the family

T/F First episodes of psychosis and unusual presentations of psychotic conditions are indications of hospitalization

T/F: Patients experiencing extreme fear and significant confusion require long term hospital care

F short term only

T/F: Patients with suicidal risk and command hallucinations require long term hospital care

F short term only

T/F Treatment of significant comorbidity from med illness, substance abuse, and med complications require long term hospital care

T/F: Protection from self-inflicted harm or danger to others require short-term hospital care

F long term

First generation antipsychotics

Dopamine Receptor Antagonist

T/F: First generation antipsychotics are effective in positive symptoms

T/F: First generation antipsychotics include chlorpromazine

T/F: Typical neuroleptics are completely absorbed after oral administration, with low protein binding, volume of distribution, and lipid solubilities

F they are INCOMPLETELY ABSORBED; with HIGH protein binding, etc

Typical neuroleptics Peak plasma concentration : ____ hours Half life: _____ hours Metabolized in the liver with steady state in ____ days

Peak plasma concentration : 1-4 hours Half life: 10-20 hours Metabolized in the liver with steady state in 5-10 days

T/F: Typical neuroleptic aliphatics such as Chlorpromazine and Levomepromazine are already phased out

This drug comes in handy especially when there is an agitated patient in the ER, due to its fast sedation and de-escalation of violence or aggression

Haloperidol Class Butyrophenone

This very good antipsychotic but behaves like an atypical psychotic is used at low doses as adjunct for negative thoughts if a person is depressed

Amisulpride Class Benzamide

These three medications are injectables good for 1 month. Ideal for patients who are noncompliant and find it hassle to take medicine everyday

Fluphenazine Flupenthixol Haloperidol

T/F: Oral forms of therapy are necessary for patients who are too agitated or incapacitated to comply with treatment

F Parenteral forms

This adverse effect results from the blockade of dopamine receptors in the basal ganglia, and occurs upon intake of high-potency neuroleptics like ____________

Extrapyramidal Syndromes; haloperidol

This EPS syndrome occurs immediately after intake of neuroleptic, and involve sudden tonic contractions of the muscles of the tongue, neck, ,back, mouth and eyes Usual affected population: Drug to alleviate this EPS:_______________

Acute dystonia Young males Diphenhydramine

This EPS syndrome occurs after 1 week o f intake of medication causing motor restlessness, inability to keep legs and feet still Commonly affected population: Common in patients taking this atypical antipsychotic:

Akathisia Middle-aged Women Aripiprazole

T/F: Parkinsonism as an EPS may occur in the first months of treatment

F first weeks

Some of the manifestations of this EPS is drooling, mask-like facies, loss of postural reflexes

Parkinsonism Other manifestations: cogwheel rigidity, bradykinesia, tremor

What happens in patients with Tardive dyskinesia as EPS?

fasciculations of the tongue, choreoathetotic movements of the extremities and trunk occurs among chronic patients

T/F: Tardive dyskinesia is a late-onset movement disorder due to a disturbance in dopamine-acetylcholine balance in the basal ganglia

Best remedy for Tardive dyskinesia

Clozapine

4 discussed examples of EPS as a side effect of neuroleptics

Acute dystonia Parkinsonism Akathisia Tardive Dyskinesia

This is the most dreaded adverse effect of neuroleptic therapy, which causes rapid onset of muscular rigidity, fever, autonomic instability and altered levels of consciousness Can possibly treated with ____ and ___

Neuroleptic Malignant Syndrome Dantrolene and Bromocriptine

T/F: CV effects are associated with high potency neuroleptics like Levomepromazine and Chlorpromazine CV Effects are very common with the atypical antipsychotic _______

F Must be low-potency - Quetiapine

Hypothalamic effects cause (increased/decreased) libido and (increased/decreased) appetite; hypersecretion of prolactin is also common in drugs ________ and _________

Decreased Libido Increased Appetite Risperidone and Amisulpride

Agranulocytosis is usually associated with this neuroleptic ______

Clozapine

T/F: Dermatologic effects may be observed in patients with schizophrenia

Aripriprazole is a (typical/atypical) antipsychotic Dose range: _____ Peak plasma: Half life:

Atypical 5-30 mg Peak plasma: 3-5 hours Half life: 75 hours

Clozapine is a (typical/atypical) antipsychotic Lowest and highest doses__ Peak plasma: Half life:

Atypical Lowest dose: 25 mg highest: 800 mg Peak plasma: 2 hours Half life: 12 hours

Risperidone and paliperidone can cause prolactin changes and can cause ______ at high doses

Parkinsonism

Risperidone is a (typical/atypical) antipsychotic Dose range: _____ Peak Plasma: Half life

Atypical 0.5-6 mg Peak plasma: 1 hour Half life: 20 hours -> once daily

Paliperidone is a (typical/atypical) antipsychotic T/F: Available in oral form

Atypical F- available as long acting injection

Olanzapine is a (typical/atypical) antipsychotic Dose range: _____ Peak Plasma: Half Life:

Atypical 10-20 mg Peak plasma: 5 hours Half life:31 hours

this atypical neuroleptic is for treatment-resistant schizophrenia

Clozapine

Risperidone is the first line treatment for: (SAPA)

Schizophrenia Aggression Psychotic Depression Acute Mania same as olanzapine, quetiapine, aripiprazole

T/F: risperidone is notorious for weight gain

F Olanzapine

Quetiapine Peak plasma: Half life:

peak plasma: 1-2 hours Half life: 7 hours

Quetiapine 25 (low dose) can be used for ________ 75-150 (mid dose) mg can be used for ____ 300-600 mg can be used for __________ 400-800 and above can be used for _________

Insomnia Anxiety Psychotic Disorders Bipolar Disorder

Cleanest neuroleptic

Aripiprazole but worst effect is akathisia

What is electroconvulsive therapy?

This is reserved for patients with severe psychotic symptoms, suicidal/homicidal patients, to also treat treatment-resistant schizophrenia It is done once daily, with 2 more administrations if significant improvement is observed. add 2 more if significant improvement after 4 days

what are the other biological therapies for faster recovery of patient who just relapsed?

Electroconvulsive Therapy Vagus Nerve Stimulation Transcranial MAgnetic Stimulation Psychosurgery

Psychotic Disorders Flashcards

(80 cards)