Psychotic Disorders

Question 1

What 2 elements of diagnostic criteria should you focus on?

Answer 1

Duration of symptoms and Severity of symptoms

Question 2

What is the duration of a Brief Psychotic Disorder?

Answer 2

> 1 day but <1 month

Question 3

What are common symptoms in a Brief Psychotic Disorder ?

Answer 3

Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior

Question 4

How do you treat Brief Psychotic Disorder ?

Answer 4

Antipsychotic medications

Question 5

What is the duration of Schizophreniform disorders?

Answer 5

> 1 month but < 6 months

Question 6

What are common symptoms in Schizophreniform disorders?

Answer 6

Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior and negative symptoms

Question 7

What are common negative symptoms?

Answer 7

Flat affect, poor grooming, social withdrawal

Question 8

How do you treat Schizophreniform disorders?

Answer 8

Antipsychotic medications

Question 9

What is the duration for Schizophrenia?

Answer 9

> 6 months

Question 10

What are common symptoms of Schizophrenia?

Answer 10

Delusions, hallucinations or disorganized speech
Grossly disorganized or catatonic behavior and negative symptoms
Severely affected level of functioning

Question 11

How do you treat Schizophrenia?

Answer 11

Antipsychotic medications

Question 12

What receptors are associated with Positive symptoms?

Answer 12

Dopamine -Receptors

Question 13

What receptors are associated with Negative symptoms?

Answer 13

Muscarinic-Receptors

Question 14

What must you first do to diagnose Schizophrenia?

Answer 14

Urine drug screen to r/o cocaine or amphetamine use

Question 15

What are the diagnostic criteria for schizophrenia?

Answer 15

> 6 months with 2 or more of the following
-Delusions, hallucinations, disorganized speech
-Negative symptoms, disorganized or catatonic behavior

at least 1 symptom must be Delusion, hallucination or disorganized speech

Question 16

What is seen on CT in patients with Schizphrenia?

Answer 16

Third ventricle enlargement with decreased cortical volume

Question 17

What is seen on PET scan in patients with schizophrenia?

Answer 17

Hypoactive Frontal lobes and Hyperactivity in the basal ganglia

Question 18

How do you treat Schizophrenia?

Answer 18

Hospitalize acutely psychotic patients
Ensure patient safety and use atypical antipsychotics as 1st line
consider long-acting antipsychotic for noncompliant patients

Question 19

What is the most effective drug for treatment-resistant Psychosis?

Answer 19

Clozapine: not used 1st line due to adverse effects

Question 20

When is Clozapine use indicated?

Answer 20

Patients have no response to 2 trials of typical or atypical antipsychotics: never a first line drug

Question 21

What are good prognostic factors in Schizophrenia?

Answer 21

Late onset, rapid course, positive symptoms, absence of family history, lack of structural brain abnormalities

Question 22

What are the 2 major suffixes for atypical antipsychotics?

Answer 22

-Pines and -Dones

Question 23

What adverse effects are associated with the “-Pine” atypical antipsychotic drugs?

Answer 23

Increased risk of weight gain, metabolic syndrome and diabetes

Question 24

What are commonly used “-Pine” atypical antipsychotics?

Answer 24

Olanzapine
Quetiapine
Asenpine
Clozapine

Question 25

What adverse effects are associated with the "-Done" atypical antipsychotic drugs?

Answer 25

Increased risk of movement disorders, cardiac conduction problems

Question 26

What are commonly used "-Done" atypical antipsychotic drugs?

Answer 26

Risperidone Lurasidone Ziprasidone Iloperidone

Question 27

What side effects are associated with Olanzapine?

Answer 27

Greater incidence of DM and Weight gain: avoid in patients with DM and obesity

Question 28

What side effects are associated with Risperidone?

Answer 28

Increased incidence of movement disorders

Question 29

What side effects are associated with Quetiapine?

Answer 29

Lowe incidence of movement disorders: most appropriate to use in patients who already have movement disorders

Question 30

What side effects are associated with Ziprasidone?

Answer 30

Increased risk of QT prolongation: avoid in patients with conduction defects

Question 31

What side effects are associated with Aripiprazole?

Answer 31

Compulsive behaviors: gambling

Question 32

What side effects are associated with Lurasidone?

Answer 32

Safe to use in pregnant patients

Question 33

What atypical antipsychotics are least likely to cause weight gain?

Answer 33

Aripiprazole and Ziprasidone

Question 34

When does Acute dystonia due to Antipsychotic medication present?

Answer 34

Hours to days

Question 35

What are common symptoms of Acute dystonia due to Antipsychotic medication?

Answer 35

Muscle spasms, torticollis, laryngeal spasms, oculogyric crisis

Question 36

How do you treat Acute dystonia due to Antipsychotic medication?

Answer 36

Benztropine Trihexyphenidyl Diphenhydramine

Question 37

When does Akathisia due to antipsychotic medication present?

Answer 37

weeks

Question 38

What are common symptoms of Akathisia due to antipsychotic medication?

Answer 38

Generalized restlessness, pacing, rocking, inability to sit still

Question 39

How do you treat Akathisia due to antipsychotic medication?

Answer 39

Reduce dose, Beta-blockers, switch to atypicals, benzodiazepines

Question 40

When does Tardive Dyskinesia due to antipsychotic medication present?

Answer 40

Rare before 6 months

Question 41

What are common symptoms of Tardive Dyskinesia due to antipsychotic medication?

Answer 41

Abnormal involuntary movements of the head, limb, or trunk Perioral movements are the most common

Question 42

How do you treat Tardive Dyskinesia due to antipsychotic medication?

Answer 42

Switch to atypical antipsychotic: clozapine has the lowest risk Valbenazine, Tetrabenazine, Deutetrabenazine

Question 43

When does Neuroleptic Malignant Syndrome (NMS) due to antipsychotic medication present?

Answer 43

No specific time

Question 44

What are common symptoms of Neuroleptic Malignant Syndrome (NMS) due to antipsychotic medication?

Answer 44

Muscular rigidity, fever, autonomic changes, agitation and obtundation

Question 45

How do you treat Neuroleptic Malignant Syndrome (NMS) due to antipsychotic medication?

Answer 45

Dantrolene or Bromocriptine

Question 46

What is Schizoaffective disorder?

Answer 46

Uninterrupted period of mood symptoms that meet the criteria for MDD or Bipolar + psychotic symptoms

Question 47

What are the diagnostic criteria for Schizoaffective disorder?

Answer 47

MDD must be present for the majority of the total duration of the disorder Psychotic symptoms must be present at least 1 month and must be present when there are no mood symptoms for at least 2 weeks

Question 48

How do you treat Schizoaffective disorder?

Answer 48

Determine if Hospitalization is indicated Antidepressant and/or mood stabilizer: for mood symptoms Antipsychotic for Psychotic symptoms

Question 49

What is a delusional disorder?

Answer 49

Prominence of Non-bizzare delusions (false but plausible) for >1 month with no impairment in level of functioning

Question 50

How do you treat Delusional Disorder?

Answer 50

Atypical Antipsychotic agents are 1st line Consider adding Psychotherapy to promote reality testing