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19 Cards in this Set
- Front
- Back
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38 yo pt w/ paranoid schizophrenia is found lying in his bed w/ a temperature of 103F by his caseworker at home. +disorientation/rigid. Cause?
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NMS 2/2 use of antipsychotic (neurolepitc). Typically seen w/ high-potency. sx: ridigity, fever (2/2 thermogenic effect of muscle contraction), AMS, autonomic instability. Look for elevated CBC, CPK. and RF 2/2 to myoglobinuria.
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Treatment for NMS
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dc all meds, IVF, cooling blankets and antipyretics. If severe, can use bromocriptine (dopamine agonist) and dantrolene (muscle relaxant).
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What detail in history is useful to differentiate NMS v Malignant hypertermia?
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Hx of recent exposure to anesthetics or antipsychotics
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45 yo w/ chronic mental illness is seen constantly chewing, darting her tongue and smacking her lips.
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tardive dyskinesia 2/2 to exposure to traditional antipsychotics (high-potency usually).
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Prevalence of schizophrenia is siblings.
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10%. in first degree relatives its 1% and children of schizophrenics have a 12.8%
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in the absence of other symptoms, episodic automatisms and olfacotry hallucinations are suggestive of...
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olfactory hallucinations are rare in disorders other than temporal lobe epilepsy.
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What kind of hallucinations are predominant in schizophrenia?
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auditory
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for 6 weeks, college student has PI of mafia being after him, cameras in his apt w/ +AH. Past 2months has been withdrawn, disinterested in school and poorly-groomed.
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Schizophreniform d/o. differentiate from schizophrenia ONLY by duration of symptoms + prodromal.
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35 yo female has been hospital resident x 15 y. Spends her day rocking, muttering to self or staring into mirror. Needs assistance for ADL and giggles for no reason.
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Schizophrenia, disorganized type. Look for disorganized speech, flat or inappropriate affect, functional impairment and inability to perform basic activities.
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Hospitalized patient w/ CMI is mute and immobile x 2weeks. Occasionally has brief periods of sudden, unprovoked agitated and aggressive behavior.
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Catonia. Looked for marked psychomotor disturbances (prolonged immobility, posturing, extreme negativism waxy flexibility, mutism, echolalia and echopraxia. Periods of agitation (catatonic excitement) can be seen too.
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45 yo legal secretary lives isolated but unremarkable life. Has written hundreds of love letters to famous movie star. Convinced that star's wife is keeping them apart.
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Delusional disorder. Presence of 1 or more NON-BIZARRE delusions w/o deterioration of psychosocial functioning and in the absence of bizarre or odd behavior. Hallucinations, if present are related to delusional theme.
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25 yo college student has 6mo hx of strange behavior and weird ideas. 6 weeks PTA, +PI/AH. Talking in disorganized and obscure way. +Depression/weight loss/insomia. Dx?
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Schizoaffective disorder. +schizophrenia criteria AND persistence major depressive episode or a manic episode.
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Characterization of thought disorder
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disturbance of the flow of the ideation including thought blocking, poverty of speech and lifht of ideas. Concrete and illogical thinking are forms of formal thought disorder. No form is disorder-specific
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Contraindications of clozapine
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pre-existing seizure disorder. Also can cause agranulocytosis (get weekly CBC)
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47 yo homeless F attempts suicide by jumping off bridge but doesn't die. +PI. treated with risperidone and sertraline. 3 weeks s/p SA, patient mood improved but NOT PI. 3 similar episodes in the past 10 years. Dx?
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Schizoaffective d/o. Look for depressive or manic episodes superimposed on schizophrenia sx. Notice how treatment only improved her mood but psychosis persist (v. psychotic depression, where always associated with affective sx)
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T/F: critical families of schizophrenia patients have NO effect on patient.
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False. Family therapy has proved to reduce relapse rate in schizophrenia.
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antipsychotic recommendation for patient w/ prevalence of negative sx.
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clozapine and olanzepine. Start with olanzepine since clozapine can cause agranulocytosis.
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indications for clozapine
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refractory schizophrenia, treatment of severe TD and psychotic symptoms in patient's with Parkinson's
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45 yo women treated w/ antipsychotic medication develops an uneven pigmentation over her face, shoulders, and arms after a trip to the beach. Medication?
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photosensitization effect is a common side effect in low-potency antipsychotics like chlorpromazine. wear sun block
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