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28 Cards in this Set
- Front
- Back
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In schizophrenia, hallucinations and delusions are regarded as what type of symptoms?
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Positive
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Delusions and hallucinations are each defined as disturbances of what?
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Delusions = disturbances of thought content
Hallucinations = disturbances of perception |
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What are the negative symptoms of schizophrenia? (4 A's + 2)
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1. Affective blunting - decreased expression or feeling
2. Anhedonia - diminished emotional range 3. Alogia - poverty of speech 4. Avolition - decreased goal directed behavior, decreased drive & interest 5. Diminished social drive 6. Diminished sense of purpose |
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What is the differential diagnosis for negative symptoms?
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Antipsychotic EPS side effects
Psychosis Depression and anxiety Demoralization |
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What are four environmental risk factors for developing schizophrenia?
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1. OB trauma
2. In-utero events 3. Substance abuse 4. Stressful life events |
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Hallucinations are caused by overactivity of what system?
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Limbic
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What anatomical brain changes are typically associated with schizophrenia?
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Loss of gray matter with expansion of the ventricles
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What are the non-cognitive symptoms in dementia? (6)
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1. Depression
2. Delusions 3. Hallucinations 4. Personality changes 5. Agitation 6. Sleep disturbance |
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What is the mechanism of memantine?
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NMDA blocker
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What are the four major causes of delirium?
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1. Underlying medical condition
2. Substance intoxication 3. Substance withdrawal 4. Combination of any of the above |
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What is the time course for delirium?
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Develops over short period (hours to days) and usually resolves in 10-12 days (may last up to 2 months)
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What are the clinical features of delirium? (8)
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1. Prodrome
2. Fluctuating course 3. Attentional deficits 4. Arousal/psychomotor disturbance 5. Impaired cognition 6. Sleep-wake disturbance 7. Altered perceptions 8. Affective disturbances |
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What are the 11 specific causes of delirium?
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"I WATCH DEATH"
1. Infections (encephalitis, meningitis, sepsis) 2. Withdrawal (ETOH, sedative-hypnotics, barbituates) 3. Acute metabolic (acid-base, electrolytes, liver or renal failure) 4. Trauma (brain injury, burns) 5. CNS Pathology (hemorrhage, seizures, stroke, tumor (mets)) 6. Hypoxia (CO poisoning, hypoxia, pulmonary or cardiac failure, anemia) 7. Deficiencies (thiamine, niacin, B12) 8. Endocrinopathies (hyper- or hypo-adrenocortisolism, hyper- or hypoglycemia) 9. Acute vascular (hypertensive encephalopathy and shock) 10. Toxins or drugs (pesticides, solvents, meds, drugs of abuse) 11. Heavy metals (lead, manganese, mercury) |
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What is the potentially fatal complication associated with haloperidol and inapsine?
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Torsade de pointes
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Benzodiazepines are contraindicated in delirium due to what?
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Hepatic encephalopathy
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What is the effect of dopamine blockade in: a) limbic and frontal cortical regions, b) basal ganglia, and c) hypothalalmic-pituitary axis?
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a) Limbic and frontal cortical regions = antipsychotic effect
b) Basal ganglia = extrapyramidal side effects (EPS) c) Hypothalamic-pituitary axis = hyperprolactinemia |
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What adjunctive medications can be used in the management of akathisia in a patient on an antipsychotic?
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Propanolol (or other beta-blocker)
Benztropine Benzodiazepines |
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What is considered the worst of the extrapyramidal side effects caused by antipsychotics?
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Tardive dyskinesia
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Neuroleptic malignant syndrome is a side effect of what?
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Antipsychotics
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What is the general difference between the typical and atypical antipsychotics?
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Typicals primarily act on D2 receptors
Atypicals have less D2 affinity and more 5-HT affinity |
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Clozapine is most effective at treating what type of schizophrenic symptoms?
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Positive
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What is the major side effect of clozapine?
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Agranulocytosis
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What is the major advantage, in terms of side effects, of clozapine over a typical anti-psychotic?
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No EPS or TD
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As a group, what side effects are caused by atypical antipsychotics that do not occur with typicals? (2)
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Weight gain
Metabolic problems |
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What are some contraindications/substantial risk factors for ECT?
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1. Space-occupying cerebral lesion
2. Recent MI with unstable cardiac function 3. Recent intracerebral hemorrhage 4. Bleeding, or otherwise unstable, vascular aneurysm or malformation 5. Retinal detachment 6. Pheochromocytoma 7. Anesthetic risk rated at ASA level 4 or 5 |
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What are the six components of anesthetic management in ECT?
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1. Pretreatment with anticholinergic agents
2. Short-acting barbiturate 3. Induction of paralysis 4. Blockade of succinylcholine-induced fasciculation's 5. Blockade of cardiovascular response 6. Maintenance of airway |
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What are five medications often withdrawn or decreased prior to and/or during ECT?
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1. Theoyphylline
2. Lithium 3. Benzodiazepines 4. Anticonvulsants 5. MAOIs |
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What are four advantages to transcranial magnetic stimulation?
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1. No muscle relaxation
2. No anesthesia 3. Seizure can be avoided 4. Minimal cognitive side effects |
