Psychotic Disorders

Front 1

3 Hallmark features of Psychosis

Back 1

Delusion Hallucination and Loosening of Associations

Front 2

3 Negative-Lack of abilities for Psychosis

Back 2

avolition, Apathy and blunted affect

Front 3

Schizofenia Remission Defn:

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reduction in pos and neg symptoms for at least 6 months usually with treatment

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Schizofrenia Rule of Thirds

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1/3 good outcome,, 1/3 chronic course, 1/3 dont respond to treatment

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single criterion diagnosis for Schizofrenia

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Running commentary on behavior or two voices conversing with each other

Front 6

What two disorders are important to exclude from Schizofrenia?

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rule out Schizoaffective disorder and mood disorder + make sure no bipolar episodes

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Differences in Schizophreniform Disorder

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it has a short duration,

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Brief Psychotic Disorder

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it has a short duration and ambivalent to psychosis

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Schizoaffective Disorder Differents

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it has bipolar and or mood episodes during active symptoms and other positve symptoms

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Bipolar Disorder Type 1

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has bipolar episodes but NO other active symptoms

Front 11

Clonazapine use and chief SE

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use after failed two trials andcan cause agranulocytosis

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How to manage acute psychosis

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Benzos and mood stabilizers at Valproic acid

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How to treat catatonia

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benzos and ECT

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treating cognitice deficits and negative symptoms

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no drugs

Front 15

prototypical high-potency antipsychotic

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Haloperiodol

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High potency antipsychotics bind what and cause what SE>

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bind D2 receptors and cause extrapyramidal side ffects

Front 17

Clonazapine SE

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sedation and anticholinergic SE from H1 and sert receptors

Front 18

Risperiodne MOA

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D2 / 5-HT2 receptor antagonists

Front 19

Risperidone Dose profile

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low does have low incidence of EPS but high doeses have higher likelyhood

Front 20

EPS SE Profile timeline hours days months years

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hours see dystonia, days see akathisia, months see PD, years see Tardive Dyskinesia

Front 21

Akathisia

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inability to sit still

Front 22

Tardive dyskinesia

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purposeless muscle contractions

Front 23

List the 4 relevant DA Pathways

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Mesolimbic Mesocortical Nigrostriatal tubero-infundibular

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what pathways do positive signs and symptoms com from

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mesolimbic pathway

Front 25

these drugs with one exception antagonize Dopamine D2 receptors

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antipsychotics with the exeption of atypica aripoprazole

Front 26

Blocking Dopa D2 receptors in the Nigrostriatal pathway causes what SE

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EPS

Front 27

Blocking D2 in the Tubero Infundibular pathways causes what SE

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hyperprolactinemia

Front 28

Blocking D2 in the mesolimibic pathway causes what

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efficacy against positive signs and symptoms

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4 main psychopathological domains of schizophrenia

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Positive signs and syms, negateive ss, cognitive dysfunction, mood/anxiety syms

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List as many negative signs and symptoms as you can (all start with A)

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attention deficits, asociality, anhedonia, avolition, alogia,

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Atypical antupsychotics work better for what signs and symptoms and for what degree

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treating negative signs and symptoms to a modest degree

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Only atypical antipsychotic that is better at treating positive signs and symptoms

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clozapine

Front 33

what does potency mean

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'potency' of D2 binding'

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Name two low potency Typical antipsychotics

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Thiooridazine and Chlorpromazine

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Name 4 high potency typical Antipsychotics

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Fluphenaine Trifluoperazine thithixine Haloperidol all the rest are mid-potency

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Are high potency drugs more efficacious then lower potency drugs

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No but dosing must be adjusted

Front 37

EPS, HPL, Tardive dyskines are more associated with which drug potency do to D2 blockade?

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High potency drugs

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low potency drugs have interactions with these receptors

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H-Histamine H1, Alpha1-Adrenergic, Muscarinic M1

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H1 receptor side effects

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sedation and weight gain

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a1 receptor side ffects

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orthostasis and reflex tachycardia

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M1 receptor side effects

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blurry visionm dry mouth, urinaary retenion and constripation

Front 42

Special CNS side effects of low potency antipsychotics

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lower seiszure threshold except Clozapine

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Special cardiax effects of low potency typical antipsychotics

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thiordazine -Qtc prolongation-->greats risk of torsadess

Front 44

SE from high does of thordazine

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reinitis pigmentosa

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SE of Low potency drugs that has to do with hypothalamus

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POMC can cause photosensitivity and skin discoloration

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2 typical neuroleptics (antipsychotics) available in depot forms

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Haloperidol and fluphenazine

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biggest reaspn for acute psychosis

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poor medication compliance

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4 forms of EPS

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Acute dystonia, Akathisia parkonsonism Tardive dyskinesia

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Akathisia defn

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uncomfortable stae of motor restlessnesss usually in the legs, look for pacing

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Tardive dyskinesia defn

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potentaially permanent slow writhing movements of the moth and tongue like gum chewing

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why is akathisia bad?

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predicts agitation and suicidal behavior

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patient becomes agitated and restlesss after being stated ona neuroleptic

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do not increaase does of antipsychotic it will make the akathinesia worse

Front 53

treatments for acute dystonia

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give anticholinergic drugs like benztropine and diphenylhydramine and if that doesnt work lorazepam

Front 54

how to treat aakathesia

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lower antipsychotic, use benzos or anticholinergics

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how to treat neuroleptic induced PD

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lower antipsychotic, switch to lower risk agent like atypical, like clonazapine or quietapine

Front 56

Predisposing factor of NMS

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antipsychotic s drugs

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predisposing factor of sert syndrome

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sert drugs often MAOI

Front 58

Mental changes in NMS and 5HT

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acute MS change delirium

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Cital sign changes in NMS and 5HT

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hyperpyrexia, tachycardia, labile htn

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Muscle changes in NMS

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lead pipe ridigid

Front 61

Muscle chagnes in 5HT

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hyperreflexia

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Labs to look for in NMS

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look for CK and WBC elecation

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hwo to traet neuroleptic malignant syndrome

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fluids, resp support and fever reuction

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3 Benefits of atypical antipsychotics

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lower eps risk,low hol risk, lower long term tardive dyskinesia risk

Front 65

Major pharm mechanism difference between of atypical antipsychotiscs

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atypicals aantagonize 5-HT2A recepters much more than D2 except for ariprazoelwhich is a D2 agonist

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Name an additional receptor taht clonazapine blocks

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D4 + 5Ht2A>D2

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Clonazpine benefits

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works when others dont and only drugs show to reduce suicidal behavior

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unique motuhs SE of clonazapine

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excess saliva

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describe risperdone bidnigna

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hHT2A>D2 but D2 is high potency then other atypicals

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weird SE of risperidone

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highes HPL risk

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describe metabolic profile of atypicals

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clonz and olanz are the worse, then risp and quietapine in the middle

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Describe HAM bidnign of risperdone

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low H and M but high A so high orthostasis risk

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Quiertapine receptor profile

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5HT2A>D2 but very low D2

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ziprasidone additional blockage

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blocks reuptake pumps and 5HTA1 agonist like buspirone

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Special zuprasidone intake considerations

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mist take with food or not absorbes

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Ziprasidone uses

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for schizofrenia and mood

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Ariprazole special bidnign

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D2 agonist and 5HT2A antagonist

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Aripirazole profile differecen

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partial D2 agonist

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ariprazole use

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schizofrenia dna cute menia