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Psychosis 411

Psychosis and Schizophrenia

Disorders/conditions which may present symptoms of psychosis bipolar, depression, other: med induced, illicit substance-induced, precipitated by med conditions
Added to a pts normal presentation Positive Symptoms
Positive Symptoms Examples hallucinations/illusions, delusions, disorganized speech, grossly disorganized or catatonic behavior, paranoia/suspiciousness
Taken away from pts normal presentation Negative Symptoms
Negative Symptoms Examples Asociality, anhedonia, affective impairment, alogia, poverty of speech, amotivation
Cognitive Symptoms Examples poor concentration, memory disturbances, inability to plan, difficulty executing tasks, poor abstractation, impaired decision making
Typical Antipsychotics-Therapeutic benefit-receptor effects Dopamine blockade
Atypical antipsychotics-Therapeutic benefits-receptor effects Dopamine and Serotonin blockade
Dopamine blockade adverse events worse neg symptoms, EPS & TD, polactin elevation
Serotonin blockade adverse events sedation, weight gain
Typical Antipsychotics (1st gen) Chlorpromazine, Thioridazine, Mesoridazine, Perphenazine, Trifluoperazine, Fluphenazine, Thiothixene, Haloperidol, Loxaopine, Molindone
Atypical Antipsychotics (2nd gen) Clozapine, Olanzapine, Risperidone, Quetiapine, Ziprasidone, Aripiprazole, Clozapine
Sudden severe onset of abnormal posture (muscle movement). May involve tongue, jaw, eyes, neck, trunk, limbs, or toes. Usually 24-96 hrs after does Dystonia
Motor restlessness or inability to sit still. Pacing, shifting, shuffling, foot tapping, inner restlessness. Akathisia
Akinesia, bradykinesia, slowed speech, resting tremor, pill rolling tremor, cogwheel rigidity, postural abnormalities. Generally reversible Pseudoparkinsonism
Involuntary abnormal movements occurring late in onset in reaction to intiation of antipsychotic therapy. May include facial. tongue, limb, neck, or trunk movements. Early signs may be reversible, may become irreversible if undetected. Tardive Dyskinesia (TD)
Typical Antipsychotics Boxed Warning QTc prolongation: Thioridazine, Mesoridazine
Atypical Antipsychotics Black Box warning increased rate of death in elderly w/ dementia
Atypical Antipsychotics benefits Less EPS, less TD, less hyperprolactinemia (except Risperidone), may be better at improving neg symptoms and cognition
Atypical Antipsychotics Metabolic Complications weight gain, hyperglycemia, cardiovascular probs, new onset diabetes, hyperlipidemia, hypercholesterolemia
Clozapine (Atypical) For treatment resistant pts. Unique potency for treatment of persistent psychotic symptoms, neg symptoms, and suididality.
Clozapine ADR/contraindication Agranulocytosis
Chlorpromazine Typical Antipsychotics (1st gen)
Thioridazine Typical Antipsychotics (1st gen)
Mesoridazine Typical Antipsychotics (1st gen)
Perphenazine Typical Antipsychotics (1st gen)
Trifluoperazine Typical Antipsychotics (1st gen)
Fluphenazine Typical Antipsychotics (1st gen)
Thiothixene Typical Antipsychotics (1st gen)
Haloperidol Typical Antipsychotics (1st gen)
Loxaopine Typical Antipsychotics (1st gen)
Molindone Typical Antipsychotics (1st gen)
Clozapine Atypical Antipsychotics (2nd gen)
Olanzapine Atypical Antipsychotics (2nd gen)
Risperidone Atypical Antipsychotics (2nd gen)
Quetiapine Atypical Antipsychotics (2nd gen)
Ziprasidone Atypical Antipsychotics (2nd gen)
Aripiprazole Atypical Antipsychotics (2nd gen)
Clozapine Atypical Antipsychotics (2nd gen)
Created by: lbreimeir