Psychosis clinical
30 important questions on Psychosis clinical
What are the criteria for diagnosing schizophrenia according to DSM-5?
Presence of at least two of the following:
- Delusions
- Hallucinations
- Incoherent speech
- Seriously chaotic behavior
- Negative symptoms
- Social or occupational dysfunction
Symptoms present continuously for at least 6 months
Exclusion of primary mood disorders and drug use or general medical conditions
What is the approximate prevalence of schizophrenia in the worldwide population?
What is the typical onset age for schizophrenia in men and women?
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What are the percentages of substance abuse among patients with schizophrenia?
- Alcohol: 40%
- Cannabis: 20%
- Cocaine: 7%
What percentage of patients with a first psychotic episode eventually receive a diagnosis of schizophrenia?
What are the different global courses of schizophrenia as mentioned?
- 35%: Multiple episodes, no or slight reduction in functioning
- 10%: Multiple episodes with steady loss of functioning
- 35%: Reduction in functioning increases with each episode
What are the effects of the treatment on positive symptoms and new episodes prevention?
- Effective in preventing new episodes
Which motor side effects are frequent in antipsychotics with strong D2 receptor binding?
- Tardive dyskinesia
- - Involuntary movements in face
- - Do not always disappear after cessation of medication
- Dystonia
- - Involuntary muscle spasm
What are examples of metabolic side effects mainly associated with atypical antipsychotics?
- Increased cholesterol
- Diabetes mellitus
How can metabolic syndrome in patients on antipsychotics be managed?
- Switch to another antipsychotic (classical, aripiprazole)
- Monitor metabolic parameters before and during use (eg. weight, glucose)
- Provide diet advice; stimulate exercise
- Add metformin if needed
What new developments have been made in reducing weight gain associated with olanzapine use?
- Semaglutide (Ozempic) for weight loss and blood glucose reduction in obese individuals
What are the symptoms of a manic episode?
- Irritability
- Grandiose ideas (e.g. thinking one is God)
- Diminished need for sleep
- Racing thoughts, speech
- Decreased attention
- Increased activity
- Painful consequences of seeking pleasure
What are the characteristics of bipolar disorder?
- Affects 1% of population
- Onset peaks around 20-25 years of age
- 10% risk of suicide
- 80% heritable factors
What are the pharmacotherapy options for bipolar disorder?
- Anti-epileptics: valproate, carbamazepine
- - Block ion channels
- - Can cause birth defects
- Antidepressants, if necessary in persistent depression
- Benzodiazepines in acute phase
What is the estimated percentage of heritable factors contributing to bipolar disorder? What is the role of the environment in causing this disorder?
- Environment plays a minor role in triggering episodes
What is the first step in pharmacotherapy for bipolar disorder?
What is the initial pharmacological approach for acute mania in bipolar disorder treatment?
- Benzodiazepines can also be used
How should pharmacotherapy be escalated in bipolar disorder treatment if necessary?
What precaution should be taken when treating depression in bipolar disorder with pharmacotherapy?
- Beware of inducing mania during treatment
How long does it typically take for the effects of pharmacotherapy to be visible in manic episodes of bipolar disorder? And in cases of depression?
- In depression, the effect may take 4-6 weeks to show
What are the side effects of lithium treatment for depression and bipolar disorder?
- Dry mouth, thirst
- Thyroid disorder
- Risk of kidney failure
- Increased urination
- Fluid retention
- Weight gain
- Strict regulation of blood levels
- Irreversible brain damage with three times increase
How can valproic acid impact pregnancy when used for epilepsy?
- Open spine, cleft lip, heart defects, limb defects
- Extra caution with women of childbearing age
- Importance of warning and contraceptives
What is emphasized in the treatment of bipolar disorder?
- Prominence of biological factors
- Pharmacotherapy
- Minor role of psychotherapy
- Mention of ECT
Why are the names of psychotropic drugs considered confusing?
- Often effective across diagnoses
- Symptoms overlap between disorders
What are the two leading candidate mechanisms of lithium action in the nervous system?
- Action of lithium on the Wnt signaling pathway
How does valproic acid affect synaptic levels of γ-aminobutyric acid (GABA)?
- It blocks convulsive effects of GABA A receptor antagonists
What are the two known mechanisms of carbamazepine that are relevant to its antiepileptic effect?
- Carbamazepine blocks presynaptic sodium channels
How does lamotrigine work at the cellular level to reduce excitatory effects in the nervous system?
- Lamotrigine inhibits low-voltage sodium channels
How does carbamazepine inhibit repetitive firing of action potentials in neurons?
- This results in use-dependent and voltage-dependent block, inhibiting repetitive firing of action potentials
What effect does lamotrigine have on serotonin and dopamine reuptake?
- However, it is unclear if these properties confer antidepressant benefits
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