Psychotic

这是一篇关于Psychotic的思维导图，包括Brief psychotic disorder、Schizophreniform disorder、Schizophrenia、Schizoaffective disorder、临床表现等内容。

Psychotic

• Psychotic disorder
  • Brief psychotic disorder
  • Schizophreniform disorder
    • 发病时间
      • 1个月
  • Schizophrenia
    • 发病时间
      • ＞6个月
  • Schizoaffective disorder
    • Psychosis + mood disorder (mania or depression)
    • 发病时间
      • 1个月
  • 临床表现
    • Hallucination
    • delusion
    • disorganization sympton
      • formal
      • process
        • Perseveration
          • repeating the same words/answers.
        • Echolalia
          • repeating exactly what someone has said.
        • Neologism
          • making up new words.
        • Word salad
          • disorganised speech, sentences that do not make sense.
    • negative Sydrome
    • first-rank symptom of schizophrenia
      • A
        • Auditory hallucinations
      • B
        • Broadcasting of thoughts, withdrawal, insertion
      • C
        • Controlled emotions and actions, passive impulsivity phenomena
      • D
        • Delusional perceptions
• Delusional disorder/妄想性障碍
  • 定义
    • 妄想发作时没有心境障碍（depression/manic）没有精神分裂症（幻觉\瓦解综合征\阴性症状），女性以情爱型（erotomanic）
  • 临床类型
    • Othello
      • 配偶不忠，跟踪、限制外出等
    • Clerambanlt
      • 某异性对自己钟情
    • 疑病
    • 特点
      • 妄想形式固定，现实中可能发生的，符合逻辑的
• 治疗
  • Antipsychotic
  • ECT
  • 抗精神病藥物
    • 1st gen
      • chlorpromazine
      • haloperidol
    • 2nd gen
      • clozapine
        • 粒細胞缺乏症
          • 查FBC（Full blood count）
        • 惡性綜合徵
        • myocarditis
        • Clozapine reduces seizure threshold, making seizures more likely
      • olanzapine
        • higher risk of dyslipidemia and obesity（commonly）
      • risperidone
      • aripiprazole
        • particularly effective in preventing a rise in prolactin levels
  • 副作用
    • 锥体外系
      • 急性肌张力障碍/Acute Dystonia
        • sustained muscle contraction
          • oculogyric crisis(eye deviated upwards and inward and he started blinking repeatedly.)
            • anti-cholinergic procyclidine, which can take effect within 5-minutes
          • Torticollis（neck stiffness with restricted range of motion）
          • opisthotonus
      • 静坐不能/akathisia
      • 类帕金森/parkinsonism
        • bilateral resting tremor
      • 迟发型运动障碍/Tardive dyskinesia
        • involuntary chewing and pouting of jaw
          • Tetrabenazine
      • EPSEs(extrapyramidal side-effects) are more common with first-generation antipsychotics/Around 90% of these reactions occur within the first 4 days of initiation/ dose increase.
    • 恶性综合征/Neuroleptic malignant syndrome
      • rare but potentially life threatening side effect
    • hyperprolactinaemia/galactorrhoea
      • gynaecomastia, loss of libido and erectile dysfunction
    • 雜項
      • Antipsychotics in the elderly - increased risk of stroke and VTE
      • This is because when you start Clozapine after a break of >48 hours, it can make side effects worse
      • Patients with poor oral compliance to antipsychotics should be considered for once monthly IM antipsychotic depot injections
      • cigarettes that induce the CYP450 (1A2) activity, causing an increased metabolism of Clozapine
      • Sudden onset psychosis following course of corticosteroids – consider steroid-induced psychosis
      • The strongest risk factor for developing a psychotic disorder (including schizophrenia) is family history. Having a parent with schizophrenia leads to a relative risk (RR) of 7.5.
      • Pre-morbid social withdrawal is a poor prognostic indicator in schizophrenia, as is low IQ, family history of schizophrenia, gradual onset of symptoms and lack of an obvious precipitant.