Study Guide

Schizophrenia and other Psychotic Disorders

Bipolar Disorders
Substance Abuse
Emergency Psychiatry, including emergency presentation of reactions to psychotropic
medications
Anti-psychotic medications
Mood Stabilizer Medications
1) What is the differential diagnosis of acute psychosis? (This should be a long list,
which should include: primary psychiatric illness, medical/neurological illness,
and substance-related illness.) What is the overlap between this differential and
altered mental status (a phrase used frequently in internal medicine services)?
2) Put the diagnostic criteria for schizophrenia, acute mania, and substance-induced
psychosis, and psychosis secondary to a general medical condition side by side.
How can you go about distinguishing these disorders in the acute setting? What if
the patient is unable to give you history? If the patient can give you history, what
would you want to know? If you saw the patient over time, how would these
illnesses start to look different?
3) What are the similarities and differences between Psychosis Not Otherwise
Specified, Brief Psychotic Disorder, Schizophreniform Disorder, and
Schizophrenia? Pay particular attention to the time course of symptoms.
4) What are the positive symptoms of schizophrenia? What are the negative
symptoms?
5) Memorize the criteria for a manic episode. Memorize the criteria for a hypomanic
episode. You should know symptoms, duration, and degree of impairment in
functioning.
6) What is the difference between bipolar I disorder and bipolar II disorder?
7) What is the difference between substance abuse and substance dependence?
8) Know the desired effects, adverse effects (psychiatric and medical/neurological),
withdrawal effects, and presentation of overdose for all drugs of abuse, but
especially alcohol, cocaine, methamphetamine, and opiates.
9) Typical antipsychotics can be divided into high potency and low potency
drugs, based on their potency of dopaminergic blockade and anticholinergic side
effects. You should know a couple low potency and a couple high potency
typical antipsychotics.
10) Atypical antipsychotics: Why are these drugs now used as first line
antipsychotics, even though they are massively more expensive than typical
antipsychotics? How are the common side effects of atypical antipsychotics
different than those of typical antipsychotics?
11) What is the metabolic syndrome caused by atypical anti-psychotics?
12) What is the risk of using antipsychotic medications in elderly patients?
13) What are medications used (usually IM) to treat acute agitation in emergency
(medical and psychiatric) settings? What is meant by a cocktail for agitation?

14) Both tricyclic anti-depressants and monoamine oxidase inhibitor anti-depressants

can be fatal in overdose. How do people who have ODd on these medications
present in an emergency setting?
15) Lithium is a tremendously helpful and well-studied medication that can cause
many nuisance side effects, serious long-term effects, and death. What are the
early signs of lithium toxicity? What are the urgent and life-threatening signs of
lithium toxicity?
16) Valproic acid can cause damage to two different abdominal organs? Which ones?
17) All antipsychotics can cause the following side effects: acute dystonia, akathisia,
extra-pyramidal or parkinsonian symptoms, and tardive dyskinesia. Define all of
these symptoms. How soon do these symptoms appear after the patient takes their
antipsychotic? What is the treatment for each of these side effects?
18) What are the criteria in California for a 5150, or 72-hour involuntary psychiatric
hold? (This is not in your book. Ask residents and faculty.)
From 2nd edition of Blueprints Clinical Cases in Psychiatry:
Read cases 1, 16, 20, 26, 29, 30-38, 45, 59 & 60.