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75 Cards in this Set
- Front
- Back
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Psychotic implies the inability to ___ ___? and manifests itself what 5 symptoms
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test reality
hallucinations delusions disorganized thinking and speech referential thinking frequent illusional perceptions |
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what is disorganized thinking in schizophrenia
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problems with information organization and interpretation that are best assessed in the speech patterns of patients
loose associations derailment tangentiality word salad |
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what are examples of disorganized behavior
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silliness
unpredictable anger disheveled odd or unusual dress inappropriate sexual activity stereotypic motor activity |
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abnormalities that lead to suspected impaired neuronal communication are:
excess____ in the _____ pathway decreased_____ in the ____ pathway excess____ decreased ____ decreased____ (neurotransmitter) |
excess dopamine, mesolimbic
decrease dopamine in mesocortical excess glutamate decreased GABA decreased serotonin |
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what % of the population are schizophrenic
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1-1.5%
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What 3 areas are higher rates of schizophrenia
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urban born
first born lower socioeconomic status |
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how does the incidence of schizophrenia effect men and woman
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equally
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onset of schizo in men
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18-25 years
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onset of Schizo in women
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25-35 years
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what has a pathological and prognostic significance in schizophrenia
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age of onset
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Psychotic implies the inability to ___ ___? and manifests itself what 5 symptoms
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test reality
hallucinations delusions disorganized thinking and speech referential thinking frequent illusional perceptions |
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what is disorganized thinking in schizophrenia
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problems with information organization and interpretation that are best assessed in the speech patterns of patients
loose associations derailment tangentiality word salad |
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what are examples of disorganized behavior
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silliness
unpredictable anger disheveled odd or unusual dress inappropriate sexual activity stereotypic motor activity |
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abnormalities that lead to suspected impaired neuronal communication are:
excess____ in the _____ pathway decreased_____ in the ____ pathway excess____ decreased ____ decreased____ (neurotransmitter) |
excess dopamine, mesolimbic
decrease dopamine in mesocortical excess glutamate decreased GABA decreased serotonin |
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what % of the population are schizophrenic
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1-1.5%
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What 3 areas are higher rates of schizophrenia
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urban born
first born lower socioeconomic status |
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how does the incidence of schizophrenia effect men and woman
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equally
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onset of schizo in men
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18-25 years
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onset of Schizo in women
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25-35 years
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what has a pathological and prognostic significance in schizophrenia
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age of onset
|
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Psychotic implies the inability to ___ ___? and manifests itself what 5 symptoms
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test reality
hallucinations delusions disorganized thinking and speech referential thinking frequent illusional perceptions |
|
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what is disorganized thinking in schizophrenia
|
problems with information organization and interpretation that are best assessed in the speech patterns of patients
loose associations derailment tangentiality word salad |
|
|
what are examples of disorganized behavior
|
silliness
unpredictable anger disheveled odd or unusual dress inappropriate sexual activity stereotypic motor activity |
|
|
abnormalities that lead to suspected impaired neuronal communication are:
excess____ in the _____ pathway decreased_____ in the ____ pathway excess____ decreased ____ decreased____ (neurotransmitter) |
excess dopamine, mesolimbic
decrease dopamine in mesocortical excess glutamate decreased GABA decreased serotonin |
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what % of the population are schizophrenic
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1-1.5%
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What 3 areas are higher rates of schizophrenia
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urban born
first born lower socioeconomic status |
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how does the incidence of schizophrenia effect men and woman
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equally
|
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onset of schizo in men
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18-25 years
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onset of Schizo in women
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25-35 years
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what has a pathological and prognostic significance in schizophrenia
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age of onset
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what is characteristic of early age onset schizo
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tend to be men
poorer premorbid functioning more structural brain abnormalities more prominent negative symptoms more cognitive impairment poorer prognosis |
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what is characteristic of later age of onset of schizo
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tend to be women
less structural abnormalities less cognitive impairment better prognosis |
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what are positive symptoms (8) and are caused by
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hallucinations
delusions referential thinking disorganized behavior hostility gradiosity mania suspiciousness caused by increased dopamine in the mesolimbic pathway |
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what are negative symptoms and caused by (7)
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affective flattening
algoia or poverty of speech avolition apathy abstract thinking problems anhedonia attention deficits best respond to atypical AP caused by a decrease in dopamine in the mesocortical pathway |
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what are 5 associated symptoms of schizophrenia
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inappropriate affect
dysphoric mood depersonalization derealization high anxiety |
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what is the diagnostic criteria for schizophrenia
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two or more of the following frequently present during a one month period and only one of the delusions are bizarre or hallucinations consist of voice that is a running commentary or two or more voices conversing with each other
delusions- bizarre and unorganized type, example is loss of control over mind and body hallucination- bizarre and unorganized type (not likely to occur) disorganized speech grossly disorganized behavior presence of negative symptoms duration last for at least 6 months**** |
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what happens to negative and positive symptoms in schizophrenia
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negative symptoms tend to appear first and persist over time.
positive symptoms decrease over time |
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what are factors predictive of good outcome
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good premorbid functioning
acute onset later stage onset clear precipitating even married client good support system positive symptoms absence of brain abnormalities family history of a mood disorder |
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what are the physical exam findings in schizophrenia
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abnormal smooth pursuit eye movement
abnormal saccadic eye movement poor eye hand coordination "clumsy" or "awkward" soft signs Astereognosis dysdiadochokinesia (impairment of rapid alternating movements) impaired fine motor movemement left-right confusion mirroring hard signs - weakness or decreased reflexes highly arched palate narrow or wide set eyes malformations of the ears |
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what is the differential diagnosis of schizophrenia
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epilepsy
CNS neoplasm AIDS acute intermittent porphyria B12 deficiency heavy metal poisening huntingtons disease neurosyphiils Lupus Wernicke-Korsakoff Wilsons disease Bipolar substance induced psychotic disorder |
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SDAs block dopamine in this pathway causing decreased positive symptoms
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mesolimbic pathway
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SDAs increase dopamine in this pathway decreased negative symptoms
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Mesocortical pathway
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What pathway?
dopamine has a reciprocal relationship with ACh. When serotonin is blocked by the SDA, dopamine increases, therefore ACh decreases which causes decreased EPS |
Nigrostriatal pathway
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EPS is caused by an increased ____?
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ACh
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What pathway?
Dopamine inhibits prolactin. The blockade of dopamine by SDAs causes prolactin to increase, causing galactorrhea |
tuberoinfundibular pathway
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why is it that or what is associated with hyperprolactinemia
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sexual problems, glactorrhea, amenorrhea, and bone demineralization in postmenopausal women not on estrogen
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for Clozaril how often do you check WBC count during
the first 6 months second 6 months then |
every week
then every 2 weeks then every month if WBC/ANC normal |
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what lab is elevated with Seroquel and what do you have to monitor for
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LFTs
Cataracs |
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what atypical antipsychotic causes the most prolactin elevation
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Risperdal
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What SDA requires QTc monitoring
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Geodon
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With Geodon what are the indications of ingestion
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with food increases absorption twofold
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What class of drugs does NOT help with negative symptoms of schizophrenia
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typical AP
makes it worse by blocking dopamine in the mesocortical pathway |
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describe high potency vs low potency
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high potency- has a greater risk of EPS but less risk of sedation and ACh symtpoms
low potency- low risk of EPS but a greater risk of sedation and anticholinergic side-effects. |
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what does nicotine and caffeine do to antipsychotics
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causes a diminished effect
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how do you treat EPS
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anticholinergics
antihistimines dopamine agonists benzodiazapines |
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what test is used to detect TD
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AIMS every 3-6 months
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what are the 4 risk factors for TD
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long term tx
older age female mood/cognitive d/o |
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NMS
occurance risk factors labs (3) symptoms (3) autonomic instability (7) treatment (4) |
occurs in both types of AP at any time
rapid dose escalation use of high potency TAP parental administration of AP labs high CPK, WBC, LFT Assess altered sensorium hyperthermia, hyper reflexia hypotention extreme muscle ridgidity hyperthermia tachycardia diaphoresis tachypnea coma/death tx immediate medical intevention discontinuation of AP meds supportive tx administration of Dantrium or Parlodel |
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What is Akathisia
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Motor restlessness, inability to remain still, rocking, pacing, or constant motion of unilateral limbs (mistaken for anxiety often)
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What is akinesia
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absense of movement, difficulty initiating motion, subjective feeling of lack of motivation to move
mistaken for laziness or lack of interest |
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dystonia
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muscle spasm, painful but not clinically significant
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pseudo-parkinson's
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presence of symptoms of Parkingson's disorder prodcued by D2 blockade, shuffling gait, motor slowing, mask-like facial expression, pill rolling, tremors and muscle rigidity
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what 9 meds are used to treat EPS
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Cogentin, Kemadrin, Artane, (all anticholinergics) Benadryl
Almost all symptoms of EPS (above, except Benedryl no on the Akathisia) symmetrel (dopamine agonist) inderal (akathisia only) Catapres (akathisia only) Klonopin( Akathisia and dystonia) Ativan (akathisia and Dystonia only) |
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what 2 problems result in alpha adrenergic blockade
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Cardiovascular
orthostatic hypotension |
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what are the 4 muscarinic cholinergic blockade
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dry mouth
blurred vision constipation urinary retention |
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endocrine S/E
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weight gain
prolactin levels increase |
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what type of therapy is used to treat hallucinations and delusions
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CBT
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what does group therapy focus on in Schizophrenics (4)
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problem solving
education medication life-skills |
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what are the rates of substance abuse in schizophrenia
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20-40%
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what % of schizophrenics commit suicide
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10%
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what are the 9 risk factors for suicide in a psychotic person
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male
age 45 or less hopeless depressive symptoms unemployed noncompliance recent hospitalization post psychotic period comorbid substance use |
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considering lifespan what are 3 risk factors
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postmenopausal states
human leukocyte antigen positive family history |
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what is the difference between schizophrenia and schizophreniform disorder
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total duration of illness is at least one month but less than 6 months including prodromal active, illness period and residual phase
does not require for diagnosis that there be impaired social or occupational functioning, although may be present |
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what is the diagnostic criteria of Schizoaffective D/O
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at lease one month of symptoms of schizophrenia and on or more mood disorders
presence of delusions OR hallucinations for at least 2 weeks in the absence of prominent mood symptoms |
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what are the 6 types of Delusional disorder
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Erotomanic
Grandiose Jealous Persecutory Somatic Mixed |
