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30 Cards in this Set
- Front
- Back
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Schizophrenia: Vermont Model
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Self-sufficiency, rehabilitation and community integration
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Schizophrenia: Positive Symptoms
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Something is present. E.g. Hallucination, delusion
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Schizophrenia: Negative Symptoms
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Missing something. E.g. apathy, lack of interest
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Typical Antipsychotics: Benefits and Side Effects
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Antagonistic of dopamine receptors. 2nd gen, dop and serotonin, 3rd partial agonist. Reduced positive symptoms, cheaper, less SEs than previously thought. Extrapyramidal SEs.
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Atypical Antipsychotics: Benefits and Side Effects
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Less extrapyramidals. Less anticholinergic ADRs. Minimal effects on prolactin E.g. Seroquel
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Neurotransmitter targeted by antipsychotics
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Dopamine
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Pathways: Substantia Nigra
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Creates Dopamine
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Pathways: Mesolimbic
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Too much dopamine here leads to positive symptoms. Emotional control center in brain. Meds try to block this pathway
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Pathways: Mesocortical
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Too little here leads to negative symptoms (cognitive, negative, affective).
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Pathways: Nigrostriatal
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Deficits leads to tardive dyskenesia and movement disorders. Movement.
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Pathways: Tuberoinfundibular
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Deficits increase prolactine and lead to 1) galactorrhea, 2) ammenorhea, 3) low libido. Thalamic dopamine system
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Dopamine: Production
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Tyrosine transformed to DOPA and packed in vesicles. Docks on the edge of axon and squirts out to other neuron
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Dopamine: Termination
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MAO breaks down into inactive elements OR transported back into cell to be broken down or recycled
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Dopamine: Receiving Neuron
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1) one or more dopamine receptors 2) D2 receptors blocked by meds (only) 3) autoreceptors tell DNA how much dopamine
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PORT: Are second gens better than 1st for positive symptomology?
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No
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PORT: Use antipsychotic for 1st episodes?
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No
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PORT: Are typicals cheaper and have less side effects?
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Yes
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PORT, maintenance: ______ treatment does not work well
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Intermittent
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PORT, maintenance: Discontinuing treatment ____ rate of relapse five fold
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increased (in first or early episodes pts. 96% relapse)
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PORT: What med for tx resistant pts.
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Clozapine (used to decrease persistent violent behaviors and hostility, decreases suicidal rate 3-fold)
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Study that showed 1st and 2nd gens did not differ in effectiveness or extrapyramidal effects or that 2nd gens were no better for negative symptoms?
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CATIE
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Study showing 1st generations being a little better than 2nd, no difference in extrapyramidal side effects
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CUTLASS
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Atypical antipsychotic also used for treating autism, with SEs of weight gain, anxiety, nausea, hypotension, orthostasis, increased prolactin
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Risperidone
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"Educational" drug
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Mellaril
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Abillify, Seroquel, Risperdal, Geodone, Clozapine
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Atypical
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Haldol
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Typical
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Most potential for weight gain? Least?
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Clozaril and Zyprexa. Geodon
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Least dopamine blockage and least prolactin
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Clozapine (Clozaril)
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Involuntary Movements, tremors or muscle stiffness
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Extrapyramidal effects
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Inner restlessness
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Akathisia
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