Antipsychotics And Schizophrenia

Front 1

Chlorpromazine

Back 1

1st gen. low potency. Effective for reduction of hallucinations/delusions. S/E: movement d/o's, cardiotoxicity - QT & PR prolongation, T wave blunting, ST depression. High weight gain, seizure risk, sedating, orthostatic hypotension, blurred vision, constipation, urinary retention, N/V, dermatitis, photosensitivity and eye pigmentation (reversible)

Front 2

Thioridazine

Back 2

1st gen, low potency. High weight gain, seizure risk, retinal pigmentation (permanent), cardiotoxicity, QT prolongation, Torsade de Pointes; ↑orthostatic hypotension ; Peripheral Anticholinergic: blurred vision, constipation, urinary retention, mydriasis, N/V ; *↑Sexual dysfunction*

Front 3

Fluphenazine

Back 3

1st gen. high potency. High EPS (extrapyramidal side effects), sedation; Depot form available. Good for acute mania, delusional d/o, depression w/psychosis

Front 4

Haloperidol

Back 4

1st gen, high potency. high EPS and sedation. Tourettes, depression w/psychosis, acute mania, delusional d/o. Depot available

Front 5

Trifluoperazine

Back 5

1st gen. high potency. Hight EPS and sedation. Acute mania, depression w/psychosis, delusional d/o

Front 6

Aripiprazole (Abilify)

Back 6

2nd Gen- only partial agonist for serotonin and dopamine. Newer drug, low risk of having: EPS, sedation, weight gain, prolactin elevation. May have akathesia effect because Aripiprazole "energizes" pts, good in depressive sxs

Front 7

Clozapine

Back 7

2nd Gen (SDA), effective but "dangerous" b/c of agranulocytosis risk, almost NO EPS! High weight gain. Sedation, N/V, dizziness, GI sxs, hypersalivation. Do not use first line, reserved for very resistant cases and those who cannot tolerate any EPS. can treat severe tradive dyskinesia. Huntington's, effective for suicidal schizophrenic pt's to prevent suicide, OCD & childhood autism (with other drugs)

Front 8

Risperidone

Back 8

2nd gen (SDA), EPS with high dose, low tardive dyskinesia, less weight gain

Front 9

Olanzapine

Back 9

2nd gen (SDA), non-sedative, high weight gain, no prolactin release. Also used for severe tardive dyskinesia, Bipolar I mania, OCD, anxiety, Tourette's, depression

Front 10

Quetiapine

Back 10

2nd Gen, LOW to NO EPS, no prolactin release, weight gain, postural hypotension, fatigue, no major interactions with other pharmaceuticals

Front 11

Ziprasidone

Back 11

2nd Gen, Few, few EPS, no prolactin release, no significant weight gain

Front 12

Positive Symptoms

Back 12

Delusions, hallucinations, disorganized speech, disorganized behavior, agitation

Front 13

Negative Sypmtoms

Back 13

Passivity, emotional/ social withdrawal, apathy, stereotyped thinking, attention impairment

Front 14

Cognitive sypmtoms

Back 14

Poor verbal fluency, serial learning impairment, difficulty focusing or keeping attention, difficulty with concentration

Front 15

In which brain system is excess dopamine thought to cause positive symptoms?

Back 15

Mesolimbic system (responsible for positive sxs)

Front 16

In which brain system is depressed dopamine thought to cause negative sypmtoms as well as cognitive sypmtoms

Back 16

Mesocortical system (responsible for neg sxs and cognitive sxs)

Front 17

In which pathway of the brain does nicotine raise dopamine to cause a subjective improvement in sypmtoms?

Back 17

Mesocortical system-
Many schizophrenic patients feel smoking tobacco helps with their cognitive symptoms because nicotine can increase dopamine in the mesocortical system. This is really because nicotine can increase dopamine everywhere (non specific) however, since mesocortical system is deficient in schizophrenic pts and improvement will be felt here. Nicotine can increase dopamine in the mesolimbic system as well (non specific), exacerbating the pt's psychosis or positive sxs

Front 18

Which class of antipsychotics is associated to a decrease in the number of trips to the emergency department, relapses, hospitalizations and inpatient day programs for schizophrenic patients?

Back 18

Second generation antipsychotis/ atypicals/ serotonin-dopamine antagonists (SDA's)
They have a much better mechanism for treated schizophrenic sypmtoms

Front 19

What percentage of suicides is thought to be from schizophrenic patients?

Back 19

10% of all suicides

Front 20

What class of antipsychotics is considered first-line?

Back 20

Second generation or atypical antipsychotics

Front 21

Which have a greater number of side effects, the low potency first generation antipsychotics or the high potency first generation antipsychotics?

Back 21

Low potency

Front 22

Which second generation (atypical) antipsychotic is not considered a first-line treatment?

Back 22

Clozapine - too many dangerous side effects (agranulocytosis). Although effective, clozapine should be reserved for highly resistant patients after exhausting all other drug options.

Front 23

If you chose to put a patient on Clozapine which laboratory study do they need to have done?
What is the frequency of this test during the first 6 months of administration?

Back 23

WBC count, weekly

Front 24

What was the first antipsychotic identified by a physician in Paris?

Back 24

Chlorpromazine (Thorazine) in 1952

Front 25

What is the concordance rate for schizophrenia among monodizygotic twins?

Back 25

50% (means schizophrenia is partially triggered by the environment)

Front 26

Men over what age are thought to have an increased risk of having a schizophrenic offspring?

Back 26

Men over 60; possibly related to a higher risk of epigenetic damage during spermatogenesis

Front 27

Besides dopamine, name at least 3 neuotransmitters thought to be disrupted in schizophrenic brains?

Back 27

-Serotonin (excess),
-Norepinephrine (inconclusive data),
-Neuropeptides (substance P, neurotensin),
-GABA (GABAergic neurons regulate dopamine)
-Glutamate (related to psychosis), -Acetylcholine/Nicotine (poor receptor functionality causes cognitive sypmtoms)

Front 28

What "street" drug is thought to antagonize glutamate and cause acute symptoms similar to schizophrenia?

Back 28

Phencyclidine (PCP)

Front 29

Name some abnormalities of the hippocampus seen in autopsies and brain MRIs of schizophrenic patients

Back 29

Decreased size of hippocampus, abnormal functioning of hippocampus- as seen in disturbed glutamate transmission. Disorganization of hippocampal neurons

Front 30

Eye movement dysfunction and schizophrenic patients

Back 30

Eye movement dysfunction may be a trait marker for schizophrenia.

Front 31

Which subtype is characterized by delusions of persecution or grandeur?

Back 31

Paranoid schizophrenia

Front 32

Name some clinical manifestations or symptoms of residual schizophrenia

Back 32

emotional blunting, social withdrawal, eccentric behavior, illogical thinking, mild loosening of associations. No predominant delusions or hallucinations are present, disorganized speech or pattern of behavior is not predominant.

Front 33

Which personality disorder was previously classified as pseudoneurotic schizophrenia?

Back 33

Borderline personality disorder

Front 34

How do schizophrenic patients tend to score on intelligence tests?

Back 34

Low intelligence range, thought to have poor insight on exam

Front 35

Illusions

Back 35

illusions are distortions of real images or sensations vs. hallucinations which have no real image or environmental basis.

Front 36

With schizophrenic patients who are at increased suicide risk (with prior hospitalizations for SI), which second generation antipsychotic might be most appropriate in reducing suicidal ideation?

Back 36

Clozapine.
Also, adding an antidepressant to any medication may be helpful in this scenario

Front 37

Name some medical comorbid conditions associated with schizophrenia?

Back 37

increased risk of obesity, diabetes mellitus type-II, HIV, COPD, cardiovascular disease
interestingly, there is a 1/3 decreased risk associated to rheumatoid arthritis in schizophrenic pts

Front 38

When a manic or depressive disorder develops concurrently with the major symptoms of schizophrenia what is the most appropriate Axis I diagnosis?

Back 38

Schizoaffective disorder

Front 39

Delusional disorder

Back 39

Non-bizarre delusions present for at least one month without other symptoms of schizophrenia or a mood disorder could be diagnosed as delusional disorder

Front 40

Common age range for onset of schizophrenia in males

Back 40

10-25 y/o

Front 41

Common age range(s) for onset of schizophrenia in females

Back 41

25-35 & >40 yrs

Front 42

Lifetime prevalence of schizophrenia in the United States

Back 42

1% or 1/100, this is common!

Front 43

Gender prevalence of schizophrenia

Back 43

Men = women in prevalence rates

Front 44

Population density and how it impacts prevalence of schizophrenic cases

Back 44

Schizophrenia is rare in cities with fewer than 10,000 people, it is less common in areas of 100k-500k and occurs regularly in populations >1 million people

Front 45

Risk of homicide among schizophrenic patients

Back 45

schizophrenic patients are no more likely to commit homicide than is a member of the general population