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45 Cards in this Set
- Front
- Back
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Describe the DSM-IV criteria for schizophrenia:
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A. Two or more of the following in a one month period:
--delusions --hallucinations --disorganized speech -grossly disorganized or catatonic behavior --negative symptoms --(may be one if voices keep a running commentary or converse with each other) B. Social/Occupational dysfunction C. continuous signs of the disorder for 6 months D. exclude mood disorders E. not due to medical disorder or substance abuse F. if a history of PDD is present, must have hallucinations/delusions for 1 month. |
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Describe the epidemiology of schizophrenia, specifically age of onset, prevalence in males vs females, and cultural differences:
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Onset: 15-25 (rarely after 40)
Sex: males and females are equal, onset is earlier in males Culture: no variance across cultures or social classes |
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Describe the four points in the clinical course of schizophrenia:
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Onset: abrupt or insidious (prodromal phase with negative symptoms)
Initial Dx: usually with positive symptoms Disease Course: fluctuates but almost always deteriorates Remission: complete remission is uncommon |
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What are the 5 + 1 pieces of the schizophrenia symptoms puzzle?
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positive symptoms
negative symptoms cognitive symptoms aggressive symptoms mood symptoms social and occupational dysfunction |
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List common positive symptoms of schizophrenia:
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hallucinations
delusions disorganized speech bizarre behaviors psychomotor agitation |
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List the negative symptoms of schizophrenia:
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alogia (poverty of speech)
flattened affect (appearance) avolition (loss of motivation/drive) anhedonia (inability to experience pleasure) poverty of speech psychomotor retardation |
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List the cognitive symptoms of schizophrenia:
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impaired attention
impaired memory impaired executive function |
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List the mood symptoms of schizophrenia:
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depression
dysphoria hopelessness demoralization anxiety |
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List the effects of schizophrenia on social and occupational dysfunction:
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social isolation
employment issues strained family relationships strained social relationships interrupted daily life activities |
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Is schizophrenia genetically related?
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yes, one monozygotic twins has a 50% chance of having schizophrenia if the other twin does
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What NT levels are schizophrenia associated with?
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DA hyperactivity in limbic system
DA hypo functioning in prefrontal cortex |
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What are the three categories of therapeutic goals (list examples)?
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--Acute Stabilization (reduce threat to self and others, improve function)
--Stabilization (minimize relapse, medication compliance, optimize dose to prevent ADRs) --Maintenance (improve QOL, monitor for symptoms of relapse, maintain baseline function) |
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List twelve target symptoms for antipsychotics:
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hostility, agitation/anxiety, insomnia, suspiciousness, poor self-care habits, mutism, social withdrawal, loose associations, inappropriate affect, delusions, hallucinations, preoccupations
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List the four DA pathways:
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mesolimbic
nigrostriatal mesocortical turberoinfundibular |
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Explain the effects of the mesolimbic pathway on schizophrenia:
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mesolimbic overactivity results in the positive symptoms of psychosis
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Explain the effect of the mesocortical pathway on schizophrenia:
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mesocortical overactivity results in increased negative symptoms
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Explain the effect of the nigrostriatal pathway on schizophrenia:
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overactivity of the nigrostriatal pathway results in EPSs
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Explain the effect of the turberofundibular pathway on schizophrenia:
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elevated prolactin levels
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Explain the effect of a D2 receptor blocker on schizophrenia:
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D2 blocker prevents DA from binding to D2 receptors, results in decreased positive symptoms
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List a few examples of high, mid, and low potency conventional antipsychotics:
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High: haloperidol, fluphenazine
Mid: loxapine, molindone, thiothixene, perphenazine Low: thioridazine, mesoridazine, chlorpromazine |
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Which AP potency results in the following:
high sedation? high anticholinergic effect? high EPSs? high CV? |
low potency
low potency high potency low potency |
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Define and explain acute dystonia (occurence, risk factors)
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Acute muscle spasms (eye-oculogyric crisis, neck-torticollis, back-retrocollis, tongue glosospasm)
Typically occurs within the first 5 days of treatment, rarely occurs after 3 months of treatment. Risk factors include high potency drugs, IM or IV administration, or large doses. |
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What is the treatment for acute dystonia?
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diphenhydramine, benztropine (Anticholinergics)
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List the three main symptoms of EPS:
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acute dystonia, pseudoparkinsonism, akathisia
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Explain pseudoparkinsonism:
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Occurs within several months.
DA blockade causes relative imbalance between DA and ACH. Presents as decreased movement, muscle rigidity, resting hand tremor, drooling, mask-like face, shuffling gait. |
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What is the treatment of pseudoparkinsonism
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decrease dose
change AP antiparkinsonian agent amantidine |
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Explain akathisia:
(presentation) |
Onset is days to weeks.
Mechanism: two theories, presynaptic DA blockade > postsynaptic DA blockade; DA blockade in mesocortical tract increases locomotor activity. Presentation: effect of inner restlessness, inability to sit still, can be confused with agitation |
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What is the treatment for akathisia?
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decrease dose
change AP add b-blocker add benzodiazepine |
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Explain tardive dyskinesia (including risk factors, presentation, treatment):
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--elderly, women
--blinking, lip smacking, twitching (watch pt's face while they write) --no treatment, irreversible (can change AP to clozaril or minimize pt's exposure to AP) |
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Explain NMS:
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Neuroleptic Malignant Syndrome
--can happen with all APs --hyperthermia, muscle rigidity, etc.. --treatment includes: d/c AP, supportive care, DA agonists |
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Explain the effects of the following receptors on schizophrenia:
D1/2/3/4/5 5HT2 Alpha 1 M1 H1 |
D1/2/3/4/5: relief of psychosis, EPS
5HT2: help suppress D activity, protect from EPS, weight gain, helps with negative effects Alpha1: orthostatic hypertension, dizziness M1: anticholinergic SEs, may protect against EPS, drowsiness, dry mouth, blurred vision, constipation H1: weight gain, drowsiness |
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Describe: Olanzapine
(EPS, Adverse effects, formulations) |
(Zyprexa)
--no EPS at conventional doses --sedation, weight gain, orthostatic hypotension --available as rapid dissolvable formulation and IM form |
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Describe: Risperidone
(EPS, Adverse effects, formulations) |
(Risperdal)
--EPS at doses > 6mg/day --prolactin elevation, orthostasis, sexual dysfunction --dissolvable tab, Consta injection (q2weeks) |
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Describe: Paliperidone
(EPS, Adverse effects, formulations) |
(Invega)
--active metabolite of risperidone --osmotic pump delivery --less risk of EPS and prolactin elevation than risperidone |
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Describe: Quetiapine
(EPS, Adverse effects, formulations) |
(Seroquel)
--No EPS --sedation, hypotension, headache, weight gain --low doses used for anxiety, insomnia, depression --high doses used for bipolar and schizophrenia |
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Describe: Ziprasidone
(EPS, Adverse effects, formulations) |
(Geodon)
--no EPS --mild sedation, minimal weight gain, QTc prolongation --IM formulation available |
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Describe: Clozapine
(EPS, Adverse effects, formulations) |
(Clozaril)
--minimal EPS --gold standard for APs, but usually try other APs first because this one is heavily sedative --agranulocytosis, sedation, weight gain |
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Describe: Aripiprazole
(EPS, Adverse effects, formulations) |
(Abilify)
--dopamine modulator (keeps it low where it doesn't need it and high where it does need it) --no effect on weight --more activating than sedating --little or none EPS |
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Explain the criteria for Metabolic Syndrome:
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Any three of the following:
--abdominal obesity --hypertension --impaired fasting glucose --decreased HDL --elevated triglycerides |
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List atypical APs in order of their likelihood to cause metabolic syndrome:
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Clozapine>Olanzapine>Risperidone>Quetiapine>Ziprasidone>Aripiprazole
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List some target symptoms for APs:
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hostility
agitation/anxiety insomnia suspiciousness poor self-care habits mutism social withdrawal loose associations inappropriate affect delusions hallucinations proeccupations |
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Explain the PcTx of APs, including early goals, adequate trial time, duration of treatment, relapse rates.
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Early goals: decrease agitation and hostility, normalize sleep and eating
Adequate trials are considered at least 6 weeks Treat first episodes for at least one year and subsequent episodes for five years. Relapse rates are extremely high. |
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Describe things that influence AP compliance:
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--non-compliance is number one reason for relapse
--lower cognitive function among patients (don't understand the need for treatment) --social problems interfere with access to information --difficult to get assistance from case workers |
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What are the four approaches/steps to AP treatment:
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Monotherapy
Switch Clozapine Combination |
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Describe the new drug: iloperidone
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(Fanapt)
-as effective as ziprasidone and haloperidol (not necessarily for refractory schizophrenia) -A/Es are a cross of ziprasidone and risperidone (QT prolongation, weight gain, adverse metabolic effects) -metabolized by 2D6 and 3A4 -less prolactin elevation and EPS/Es than risperidone -orthostatic hypotension is a concern and requires divided doses and gradual dose increases (over 4-7 days -high correlation with genetic markers for safety/efficacy |
