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45 Cards in this Set

  • Front
  • Back
Describe the DSM-IV criteria for schizophrenia:
A. Two or more of the following in a one month period:
--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.
Describe the epidemiology of schizophrenia, specifically age of onset, prevalence in males vs females, and cultural differences:
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
Describe the four points in the clinical course of schizophrenia:
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
What are the 5 + 1 pieces of the schizophrenia symptoms puzzle?
positive symptoms
negative symptoms
cognitive symptoms
aggressive symptoms
mood symptoms

social and occupational dysfunction
List common positive symptoms of schizophrenia:
disorganized speech
bizarre behaviors
psychomotor agitation
List the negative symptoms of schizophrenia:
alogia (poverty of speech)
flattened affect (appearance)
avolition (loss of motivation/drive)
anhedonia (inability to experience pleasure)
poverty of speech
psychomotor retardation
List the cognitive symptoms of schizophrenia:
impaired attention
impaired memory
impaired executive function
List the mood symptoms of schizophrenia:
List the effects of schizophrenia on social and occupational dysfunction:
social isolation
employment issues
strained family relationships
strained social relationships
interrupted daily life activities
Is schizophrenia genetically related?
yes, one monozygotic twins has a 50% chance of having schizophrenia if the other twin does
What NT levels are schizophrenia associated with?
DA hyperactivity in limbic system
DA hypo functioning in prefrontal cortex
What are the three categories of therapeutic goals (list examples)?
--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)
List twelve target symptoms for antipsychotics:
hostility, agitation/anxiety, insomnia, suspiciousness, poor self-care habits, mutism, social withdrawal, loose associations, inappropriate affect, delusions, hallucinations, preoccupations
List the four DA pathways:
Explain the effects of the mesolimbic pathway on schizophrenia:
mesolimbic overactivity results in the positive symptoms of psychosis
Explain the effect of the mesocortical pathway on schizophrenia:
mesocortical overactivity results in increased negative symptoms
Explain the effect of the nigrostriatal pathway on schizophrenia:
overactivity of the nigrostriatal pathway results in EPSs
Explain the effect of the turberofundibular pathway on schizophrenia:
elevated prolactin levels
Explain the effect of a D2 receptor blocker on schizophrenia:
D2 blocker prevents DA from binding to D2 receptors, results in decreased positive symptoms
List a few examples of high, mid, and low potency conventional antipsychotics:
High: haloperidol, fluphenazine
Mid: loxapine, molindone, thiothixene, perphenazine
Low: thioridazine, mesoridazine, chlorpromazine
Which AP potency results in the following:

high sedation?
high anticholinergic effect?
high EPSs?
high CV?
low potency
low potency
high potency
low potency
Define and explain acute dystonia (occurence, risk factors)
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.
What is the treatment for acute dystonia?
diphenhydramine, benztropine (Anticholinergics)
List the three main symptoms of EPS:
acute dystonia, pseudoparkinsonism, akathisia
Explain pseudoparkinsonism:
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.
What is the treatment of pseudoparkinsonism
decrease dose
change AP
antiparkinsonian agent
Explain akathisia:
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
What is the treatment for akathisia?
decrease dose
change AP
add b-blocker
add benzodiazepine
Explain tardive dyskinesia (including risk factors, presentation, treatment):
--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)
Explain NMS:
Neuroleptic Malignant Syndrome
--can happen with all APs
--hyperthermia, muscle rigidity, etc..
--treatment includes: d/c AP, supportive care, DA agonists
Explain the effects of the following receptors on schizophrenia:

Alpha 1
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
Describe: Olanzapine
(EPS, Adverse effects, formulations)
--no EPS at conventional doses
--sedation, weight gain, orthostatic hypotension
--available as rapid dissolvable formulation and IM form
Describe: Risperidone
(EPS, Adverse effects, formulations)
--EPS at doses > 6mg/day
--prolactin elevation, orthostasis, sexual dysfunction
--dissolvable tab, Consta injection (q2weeks)
Describe: Paliperidone
(EPS, Adverse effects, formulations)
--active metabolite of risperidone
--osmotic pump delivery
--less risk of EPS and prolactin elevation than risperidone
Describe: Quetiapine
(EPS, Adverse effects, formulations)
--No EPS
--sedation, hypotension, headache, weight gain
--low doses used for anxiety, insomnia, depression
--high doses used for bipolar and schizophrenia
Describe: Ziprasidone
(EPS, Adverse effects, formulations)
--no EPS
--mild sedation, minimal weight gain, QTc prolongation
--IM formulation available
Describe: Clozapine
(EPS, Adverse effects, formulations)
--minimal EPS
--gold standard for APs, but usually try other APs first because this one is heavily sedative
--agranulocytosis, sedation, weight gain
Describe: Aripiprazole
(EPS, Adverse effects, formulations)
--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
Explain the criteria for Metabolic Syndrome:
Any three of the following:
--abdominal obesity
--impaired fasting glucose
--decreased HDL
--elevated triglycerides
List atypical APs in order of their likelihood to cause metabolic syndrome:
List some target symptoms for APs:
poor self-care habits
social withdrawal
loose associations
inappropriate affect
Explain the PcTx of APs, including early goals, adequate trial time, duration of treatment, relapse rates.
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.
Describe things that influence AP compliance:
--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
What are the four approaches/steps to AP treatment:
Describe the new drug: iloperidone
-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