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60 Cards in this Set
- Front
- Back
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Type of schizophrenic Symptom:
hallucinations |
POSITIVE
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Type of schizophrenic Symptom:
delusions |
POSITIVE
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Criteria for DSM-IV Diagnosis of schizophrenia
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Two or more qualifying criteria for at least a 1 month period
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Main pathophysiology of schizophrenia
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imbalance in dopamine
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MOA of typical antipsychotics (1st generation)
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dopamine blockade
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MOA of atypical antipsychotics (2nd generation)
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dopamine and serotonin blockade
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Low potency antipsychotics
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chlorpromazine
thioridazine |
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Mid potency antipsychotics
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perphenazine
loxapine |
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high potency antipsychotics
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haloperidol
fluphenazine |
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Drug class:
chlorpromazine |
Low potency typical antipsychotics
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Drug class:
Thioridazine |
low potency typical antipsychotics
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Drug class:
perphenazine |
mid potency typical antipsychotics
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Drug class:
loxapine |
mid potency typical antipsychotics
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Drug class:
haloperidol |
high potency typical antipsychotics
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Drug class:
fluphenazine |
high potency typical antipsychotics
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Therapeutic use of TYPICAL antipsychotics (dopamine D2 receptor blockade)
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improve positive symptoms and cognition
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Adverse effects of TYPICAL antipsychotics (dopamine D2 receptor blockade)
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~worsening of negative symptoms and cognition
~extrapyramidal movement disorders (EPS) ~tardive dyskinesia (TD) |
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Therapeutic use of ATYPICAL antipsychotics (dopamine & serotonin receptor blockade)
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~possible improvement in negative symptoms and cognition **primarily used first because of this**
~reduced EPS and TD |
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Adverse reaction to antipsychotics that generally occurs shortly after the initiation of therapy
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extrapyramidal movement disorder (EPS)
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Adverse reaction to antipsychotics that generally occurs after long-term therapy
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Tardive Dyskinesia (TD)
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Symptoms of EPS
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dystonia
pseudoparkinsonism akathisia |
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symptoms of EPS:
dystonia symptoms and treatment |
sudden severe onset of abnormal posture
treat using antihistamines like benztropine, diphenhydramine or lorazepam |
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symptoms of EPS:
pseudoparkinsonism symptoms and treatment |
slow walking, slowed speech
resting, pill rolling tremor cogwheel rigidity postural abnormalities treat using benztropine or trihexyphenidyl |
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symptoms of EPS:
akathisia symptoms and treatment |
motor restlessness or inability to sit still
treat using B-blockers or benzodiazepines |
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Overall treatment strategies for EPS
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switch from high to low potency antipsychotic
switch typical to atypical antipsychotic |
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Tardive Dyskinesia (TD) symptoms
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involuntary abnormal movements (lip smacking)
Early signs may be reversible but may become irreversible if persistent or not caught early |
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Side effects
Atypical antipsychotics |
serotonin blockade causes sedation, weight gain
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What is "atypical" about the atypical antipsychotics
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Reduced risk for:
EPS, TD, hyperprolactinemia may be better than typical at improving negative symptoms and cognition |
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Class of drug:
CLOZAPINE |
ATYPICAL ANTIPSYCHOTIC
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significant side effects of clozapine
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agranulocytosis
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Therapeutic use of clozapine
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unique potency for treatment of persistent psychotic symptoms, negative symptoms and suicidality
RESERVED FOR TREATMENT RESISTANT PATIENTS |
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Monitoring required for clozapine
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blood monitoring required weekly for first 6 months
every 2 weeks for the next 6 months then monthly therafter must be nationally registered |
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Black box warning for atypical antipsychotics
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increased death in elderly patients with dementia
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Antipsychotic dosage forms
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oral (tabs, liquid, quick dissolving tab)
injection (short and long acting) |
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Non pharmacologic interventions
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psychosocial rehabilitation
support groups psychotherapy active community treatment |
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Time course of psychotic therapy that is most difficult to achieve
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patients with persistent residual sx:
fixed delusions and hallucinations |
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Time course of psychotic therapy where patient has an improvement in thought disorder
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3-6 weeks or greater
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After a period of 3-6 weeks or greater a patient in psychotic therapy should see an improvement in...
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improvement in thought disorder
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An improvement in socialization and mood during psychotic therapy should be seen after this amount of time
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1-2 weeks
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after 1-2 weeks of psychotic therapy a patient should see an improvement in
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improvement in socialization and mood
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A decrease in agitation/hostility, aggression/anxiety and a normalization of sleep and diet can be noted at this stage (time) of psychotic therapy
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1-7 days
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After 1-7 days of psychotic therapy a patient should see an improvement in..
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decreased:
agitation/hostility aggression/anxiety and normalization of sleep and appetite |
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Typical antipsychotics decrease positive symptoms, but can cause movement disorders such as EPS and tardive dyskinesia
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Atypical antipsychotics have less risk for EPS and TD, but can cause serious metabolic side effects
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Psychosis Definition
A severe mental disturbance that involves a profound misinterpretation of perceptions of loss of contact with reality |
Leads to inappropriate ability to interact with others or with the environment
psychotic sx are present in various disorders |
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Psychotic symptoms:
hallucinations delusions disorganized speech disorganized or catatonic behavior |
Course of Schizophrenia
Early treatment = better outcomes Majority of patients will experience multiple relapses throughout their life High incidence of comorbid conditions |
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Positive symptoms of Schizophrenia
(Add something) hallucinations delusions disorganized speech grossly disorganized or catatonic behavior |
Negative symptoms of schizophrenia
affective flattening - no emotions Alogia (Poverty of speech)-low fluency Avolition - no motivation/drive Anhedonia - loss of interest/pleasure asociality - no social interaction |
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Cognitive symptoms
Poor concentration, memory disturbances inability to plan, difficulty executing tasks poor abstraction, impaired decision making |
Prodromal phase of schizophrenia
(clues that something is happening) withdrawn odd beliefs peculiar behavior |
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Acute episode of schizophrenia
(core sx) lost touch with reality hallucinatios delusions flat or inappropriate affect difficulty with self care |
xxx
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Type of schizophrenic Symptom:
Loss of interest or pleasure |
Anhedonia
Negative |
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Type of schizophrenic Symptom:
Memory disturbances |
Cognitive
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Type of schizophrenic Symptom:
Thought broadcasting |
Delusions
positive |
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Type of schizophrenic Symptom:
disorganized speech |
positive
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Type of schizophrenic Symptom:
grossly disorganized or catatonic behavior |
positive
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Type of schizophrenic Symptom:
impaired outward display of emotions |
affective flattening
negative |
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Type of schizophrenic Symptom:
decreased speech fluency |
alogia
negative |
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Type of schizophrenic Symptom:
lack of motivation or drive |
avolition
negative |
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Type of schizophrenic Symptom:
lack the capacity for social interaction |
asociality
negative |
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Type of schizophrenic Symptom:
poor concentration |
cognitive
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Type of schizophrenic Symptom:
inability to plan |
cognitive
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Type of schizophrenic Symptom:
difficulty executing tasks |
cognitive
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