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49 Cards in this Set
- Front
- Back
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Schizophrenia is a condition involving abnormal ___ in the brain.
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Dopamine
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Schizophrenia is a disease that typically occurs in (childhood / early adulthood / the elderly)
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Early adulthood
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Schizophrenia - (Males / Females) typically tend to get the disease earlier. At what age range?
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Males
From age 15-24 (vs 25-34 for women) |
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Schizophrenia - Pathophysiology
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- Involves increased size of ventricles in the brain (leading to decreased brain tissue)
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Classification of Schizophrenia - pts must have symptoms for more than ___ months.
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6 months
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Schizophrenia - If have symptoms for 1-6 months then it is called ___.
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Schizophreniform Disorder
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Schizophrenia - If have symptoms for less than 1 month then it is called ___.
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Brief psychotic disorder (seen with substance abusers)
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Schizophrenia - Subtypes (6)
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SCP CD:
- Schizo-affective: both mood disorder and schizo - Catatonic: Disturbances with movement, rigidity, bizarre postures, imitating other people - Paranoid: Thinks someone is going to harm them, false beliefs, auditory hallucinations - Chronic undifferentiated: Have positive and negative symptoms but don't fit in other categories like paranoid, etc - Disorganized: Disorganized speech, thinking and behavior, disheveled looking |
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Schizophrenia - Assessment prior to treatment
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- Mental status evaluation - pts struggle with abstract concepts such as glass house problem
- Physical/neurologic examination - Laboratory - Baseline lipids, glucose, LFT due to metabolic syndrome with new drugs |
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Schizophrenia - Non pharmacologic treatment
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- Psychoeducation for patient and family
- Vocational support (to reintegrate into society) - Supportive psychotherapy |
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Schizophrenia - Positive symptoms
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- Delusions
- Hallucinations - Disorganized speech/behavior |
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Schizophrenia - Negative symptoms
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- Flat affect
- Alogia (poverty of speech) - Anhedonia (loss of pleasure) - Avolition (not goal oriented) |
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Schizophrenia - Cognitive symptoms
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- Impaired memory
- Impaired attention - Impaired executive function (ie. problem solving) |
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Schizophrenia - Positive symptoms arise from which area of the brain
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Limbic system
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Schizophrenia - Negative symptoms arise from which area of the brain
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Pre-frontal lobe
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Schizophrenia - Cognitive symptoms arise from which area of the brain
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Pre-frontal lobe
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Schizophrenia - Factors for good prognosis (6)
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1. No substance abuse issues
2. Short duration of illness 3. Having it later in life 4. Presence of acute stressors/precipitating factors (can control it) 5. Family Hx (of mood disorders vs schizo) 6. Good support systems |
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Schizophrenia - First line pharmacological treatment
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Second generation antipsychotics (atypical)
CROP ZAQ: - Clozapine - Risperidone - Olanzapene - Paliperidone - Ziprasidone - Aripiprazole - Quetiapine |
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Schizophrenia - Examples of first generation antipsychotics
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- Haloperidol
- Fluphenazine |
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Schizophrenia - Second generation atypical antipsychotics have greater ___ affinity relative to ___ affinity.
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Greater 5-HT affinity relative to D2 affinity.
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Schizophrenia - Second generation atypical antipsychotics are (not effective / effective) in managing the negative symptoms and have (less / more) EPS symptoms
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Effective
Less |
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Schizophrenia - In addition to blocking D2 receptors, atypicals also block ___ receptors.
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Serotonin
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Schizophrenia - Which dopamine pathway is responsible for the EPS symptoms?
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Nigrostriatal
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Schizophrenia - Which dopamine pathway is responsible for the prolactin symptoms?
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Tuberoinfundibular (acts on hypothalamus - prolactin)
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Schizophrenia - Which dopamine pathway is responsible for the nausea/vomiting symptoms?
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CTZ chemoreceptor trigger zone
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Schizophrenia - How is dopamine indirectly stimulated by atypical antipsychotics?
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Serotonin decreases dopamine. By blocking serotonin receptors, dopamine increases.
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Schizophrenia - Where is the serotonin pathway?
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Prefrontal cortex
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Schizophrenia - Antipsyhotics are (not equally / equally) effective in managing psychosis
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Equally
Only difference is in the potency and SE. |
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Schizophrenia - "Motivation" can be controlled by which area of the brain
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Prefrontal cortex
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Schizophrenia - Comment on the ADME of atypical antipsychotics
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A: Variable absorption
D: Large distribution M: Extensive liver metabolism E: Slow elimination |
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Schizophrenia - Where is there poor correlation between dose and response of atypical antipsychotics?
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It has many active metabolites, narrow TR
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Schizophrenia - What is likely the most effective atypical antipsychotic?
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Clozapine - 30% response rate in refractory patients
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Schizophrenia - Which drug do they compare all antipsychotics to in terms of clinical equivalency?
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Chlorpromazine
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Schizophrenia - Clozapine dose?
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25-50mg/day initial.
Titrate to 300-600mg/day in divided doses. |
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Schizophrenia - What is so special about Clozapine?
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Has low EPS symptoms.
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Schizophrenia - Clozapine is a (1st line / 2nd line) drug. Why?
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2nd line.
Only used for refractory patients or those who have intolerable side effects such as tardive dykinesia. |
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Schizophrenia - What are the red flags for discontinuing Clozapine?
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Agranulocytosis: WBC < 2.0 10^9 /L or granulocytes < 1.5 10^9 /L.
Weekly lab monitoring during treatment. |
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Schizophrenia - What are lab monitoring must be done with Clozapine?
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- Baseline WBC's and granulocytes - for agranulocytosis check weekly for 6 months then every 2 weeks if stable
- Baseline LFT's as liver enzymes can increase ALT by 2-3X |
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Schizophrenia - Clozapine ADR
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- Hypersalivation
- Constipation - Increase in lipids, blood sugar - Dizziness - Hypotension |
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Schizophrenia - What is a first line drug? Dose?
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Risperidone
2-6 mg/day, OD or BID |
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Schizophrenia - Risperidone exhibits ___ effects. What is seen at doses > 8mg/day?
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Dose dependent.
It acts similar to a typical antipsychotic at that dose: hypotensive effects |
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Schizophrenia - What are some advantages of using risperidone?
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- Low sedation
- No agranulocytosis - Low weight gain |
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Schizophrenia - What are some disadvantages of using risperidone?
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- Comparatively more tardive dyskinesia
- Comparatively more EPS symptoms - Comparatively more neuroleptic malignant syndrome - High prolactin elevation |
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Schizophrenia - Risperidone SE
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- Decrease in BP
- Sedation - Headache - Dry mouth - Constipation - Urinary incontinence - Insomnia - Weight gain |
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Schizophrenia - All atypical antipsychotics cause an increase in risk of metabolic syndrome (True/False)
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True.
They increase the risk of CV disease and Diabetes. |
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Schizophrenia - There is no genetic basis with Schizophrenia (True/False)
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False.
A strong genetic link exists for development of schizophrenia. Risk increases to 40% if both parents have it. Monozygotic twins have 48% risk. |
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Schizophrenia - Response to medications is immediate (True/False)
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False.
Maximal response may take up to 6 months. |
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Schizophrenia - Why are there anticholinergic effects with antipsychotic medications?
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Because in addition to dopamine receptors, they also have activity at the muscarinic, histamine and alpha receptors(although they have no therapeutic activity there)
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Schizophrenia - What are symptoms of Neuroleptic Malignant Syndrome?
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- Fever
- Severe rigidity - Muscle cramps and tremors - Altered mental status - Increased WBC count |
