Schizophrenia

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Author:
capnhue
ID:
134573
Filename:
Schizophrenia
Updated:
2012-02-13 01:51:21
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Regis University
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Description:
Schizophrenia
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  1. Positive symptoms of schizo
    • hallucinations
    • delusions (fixed false beliefs)
    • disorganized thinking
    • catatonia
    • First rank symptoms: thought insertion, thought broadcasting, ideas of reference
    • thought insertion: pt thinks others are putting thought into their head
    • thought broadcasting: pt believes others can hear their thoughts
    • ideas of reference: song on radio abouth them, or news is directed toward them or about them
  2. Negative symptoms of schizo
    • affect flattening (having no emotional response)
    • alogia (poverty speech)
    • asociality (inability to empathise)
    • anhedonia (loss to experience pleasure)
    • avolition (lack of motivation)
  3. Cognitive symptoms of Schizo
    • impaired attention
    • impaired concentration
    • impaired working memory
    • impaired judgement
  4. D2 receptor blcokade
    • helps manage positive symptoms
    • can cause EPS: dystonia, pseudoparkinsonism, akathisia
    • treat EPS: with anticholnergic, like benzotropine (or trihyphenidyl, diphenhydramine)
    • akathisia: treated w/lorazepam, propranolol or amantadine
    • can cause hyperprolactinemia
  5. 5-HT2A receptor blockade
    • Decreases EPS
    • treatment of negative symptoms
    • may also benefit pts with depression or anxiety
  6. Histamine H1 receptor blockade
    • sedation
    • drowsiness
    • appetite stimulation (weight gain)
  7. Muscarinic receptor blockade
    • blurred vision
    • dry mouth
    • urinary retention
    • constipation
    • clozapine: causes sialorrhea (hypersalvation)
  8. α - Adrenergic receptor blockade
    • postural hypotension (orthostasis)
    • dizziness
    • reflex tachycardia
  9. Tardative Dyskinesia
    • buccal-lingual-masticatory (BLM) - abnomral orofacial movements
    • forward, backward or lateral tongue movements
    • tongue thrusting, rolling or fly-catching movements
    • chewing or lateral jaw movements
    • More common in FGA than SGA (risperidone & paliperidone highest occurence)
    • do NOT treat TD with anticholinergic
    • Treat: w/clozapine or quetiapine (less risk of TD)
  10. Weight gain and Obesity are caused by what medications
    • More common in: SGAs
    • olanzapine (more severe)
    • clozapine (more severe)
    • Less common in: FGAs
    • aripiprazole (SGA)
    • ziprasidone (SGA)
  11. Lipid Abnoramilites are caused by what medications
    • Phenothiazine (FGA)
    • some SGAs
    • Less common in: SGAs
    • risperidone
    • paliperidone
    • aripiprazole
    • ziprasidone
  12. QTc interval prolongation caused by what medications
    • thiordiazone (greatest risk)
    • ziprasidone
    • clozapine
    • haloperidol
  13. Thermoregulation
    • Poikilothermia: inability to properly adjust to ambient temperature
    • can lead to heat stroke
    • caused by what medications: low-potency FGA, SGA with potent anticholinergic activity
    • chlorpromazine (FGA)
    • thioridazine (FGA)
    • olanzipine (SGA)
    • clozapine (SGA)
  14. Neuroleptic Malignant Syndrome (NMS) caused by what meds
    • high potency FGA
    • pts who have EPS
    • treat: w/
    • stopping antipsychotic
    • hydrate and control temp
    • muscle relaxant (dantrolene)
    • dopamine agonist (bromocriptine)
  15. Seizures caused by what medications
    • clozapine
    • chlorpromazine
    • Lowest risk for seizures, riperidone, and high potency FGAs
  16. Agranulozytosis caused by what medications
    clozapine
  17. Thiothixene adverse effects
    • EPS
    • Prolactin
    • FGA - High
  18. Fluphenazine adverse effects
    • EPS
    • Prolactin
    • FGA - High
  19. Haloperidol adverse effects
    • EPS
    • Prolactin
    • FGA - High
  20. Perphenazine adverse effects
    • EPS
    • Prolactin
    • FGA - High
  21. Olanzapine adverse effects
    • Weight gain
    • SGA
  22. Chlorpromazine adverse effects
    • Orthostasis
    • Drowsiness/sedation
    • FGA - Low
  23. Paliperidone adverse effects
    Prolactin
  24. Risperidone adverse effects
    Prolactin
  25. Asenapine adverse effects
    Orthostasis
  26. Clozapine adverse effects
    • (WADO)
    • Weight gain
    • Antichloinergic
    • Drowsiness/sedation
    • Orthostasis
  27. Elimination Half-life exceptions
    • Risperidone has a relatively short half life but its metabolized to paliperidone which has a half life of a day
    • Ziprasidone usually dosed BID
    • Quetiapine comes in ER because it too has a relatively short half life
  28. CYP1A2
    • Clozapine
    • Olanzapine
    • CYP1A2 inhibitors: fluvoxamine, cimetidine, Cipro
    • CYP1A2 inducers: omeprazole, nicotine
  29. CYP2D6
    • Perphenazine
    • Fluphenazine
    • Haloperidol
    • Risperidone
    • Iloperidone
    • CYP2D6 inhibitor: fluoxetine, paroxetine, sertraline (SSRI), bupropion
  30. CYP3A4
    • Haloperidol
    • Aripiprazole
    • quetiapine
    • lurasidone
    • olanzapine
    • clozapine
    • CYP3A4 inhibitors: ketoconazole, itraconazole, clarithromycin, reythromycin, indinavir, nelfinavir, ritonavir, and grapefruit jucie
    • CYP3A4 inducer: St. Johns Watr (hypericum perforatum)
  31. Psychosocial treatment options
    • Cognitive Behavioral Therapy: subjecting beliefs and experiences to reality testing
    • Individual Psychotherapy: assist pts with managing life stressors, medication compliance, improve self-esteem
    • Group Psychotherapy: provides social network for teaching coping and interpersonal skills
    • Assertive Community Treatment: Multidisciplinary team delivers services needed
    • Electroconvulsive Therapy: recommended in combo w/ antipsychotics meds for pts w/o improvements with meds alone or pregnant
  32. Clozapine
    • 3rd line: used for treatment resistant schizo
    • suicidal behavior
    • Tardive Dyskinesia
    • Clozapine fails then try adjunctive therapies
  33. Acute Stage Treatment
    • Cocktail: haloperidol, benzotropine, and lorazepam
    • Severe Syncope: Avoid use of olanzapine and lorazepam together
  34. Stabilization Stage Treatment
    • if nonadherant: Long acting meds
    • risperidone
    • paliperidone
    • haloperidol
    • fluphenazine
    • olanzapine
    • drug containing PLGA polymers
  35. Clozapine monitoring parameters
    • cannot be started if: WBC below 3500 (if below 35 on the left side of cbc chart), or ANC below 2000
  36. Clozapine Black Box Warnings
    • agranulocytosis
    • myocarditis
    • cariovascular and respiratory reactions
    • risk of seizures
    • elders pts w/ dementia and the increased risk of death
  37. Pregnancy Medications of choice
    • Haloperidol
    • Risperidone
    • ECT (electroconvlsive therapy)
  38. Long-acting (depot) Injections
    • haloperidol
    • fluphenazine
    • respirodone
    • paliperidone
    • olanzapine
  39. PLGA
    • respirodone
    • paliperidone

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