schizoprenia

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Author:
mmccaf9260
ID:
18440
Filename:
schizoprenia
Updated:
2010-05-09 11:37:12
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schizophrenia
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Description:
Therapeutics 3
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  1. Schizohrenia is not:
    • a distinct disease
    • due to flaws in personality
    • a multiple personality
    • from poverty
    • a split personality
    • demonic
    • contagious
    • a socipathic behavior
    • from bad parenting
  2. Lifetime prevelance of schizophrenia
    1%
  3. epidemiology of schizophrenia
    • no sex or racial differences
    • women late 20s
    • men early to mid 20s
    • more frequent in lower socioeconomic class
    • older people present with delusions and hallucinations and less disorganized and negative symptoms
  4. Life expectancy of a patient with schizophrenia
    • 20-30 years shorter
    • due to suicide, premature CV disease, genetics, AP drugs, lifestyle choices
  5. Environmental factors that can cause schizophrenia
    • low birth weight
    • hypoxia
    • fetal distress/prematurity
    • malnutrition
    • infectious disease (flu in 2nd trimester)
    • autoimmune causes
  6. Positive signs of schizophrenia
    • delussions
    • hallucinations
    • disorganized speech
    • unusual behavior
    • psychomotor agitation
  7. Negative symptoms of schizophrenia
    • blunted affect
    • alogia- inability to speak
    • avolition- lack of initiative or motivation
    • anhedonia- absence of pleasure or ability to experience it
    • poverty of speech
    • psychomotor retardation
  8. Cognitive symptoms of schizophrenia
    • attention
    • memory
    • executive functions
    • skill acquistion
  9. mood symptoms of schizophrenia
    • depression
    • dysphoria
    • hopelessness
    • demoralization
  10. social and occupational symptoms of schizophrenia
    • social isolation
    • emplyment difficulties
    • self-care
    • family relationships
    • social relationships
  11. 5 subtypes of schizophrenia
    • paranoid
    • disorganized
    • catatonic
    • undifferentiated
    • resdiual
  12. Standardized rating scales
    • Brief Psychiatric Rating Scale (BPRS)
    • Positive and Negative Symptom Scale (PANSS)
  13. List some tradition antipsycotics
    • chlorpromazine (Thorazine)
    • fluphenazine (Prolixin)
    • haloperidol (Haldol)
    • loxapine (Loxitane)
    • molindone (Moban)
    • perphenazine (Trilafon)
    • thioridazine (Mellaril)
    • thiothixene (Navane)
    • trifluoperazine (Stelazine)
  14. Pathophysiology of schizophrenia
    • dopamine hyper/hypoactivitiy
    • serotonin blockade???
    • excitatory amino acids
    • decreased glutamate
    • NMDA receptor dysfunction
    • increased glutamate receptors
  15. Therapeutic goals of schizophrenia
    • acute stabilization: reduced threat to self or others, reduct acute symptoms, improve role functioning, identify types of psychosocial interventions, collaborate with family members and caregivers
    • stabilization: minimize/prevent relapse, medication compliance, optimize dose vs. adverse effects
    • Stable phase/maintenance: improve functionand QOL, maintain base line functioning, optimize dose and limit AE, monitor for prodromal symptoms of relapse, monitor for ADR
  16. Non-pharmacologic interventions for schizophrenia
    • supportive/counseling
    • personal thearpy
    • social skills therapy
    • vocational sheltered employment rehabilitation therapies
  17. Atypical antipsycotics (2nd generation)
    • aripiprazole (Abilify)
    • clozapine (Cozaril)
    • olanzapine (Zyprexa)
    • paliperidone (Invega)
    • quetiapine (Seroquel)
    • risperidone (Risperdal)
    • ziprasidone (Geodon)
    • iloperidone (Fanapt)
  18. SE of chlopromazine (Throazine)
    • EPS not as prominant
    • anticholinergic delirium in elderly patients
    • QT prolongation
    • orthostasis
    • photosensitivity
  19. SE of clozapine (Clozaril)
    • agranulocytosis
    • weight gain
    • seizures
    • drooling
  20. SE of risperidone (Risperdal)
    orthostasis
  21. SE of olanzapine (Zyprexa)
    weight gain
  22. SE of quetiapine (Seroquel)
    • sedation
    • weight gain
    • anxiety
  23. SE of ziprasidone (Geodon)
    • orthostatic hypotension
    • increase QT interval
  24. Agents used to treat EPS
    • Antimuscarinics: benztropine, biperiden, trihexyphenidyl
    • Antihistamine: diphenhydramine
    • Dopamine agonist: amantadine
    • Bzds: lorazepam, diazepam, clonazepm
    • Beta blockers- propranolol
  25. How often should you monitor hyperprolactemia?
    screen for symptoms at each visit and then yearly
  26. How often should you assess EPS?
    every 2 weeks during acute phase of treatment and at each visit during the stable phase
  27. How often should you assess tardive dyskinesia?
    complete every 6 months with typical APs and every 12 months with atypical APs. if at an increased risk then every 3-6 months
  28. How often you you assess cataracts?
    ocular exam every 2 years for patients <40 and yearly >40
  29. Neuroleptic Malignant Syndrome
    • characterized by muscular rigidity, hyperthermia, altered conschiousness, and autonomic disturbances
    • most develop withing 10 days of starting therapy with AP
    • occure more in males
    • last 5-10 days after D/C medicaiton
    • incidence is rare (0.5-2.4%)
  30. NMS treatment
    • bromocriptine
    • Dantrolene
    • Amantadine

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