Schizophrenia

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Author:
alvo2234
ID:
197383
Filename:
Schizophrenia
Updated:
2013-02-02 17:44:28
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Schizophrenia
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Description:
Schizophrenia
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  1. What is dystonias
    spasms of the tongue, neck, and back
  2. What is akathisia
    continuous restlessness, inability to sit still; suicide risk
  3. what is pseudoparkinsonism
    muscle tremors, cogwheel rigidity, drooling, shuffling
  4. what is tardive dyskinesia
    abnormal muscle movements such as lip smaking
  5. when is dystonias more common
    with high potency APDs and respiradone
  6. types of dystonias
    • torticollis- condition of limited neck motion
    • opisthotonus- spasm of the body
    • oculogyric crisis- restlessness, agitation, fixed stare
  7. How to treat EPS
    • -decrease dose
    • -anticholinergics (benzotropine-most used)
    • -antihistaminics (benadryl)
    • -dopamine agonists (amantadine)
    • -benzodiazepines (lorazepam, clonazepam)
    • -Beta-blockers (propanolol)
  8. Cause of tardive dyskinesia
    • -high potency typical APDs
    • -prolonged DA receptor blackade which leads to super sensitivity of DA receptors
    • -increase DA activity with relative decrease cholinergic activity
  9. Cardinal features of neuroleptic malignant syndrome
    • -fever > 38 C
    • -autonomic dysfunction
    • -altered level of consciousness
    • -absolute rigidity (lead pipe, tensing muscle)
    • -elevated CPK-muscle and elevated WBC
  10. Cause of hyperprolactinemia/sexual dysfunction
    • -low potency conventional APDs (thioridizine, chlorpromazine)
    • -Resperidone
  11. symptoms of hyperprolactinemia
    • galactorrhea
    • amenorrhea
    • decrease estrogen- CVD, breast cancer
    • sexual dysfunction
    • anxiety, hostility
  12. how to treat hyperprolactinemia
    • -decrease dose
    • -switch agent
    • -use DA agonists (bromocriptine, amantidine)
  13. Metabolic Syndrome
    • >= 3 of the following
    • -abdominal obesity
    • -dyslipidemia
    • -HTN= BP >=135/85
    • -IFG >= 100mg/dL
  14. Drugs especially seen to prolong QT interval
    • thioridazine
    • ziprasidone
  15.  general treatment algorithm principles
    • -thorough assessment
    • -monotherapy
    • -considerations
    • -allow 2-4 wks for effect to accur
  16. What to do if pt sx do not decrease during first wks  of therapy
    augment w/2nd agent or switch to alt agent
  17. monitoring-typical response (1-3 days)
    • -decreased agitation
    • -hostility
    • -aggression
    • -normal sleep, eating
  18. monitoring-typical response (1-2 wks)
    • -improved socialization
    • -improved mood
    • -improved self-care habits
  19. monitoring-typical response (3-6 wks)
    • -improvement in thought disorder
    • -decrease in + Sx (hallucinations, delusions)
    • -more appropriate conversations
  20. monitoring- pre-treatment physical assessments
    • BMI
    • HR
    • BP
    • waist circumference
    • signs of movement disorder
    • -EPS
    • -TD
    • CBC
    • WBC with differential for clozapine
    • ECG (pts with cardiac history or on AP that may prolong the QT interval
  21. 1st line agents
    • olanzapine
    • ziprasidone
    • abilify
    • quetiapine
    • risperidone
  22. 2nd line agents
    typical APs
  23. adjunctive therapy agents
    • used to treat the side effects from APDs
    • -anticholinergics
    • -propanolol
    • -BZD
    • -antidepressants
    • -APs (IM)
    • -zolpidem
  24. Step 1:
    single SGA (try to avoid olanzapine bc of problems with weight gain)
  25. Step 2:
    In 2 weeks if patient is not doing that well then switch to another SGA not used above
  26. Step 3:
    if partial or no response to 2 treatments(two failed treatments) then try clozapine if pt agrees. if not, then try another agent.
  27. Step 4:
    • 3 failed treatments:
    • -clozapine + (SGA, CAP, ECT)
  28. Step 5:
    single SGA not used above or CAP
  29. Step 6:
    try anything; combination therapy
  30. treatment algorithm for co-existing agitation/excitement
    PO/IM BZD or AP PRN
  31. Treatment algorithm- co existing insomnia
    • BZD or zolpidem PRN
    • non responder= trazadone
  32. treatment algorithm-co existing depression
    SSRIs (nefazadone, venlafaxine, bupropion, mirtazapine)

    • non responder= reevaluate
    • non-respnder= go to next step in algorithm

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