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05 Psych > 10 Schizophrenia and psychosis > Flashcards

10 Schizophrenia and psychosis Flashcards

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0
Q

Schizophrenia Diagnostic criteria

A

Patient has social/occupational dysfunction for 6 months or greater from
Two of:
*Delusions
*Hallucinations
*Disorganized speech
*Disorganized or catatonic behavior
*Negative symptoms: alogia, no drive, flat affect, ahedonia, anergia, cognative symptoms

  • ** If more than one voices conversing in head, or if running commentary on behavior or thoughts this is schizo regardless of other symptoms***
  • **Not explained by MDD, Bipolar : Schizoaffective disorder, substances, autism, developmental delay.
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1
Q

Schizophrenia- overview and epidemiology

A
  • Split among affect, thought, emotion, and behavior.
  • Associations brakdown, Affect incongruent, Autism- ego boundries breakdown, Ambivalence
  • 1% prevalence
  • 2.5% of total healthcare expenses in US
  • generally late teen insidious onset
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2
Q

Schizophrenia Symptom classifications

A

Positive: delusions, hallucinations, behavioral disturbance
Negative: Social isolation, withdrawl, poor grooming, anergy, ahedonia, blunted affect
Cognative: Impaired abstract thinking, impaired problem solving, disturbed memory

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3
Q

Schizophrenia etiology

A

DOPAMINE-MESOLIMBIC HYPERACTIVITY, MESOCORTICAL HYPOACTIVITY

  • genetics?
  • Anatomic- enlarged lateral ventricles, sulcal enlargement
  • Physiologc- Decreased dorsolateral prefrontal cortex activation, maybe thalamus and cerebellum
  • Biochemical- D2 blockers work
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4
Q

Schizophrenia treatment

A

Dopamine: serotonin antagonists
Olanzapine, risperidone, quietapne
Dopamine antagonists: Halperidol, chlorpromazine, fluphenazine
SE: Dystonia, akasthisia (restlessness), Tardive dyskinesia (lipsmacking)

Psychosocial: Housing, case management, psychotherapy, vocational training.

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5
Q

Schzophrenia: Psychological treatment

A
  • Assertive community treatment
  • Biological rhythm adherence, medication adherence, aoid abuse substances
  • Social Skill training
  • Family therapy: Decrease displays of emotion
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6
Q

Schizophrenia prognosis

A

Relapses common-
Positive symptoms wane
Negative symptoms wax
Patients with outspoken family members do poorly
20-30% normal life, 20-30% moderate symptoms, 40-60 impaired

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7
Q

Schizophreniform disorder

A

<6 months

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8
Q

Brief psychotic disorder

A

1 day to 1 month

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9
Q

Schizoaffective Disorder

A

Concurrent mood disorder

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10
Q

Delusional disorder

A

No functional impairment except delusions

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11
Q

Dopamine pathways

A

*Mesolimbic- Ventral tegmentum to limbic lobe- Memory, arousal, stimulus processing, locomotor activity, motivational behavior - DA upregulated- positive symptoms
*Mesocortical- Ventral tegmentum to neocortex- cognition, communication, social activity- DA decreased- negative symptoms
*Niagrostriatal- substatia niagra to basal ganglia and extrapyramidal system- pharmacologic D2 Blockade downregulates EPS-> parkinsonism
*Tuberoinfandibular- Hypothalamus to pituitary- Blockade causes increased prolactin release
Tuberoinfandibular

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13
Q

Post synaptic dopamine receptors

A

D2R- Downregulated cAMP but upregulates IP3

D1R- Upregulates cAMP

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14
Q

Presynaptic dopamine receptor

A

D2 like- downregulates presynaptic cAMP and prevents vesicular fusing

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15
Q

Atypical Antipsychotics

A

Clozapine, risperidone, olanzapine, quietapine

DA blockade
5HT2 blockade in forebrain

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16
Q

Pharmacokinetics of antipsychotics

A 
Variable oral absorption
Lipid soluble
Protein binding
Large volume of distribution
Complex metabolism
17
Q

Antipsychotics

A
  • Best for treatment of positive symptoms
  • Work less well for negatives (though atypicals help these)
  • Classics cause sedation
  • Extrapyramidal effects- dystonia(1-5 days), parkinsonism(1wk-1month), akasthisia(1wk-2months), Tardive dyskenesia (months to yrs)
18
Q

Antipsychotic SE

A
  • Variable anticholinergic side efects (dry as a bone, blind as a bat, hot as a hare)
  • orthostatic
  • Neuroendocrine effects
  • allergic, liver, blood effects
  • THIORIDAZINE CARDIAC EFFECTS
  • Phenothiazines- Seizure threshold
  • weight gain (atypicals)
19
Q

Neuroepileptic malgnant syndrome

A
  • Potentially lethal
  • Hypodopaminergic side effect
  • Hyperthermia
  • parkinson-like symptoms
  • mutism and death

Tx-
Cooling, hydration, bromocriptine, dantrolene

20
Q

Phenothiazines

A

Original typicals

  • Fluphenazine, Perphenazine, Prochloroperazine, Trifluorperazine
  • Piperazines
  • Very potent
  • Less sedative
  • Highly extrapyramidal
  • Thioridazine, Mesoridazine
  • Low potency
  • sedative
  • anticholinergic
  • Chlorpromazine, Triflupromazine
  • medium potency, sedatie, anticholinergic
21
Q

Chlorprothixene, Thiothixene

A

like phenothiazines

22
Q

Haloperidol

A

Acts similar to Piperazines

- high potency, sedative, extrapyramidal reactions

23
Q

Pimozide

A
  • Neuroleptic
  • Many side effects
  • Tourettes treatment
24
Q

*Clozapine

A
  • D4- 5HT2 blocker
  • Improves refractory positive smptoms as well as negatives
  • Antimuscarinic
  • SEVERE SEIZURE THRESHOLD LOWERING
  • AGRANULOCYTOSIS
  • DECREASES SUICIDE
25
Q

Olanzapine

A
  • D1, D2, 5HT2 antagonist
  • Rare extrapyramidal symptoms, no siezures, no agranulocytosis
  • WEIGHT GAIN AND DIABETES
  • reports of abuse
26
Q

Risperidone

A
  • D2 5HT2 antagonist
  • Reduction in negative symptoms
  • Less seizure and anti-muscarinic effects
  • IM available
  • paliperidone is active metabolite
27
Q

Quietapine

A
  • 5HT2 and D2 antagonist
  • similar to clozapine
  • Good for negative symptoms
  • some weight gain
  • Shorter half life
  • Approved for depression augmentation
28
Q

Ziprasidone

A
  • 5HT2 and D2 antagonist- may have 5HT1a agonist effect (anxiolytic)
  • No weight gain
29
Q

Aripirazole

A
  • Partial D2 agonist, 5ht2 antagonist
  • less weight gain
  • Depression augmentation
30
Q

Lithium

A
  • MANIA/BIPOLAR, UNIPOLAR DEPRESSION, SCHIZOAFFECTIVE, CLUSTER HA
  • Antipsychotic- blocks IP2 recycling to IP1
  • blocks manic behavior
  • No effect on normals
  • Narrow therapeutic window
  • 12-24 hour half life
  • free cation is plasma
  • 95% urine elimination
  • Interactions with high sodium, ACEi and ANGII
31
Q

Lithium SE

A

Fatigue/muscular weakness
Tremor (treat with B blockers)
GI symptoms
Inpaired consciousness coma and death at 2-3X

32
Q

AEDS for mania

A

Carbemazepine
Valproic acid/Divalproex
Lamotrigrine and topirimate
olanzaine/fluoxetine (symbyax- bipolar, refractory MDD

05 Psych (8 decks)

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