BCPP Flashcards
Five broad diagnostic aspects of schizophrenia
Positive symptoms, negative symptoms, disorganization, social/occupational dysfunction, duration
Positive symptoms of schizophrenia
hallucinations and delusions
Negative symptoms of schizophrenia
Reduction in normal functions- asociality, anhedonia, loss of motivation
Disorganization (schizophrenia)
Thinking/speaking that is confused and lacking in logical structure
Social/occupational dysfunction (schizophrenia)
One or more area of function (work, interpersonal relations, self care) markedly below previous level
DSM V diagnosis for schizophrenia
Two or more of the below for significant portion of a one month period. At least one must be 1, 2 or 3
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms
Level of functioning in one or more areas is (ie work, self care, interpersonal relations) is declined
Continuous signs of disturbance for at least 6 mo
No MDD or manic episodes during active phase sx, or if mood sx present they were present for a minority of the duration of the active phase sx
Not substance related
If hx of autism, the additional dx is made only if prominent delusions or hallucinations are present for at least 1 mo
Schizoaffective DO
Uninterrupted period of illness containing at some point either major depressive episode, manic episode, or mixed episode concurrent w/ schizophrenia sx
Catatonia
Presence of 3 or more of:
Stupor (no activity, not reacting to environment)
Catalepsy (passive induction of posture against gravity)
Waxy flexibility (slight resistance to positioning)
Mutism
Negativism (opposition or no response to stimuli)
Posturing (spontaneous active maintenance of posture against gravity)
Mannerism (odd circumstantial caricature of normal actions)
Stereotypy (repetitive non-goal directed movements)
Agitation not influenced by external sitmuli
Grimacing
Echolalia (mimicking speech)
Echopraxia (mimicking movements)
Comparative effectiveness of FGA
Equal, but differ in SE profile
Main receptors affected by FGA
D2, muscarinic, alpha-1, histamine
Neurotransmitter cause of EPS
relative dopamine deficiency and Ach excess in nigrostriatal pathway, this is why Ach meds help with EPS
When to initiate tx for schizophrenia
As soon as clinically feasible d/t distress from disease
Time to response of treatment
May be up to 4-6 weeks, although acute sx (agitation and hostility) may respond after initial doses
Sx responding to FGA
Mostly positive sx, delusions and disorganization or incoherent thinking tend to attenuate
WHEPSOAQ
Weight gain, hyperglycemia/hypercholesterolemia, EPS, prolactin elevation, sedation, orthostatic hypotension, anticholinergic, QTc prolongation
Other possible SE from FGA
Photosensitivity (CPZ), seizure (CPZ)
Local FGA max doses
CPZ: 1600mg/day
Haldol: 80mg/day
Fluphenazine: 80mg/day
Depot FGA conversions
Fluphenazine: 25mg Q2W = 10mg/day
Haldol: 100mg QM = 5mg/day
Fluphenazine: taper and discontinue over 4-6 weeks
Haldol: Load with daily PO dose x10 three times total. DC PO haldol at time of second loading dose. Then do daily PO dose x20 biweekly starting two weeks after last loading dose. Get level 2-72 hrs before first and second scheduled maintenance doses to determine effect
FGA target level
Fluphenazine: 0.8-4ng/ml. Little additional benefit is obtained at levels > 4ng/ml
Haldol: 15-30 ng/ml. Little benefit at levels >30 ng/ml as D2 receptors tend to be fully occupied at this level
How to get more D2 blockade if insufficient blockade obtained from maximal haldol dec?
Switch to fluphenazine dec
