Exam 3 Flashcards
schizophrenia pathophysiology
neurotransmitter: multiple (dopamine, serotonin, glutamate, GABA and ACh-both nicotinic and muscarinic abnormalities)
anatomical:
-decreased brain size asymmetry
-increased ventricle size, decreased gray matter
-hippocampal volume, neuronal pruing
-blood flow/glucose metabolism
-not just “dopamine deficit”
schizophrenia diagnostic criteria
two (+) of the following, each present for a significant portion of time during a 1-month period:
-delusions
-hallucinations
-disorganized speech
-grossly disorganized or catatonic behavior
-negative symptoms
For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset
schizophreniform disorder
shorter duration (1-6 months)
impaired social/occupational function NOT required
schizoaffective disorder
-symptoms meeting criteria for mood episode are present for substantial portion of duration of illness
-uninterrupted period of illness either major depressive or manic episode concurrent with symptoms meeting criteria for schizophrenia
-impaired social/occupational function NOT required
brief psychotic disorder or episode
duration between one day and one month with eventual return to premorbid condition
delusional disorder
hallucinations not prominent
mildly impaired function, behavior not blatantly bizarre
subtypes: grandiose, jealous, persecutory
schizophrenia patient evaluation
-complete patient history
-mental status exam : rating scales (Positive & negative syndrome scale), BPRS (brief psychiatric rating scale)
-rule out other conditions
*corticosteriods, stimulants, marijuana, DA-augmenting agents, hallucinigens
*HIV/AIDS, epilepsy, CVA/TBI, infections, huntington’s disease
positive schizophrenia symptoms
hallucinations
delusions
thought disorder
hostility
excitability
negative schizophrenia symptoms
affective flattening, alogia, anhedonia, amotivation, asociality
Non-pharmacologic treatment of schizophrenia
goal: realistic and time course for target symptom response, avoidance of relapse, increasing function and integration back into the community as well as avoidance of side effects
-psychosocial rehabilitation
-psychoeducation
-targeted cognitive therapy
-active community treatment (ACT)
-therapeutic alliance
-comprehensive care in a multidisciplinary environment that offers psychological services in addition to psychotropic medication management
general schizophrenia treatment approach
*SE profiles, drug interactions, adherence, family history, and cost drive therapy choice
-based on optimized monotherapy, combinations only for most treatment resistant
-favor SGA as first line over FGA
-clozapine for treatment resistance or earlier for patients who are suicidal
-long acting injectable antipsychotics for those who prefer them
updates to antipsychotic guidelines
-newer agents have not demonstrated increased efficacy over the older traditional agents
-newer agents may have more potential permanent side effects than the older
-though the range of potential risk varies among patients, these all carry the same class warning and potential
-newer agents are more expensive
-polypharmacy of any combination of agent has not demonstrated improved outcomes or efficacy
-no APS is approved for sleep in non-psychiatric conditions
Patho of dopamine
nigrostriatal- movement disorders
mesolimbic- relief of psychosis
mesocortical- akathisia, relief of psychosis
tuberoinfundibular- increased prolactin
D2 antagonism
positive symptoms efficacy, EPS, endocrine effects High 5HT2A/D2 affinity ration antipsychotic side effects reduced EPS (vs pure D2 antagonism)
D2 partial agonism
reduced positive symptoms, lowers risk of EPS
