Guidelines for Pharmacotherapy of Schizophrenia Flashcards
Canadian schizophrenia guidelines stresses the importance of…
Earlier treatment of symptoms
Need for greater attention to physical care
Greater emphasis on recovery + providing personalized care
____ play a central role in recommendations related to pharmacotherapy
Antipsychotics
It is important to recognize that psychotic symptoms can…
Wax and wane during the course of illness
Early detection and treatment of a first episode of psychosis is crucial because…
Linked with decreased depression, increased mood/cognitive scores, and improved overall function at 10 years
Longer durations of untreated psychosis results in…
Decreased response to treatment
Pharmacotherapy given for a first episode of psychosis is…
Usually a 2nd/3rd gen AP - choose agent based on AE profile, drug interactions, cost; use lowest effective dose
Compared to 1st gen: Lower AE, lower rates of discontinuation, equal efficacy
LAIA may lower relapse risk vs. oral therapy
Treatment duration for a 1st episode of psychosis is…
Minimum of 18 months, but indefinite therapy is very reasonable (risk of relapse after 1st episode is VERY high)
Once a specific AP is selected it should be initiated and further titrated based on…
Efficacy and tolerability with a target dose (on the lower end of the dose range)
An adequate trial with an AP is considered…
Minimum of 6 weeks at the optimally tolerated dose
Upon an acute exacerbation, we should first screen for…
Non-adherence, substance use, drug interactions
Since these would not constitute AP treatment failure
Options to consider regarding pharmacotherapy for an acute exacerbation of psychosis includes…
Increasing dose of current AP
Changing AP if treatment failure; trial for 6-8 weeks to determine effect
Non-psychotic symptoms, such as mood changes may…
Necessitate treatment with non-AP medications; mood stabilizers, AD’s
Maintenance treatment with AP’s contribute to…
Relapse prevention and decreased hospitalization rates
Psychosis and schizophrenia is often co-morbid with…
Substance use disorder
Difficult to determine whether psychosis came first, or substances causing psychosis
Factors that may indicate an underlying psychotic disorder, rather than a substance causing psychosis includes…
Psychosis persisting with abstinence
Sx’s not aligning with type/amount of substance
Family hx of psychosis
Typical positive symptoms of schizophrenia, presence of negative/cognitive symptoms (prodromal period)
Does psychosis + substance use disorder change treatment options?
No evidence of benefit for one AP over another for psychosis + SUD
Treatment-resistance schizophrenia is defined as…
2+ positive symptoms of moderate severity or 1 positive symptoms of severe severity, after 2+ adequate AP trials
To see if an AP trial is confirmed a failure, we should confirm…
Adherence
Co-substance use, drug interactions
Dose assessment
First-line therapy for treatment-resistant schizophrenia is…
Clozapine
Clozapine-resistant schizophrenia is defined by…
Symptoms remaining with 8-12 weeks at doses above 400mg/day, and trough levels above 350ng/mL (OD) or 250ng/mL (BID)
Clozapine levels are not routinely done unless there are concerns about non-response, non-adherence, AE’s, or drug interactions
What could be tried for clozapine resistant schizophrenia?
Multiple clozapine augmentation strategies (limited consensus)
No consistent evidence to support high dose AP, switching AP’s, or AP polypharmacy. Polypharmacy may be useful for some but increase AE’s
A combination of clozapine and aripiprazole LAI in clozapine-resistant schizophrenia may help by…
Decrease rate of psychiatric hospitalization vs. clozapine monotreatment
Non-pharm options for clozapine-resistant schizophrenia includes…
ECT
Trans magnetic stimulation
CBT
