IC 11 - Schizophrenia Flashcards
What is the pathophysiology of schizophrenia?
Dysregulation of dopaminergic (DA), serotonergic (5HT) and glutamatergic functions
Name 1 precipitating factor involved in Schizophrenia.
Drugs-/substance
What is one perpetuating factor that prolong the course of disorder?
Poor adherence to antipsychotic medications
What are symptoms of schizophrenia?
≥ 2 of the following for least a 1 month:
1. delusions
2. hallucinations
3. disorganized speech
4. grossly disorganized or catatonic behavior
5. negative symptoms
How is schizophrenia diagnosed?
- Symptoms
- Social/occupational dysfunction
- Continuous signs of disorder for min. 6 months (inclusive of prodromal or residual symptoms)
- Exclusion of Schizoaffective or mood disorder
What is one of the assessment that should be done for accurate diagnosis of schizophrenia?
Mental state exam (assess for suicidal/ homicidal ideations and risks)
List 4 non-pharmacological management for schizophrenia.
- Individual: Vocational sheltered (sheltered: employment, rehabilitation)
- Individual Cognitive Behavioral Therapy (CBT)
- Neurostimulation - Electroconvulsive Therapy (ECT)
- Psychosocial rehabilitation programs
Electroconvulsive Therapy (ECT) reserved for ____________ Schizophrenia
treatment resistant
What is the purpose of antipsychotics for Schizophrenia?
Relieve symptoms of psychosis such as thought disorder, hallucinations and delusions, and prevent relapse
Antipsychotics are more useful for _____ schizophrenia.
acute
Why is relapse often delayed for several weeks after cessation of treatment of schizophrenia?
The antipsychotic are stored in fat cells. This allow them to diffuses back into blood stream after treatment cessation.
List three methods to overcome poor treatment adherence.
- IM long acting injections
- Community Psychiatric Nurse home visit and administer long acting injections regularly
- Patient and Family (Caregiver) Education
What is the primary use of antipsychotics in schizophrenia? Relate to MOA.
Blockade of the dopamine receptors in mesolimbic tract
What are the three undesirable effects that may occur when dopamine receptors in other tracts (except mesolimbic tract) of the central dopamine systems are blocked?
- Negative symptoms
- Extrapyramidal side effects
- Hyperprolactinemia
How can schizophrenia treatment be given?
- Single antipsychotic (first or second gen)
- If no response, use another single antipsychotic
- Clozapine if no response from 2
- Clozapine + FGA/SGA/Electroconvulsive therapy if no reponse from 3
What is the duration for adequate trial of antipsychotic (excluding clozapine)?
2 to 6 weeks at optimal therapeutic doses
What is the duration for adequate trial of clozapine?
up to 3 months
What is the drug that can be used for treatment resistant schizophrenia?
Clozapine
What is considered treatment resistant schizophrenia?
failed ≥ 2 adequate trials of different antipsychotics (at least 1 should be a SGA).
What is a mandatory routine monitoring that should be done for patients on clozapine?
Hematological monitoring (periodic FBC due to risks for agranulocytosis)
Who should use antipsychotic with caution?
- Cardiovascular diseases
- Parkinson’s disease
- Prostatic hypertrophy
- Angle-closure glaucoma
- Severe respiratory disease
- Blood dyscrasias (esp Clozapine)
- Elderly with dementia
In the event of acute agitation (emergency) and patient is cooperative, what are the two medications that can be used?
- Oral Lorazepam 1 2mg
- Risperidone (tab, oro-dispersible, solution) 1 2mg
In the event of acute agitation (emergency) and patient is uncooperative, what are the fast acting medications that can be used?
- IM Lorazepam 1-2mg
- IM Olanzapine
- IM Haloperidol 2.5-10mg, with pre treatment ECG
- IM Promethazine 25-50mg
What medication in the event of catatonia?
Benzodiazepines (i.e. PO/IM Lorazepam)
What is the Tmax of oral antipsychotics in general?
1 to 3 hours (except Brexpiprazole,
Olanzapine, Aripiprazole)
What are the oral antipsychotics that do not have long T1/2?
Chlorpromazine, Sulpiride; Amisulpride, Clozapine, Quetiapine, Ziprasidone
What are the two risks that should be considered if giving multiple dose of oral antipsychotics?
Hypotension and seizures
What are the four extrapyramidal side effects of antipsychotics?
- Dystonia
- Pseudo-parkinsonism
- Akathisia
- Tardive dyskinesia