Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

brain > IC11 Schizophrenia, psychosis (X) > Flashcards

IC11 Schizophrenia, psychosis (X) Flashcards

You may prefer our related Brainscape-certified flashcards:
The Brain flashcards
1
Q

what is the DSM-5 diagnostic criteria for schizophrenia?

A
  1. 2 or more +ve/-ve symptoms for ≥1 month
  2. functional impairment
  3. continuous signs for ≥6 months
  4. exclusion of schizoaffective or mood disorder
  5. disorder NOT due to medical disorder or substance abuse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are some positive symptoms of schizophrenia?

A
  • delusions
  • hallucinations
  • disorganized speech & behaviour
  • catatonic behaviour (can look like: not responding to other ppl/env, holding their body in unusual position, not speaking, resisting ppl who try to adjust their body, agitation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are some negative symptoms of schizophrenia?

A
  • cannot experience pleasure (anhedonia)
  • cannot initiate goal-directed activities (avolition)
  • monotone speech (little or no change to tone), no change in facial expression, even if talking abt sth upsetting/exciting (affective flattening)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are some non-pharmacological treatment for schizophrenia?

A
  • cognitive behavioural therapy (CBT)
  • electroconvulsive therapy (ECT) for treatment-resistant schizophrenia
  • psychosocial rehab to increase adaptive functioning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the drugs used to treat schizophrenia?

A

antipsychotics (thought organizers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how do they generally work?

A

in schizophrenia/psychosis, there is elevated DA levels –> therefore, antipsychotics are used to lower DA levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

are medications required long term?

A

yes; often life-long maintenance therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what happens if patient is non-adherent to med / suddenly stop bc they feel better?

A

high risk of relapse;
relapse will occur only a few weeks after discontinuation as antipsychotics are stored in fat tissue and can slowly be released into the bloodstream when discontinued

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are some methods to overcome antipsychotic non-adherence?

A
  • IM long acting injection (LAI)
  • community psychiatric nurse
  • patient & caregiver education
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the treatment algorithm for schizophrenia?

A

diagnosis –> initiate a single FGA/SGA
if inadequate or no response after adequate trial –> use another FGA/SGA
if still inadequate or no response after adequate trial –> clozapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

why is clozapine reserved only as last line?

A

due to risk of agranulocytosis that requires frequent FBC monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is considered an ‘adequate trial’ of antipsychotics?

A

at least 2-6 weeks at therapeutic dose

clozapine: up to 3m at therapeutic dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the main limiting factor when using antipsychotics?

A

adverse effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how can we manage the AEs?

A

lower dose or switch agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are some precautions when initiating antipsychotics?

A
  • CVD (esp QTc prolongation)
  • PD
  • epilepsy, conditions predisposing to seizures
  • depression
  • myasthenia gravis
  • BPH
  • angle-closure glaucoma
  • severe respiratory disease
  • hx of jaundice
  • blood dyscrasias (esp for clozapine)
  • elderly with dementia

*refer to notes for detailed explanation - may help to understand and memorise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how can we deal with a schizophrenic patient who is acutely agitated?

A

give benzos/antipsychotic to calm them down - route of administration depends on whether patient is cooperative or not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

if patient is cooperative while agitated, what are the agents available to calm them down?

A
  1. PO lorazepam 1-2mg
  2. PO antipsychotic (haloperidol + pre-treatment ECG, risperidone, quetiapine, olanzapine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

if patient is uncooperative while agitated, what are the agents available to calm them down?

A
  1. IM lorazepam 1-2mg
  2. IM antipsychotic (olanzapine, aripiprazole, haloperidol)
  3. IM promethazine
  4. combination (lorazepam/promethazine + haloperidol)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what do we need to take note of when giving these agents?

A

olanzapine & lorazepam cannot be given within 1h of each other due to risk of cardiorespiratory death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

if patient is catatonic, what can we give them?

A

PO/IM lorazepam

21
Q

if patient is depressed, what can we give them?

A

antidepressant

22
Q

describe PK of oral antipsychotics

A
  1. fast onset due to short Tmax
  2. OD dosing possible due to long half-life for most drugs
23
Q

what are some drugs whose doses cannot be consolidated to OD dosing and why?

A

clozapine, quetiapine, chlorpromazine, amisulpride, ziprasidone

due to risk of hypotension & seizures

24
Q

what does ‘decanoate’ in haloperidol decanoate tell us?

A

decanoate = esterified with long aliphatic chain = allows antipsychotic to be slowly released into bloodstream over 4 weeks = long acting (LAI)

25
Q

explain the mechanism of action of side effects caused by antipsychotics

A

recap: in psychosis, there is excess DA –> therefore, antipsychotics serve to ↓ DA levels

there are 4 dopamine pathways in the brain - mesolimbic (ML), mesocortical (MC), nigrostriatal (NS), tuberoinfundibular (TI)

functions of DA pathways:
- ML: reward & emotion
- MC: higher order thinking & executive functions
- NS: regulates voluntary movement
- TI: regulates PRL secretion

therefore, effects of DA blockade =
- ML: ↓ +ve sx
- MC: causes -ve sx
- NS: causes EPSE
- TI: hyperPRL

in schizophrenia/psychosis, dopamine blockade is intended at ML pathway. therefore, off-target effects at MC, NS and TI pathways produces AEs of -ve sx, EPSE and hyperPRL

furthermore, antipsychotics also target other receptors apart from D2, producing other off-target effects:
- (D2 antagonism: EPSE, hyperPRL)
- 5-HT2A antagonism: improve -ve sx (?)
- 5-HT2C antagonism: weight gain
- H1 antagonism: sedation, weight gain
- alpha-1 adrenoceptor antagonism: postural hypotension
- M1 antagonism: anticholinergic SE (dry mouth, constipation)

26
Q

is EPSE more a/w FGA or SGA?

A

FGA;
this is bc SGA have more potent 5-HT2A antagonism VS weak D2 antagonism, whereas FGA only has D2 antagonism, resulting in more pronounced DA antagonism side effects

27
Q

is hyperPRL more a/w FGA or SGA?

A

FGA - due to more pronounced DA antagonism than SGA (which has 5-HT2A and DA antagonism), specifically at TI pathway

28
Q

recap: what are some extrapyramidal side effects caused by antipsychotics?

A

DAPT:
- dystonia (muscles contract uncontrollably)
- akathisia (cannot remain still)
- pseudo-parkinsonism (cogwheel rigidity, tremors at rest)
- tardive dyskinesia (involuntary facial tics eg. lip smacking)

29
Q

what are the risk factors for developing dystonia in antipsychotic therapy?

A
  • high potency antipsychotics
  • naive to antipsychotics
  • young males
30
Q

how to manage dystonia SE?

A

IM anticholinergic (eg. benztropine, diphenhydramine)

31
Q

what are the risk factors for developing akathisia in antipsychotic therapy?

A

haloperidol (high potency) > risperidone (high potency) > olanzapin e(moderate potency) > quetiapine/clozapine (low potency)

32
Q

how to manage akathisia?

A
  • ↓ antipsychotic dose OR switch to SGA
  • clonazepam PRN
  • propranolol 20mg TDS (max 160mg/day)
33
Q

how to manage pseudo-parkinsonism?

A
  • ↓ antipsychotic dose OR switch to SGA
  • anticholinergics PRN (eg. benzhexol, benztropine)
34
Q

what are the risk factors for tardive dyskinesia in antipsychotic therapy?

A
  • FGA > SGA
  • worsened with anticholinergic drugs
35
Q

how to manage tardive dyskinesia?

A
  • discontinue anticholinergics
  • ↓ antipsychotic dose OR switch to SGA
  • valbenazine (40-80 mg/day)
  • clonazepam PRN
36
Q

how to manage hyperPRL?

A

switch to aripiprazole

37
Q

what are some metabolic SEs that antipsychotics may cause?

A

weight gain, DM, ↑ lipids

38
Q

what antipsychotics have a high risk of causing metabolic SEs?

A

olanzapine, clozapine (both -pines)

39
Q

what antipsychotics have a moderate risk of causing metabolic SE?

A

chlorpromazine, quetiapine, risperidone

40
Q

what antipsychotics have a low risk of causing metabolic SE?

A

aripiprazole, lurasidone, ziprasidone, haloperidol

41
Q

how to manage metabolic SE?

A
  • lifestyle modification eg. diet, exercise
  • treat DM (eg. metformin) and HLD (eg. statin)
  • switch to lower risk agents
42
Q

what antipsychotics may cause orthostatic hypotension?

A

chlorpromazine, clozapine > risperidone, paliperidone, quetiapine > olanzapine, lurasidone, aripiprazole, sulpride

43
Q

how to manage orthostatic hypotension?

A
  • switch to lower risk agent
  • slowly get up from lying down position
44
Q

what is a major adverse effect caused by antipsychotics that we have to take note of?

A

neuroleptic malignant syndrome (NMS)

45
Q

what are the signs and symptoms of NMS?

A
  • muscle rigidity (lead-pipe rigidity)
  • ↑ CK (due to muscle rigidity)
  • fever
  • autonomic dysfunction - eg. ↑ pulse, labile BP, diaphoresis
  • altered consciousness
46
Q

what are the antipsychotics that may cause NMS?

A

all antipsychotics have a risk of causing NMS; higher risk of NMS with higher potency antipsychotics (eg. haloperidol, risperidone)

47
Q

what is the duration of onset of NMS?

A

within 30 days

48
Q

how to manage NMS?

A
  • IV Dantrolene 50mg TDS
  • oral dopamine agonist (eg. amantadine, bromocriptine)
  • supportive measures
  • switch to SGA

brain (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions