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PSYC 441 - FINAL > Lecture 13: Antipsychotic drug treatment in sz > Flashcards

Lecture 13: Antipsychotic drug treatment in sz Flashcards

1
Q

What is meant by “These are anti-psychotic medications, not anti-schizophrenia medications” (Barnes & Marder)?

A
  • Medications treat symptoms, but do not cure the disease

- Drug treatment as a context for psychosocial interventions

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2
Q

What are First generation anti-psychotics and how do they work?

A
  • e.g., haloperidol,
  • chlorpromazine (remember was discovered by accident)
  • Block D2 receptors in all pathways
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3
Q

What are Second generation anti-psychotics and how do they work?

A
  • clozapine, olanzapine
  • Developed from 1st generation
  • Less potent effects on D2, also block serotonin
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4
Q

In terms of the effects on neurotransmitters, what is the difference between 1st generation and second generation anti-psychotics?

A
  • First generation antipsychotics Block D2 receptors in all pathways
  • Second generation antipsychotics have less potent effects on D2 but also block serotonin
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5
Q

In general, physicians will prescribe which generation of antipsychotics first?

A
  • In general, physicians try 2nd generation first

- 1st generation used when others do not work

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6
Q

How 1st generation antipsychotics work?

A
  • Block DA receptors (especially D2)
  • When receptors are blocked, less DA can bind
  • So, even if there is too much DA, it has a reduced effect
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7
Q

Effects of antipsychotic medications: it decreases DA in 3 pathways, what are they?

A

1) mesolimbic
2) mesocortical
3) mesostriatal

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8
Q

When antipsychotics decrease DA in mesolimbic, what are the effects on SZ?

A

↓ hallucinations, delusions – but also decreases in emotion, motivation, memory

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9
Q

When antipsychotics decrease DA in mesocortical, what are the effects on SZ?

A
  • May further impair frontal lobe function, planning
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10
Q

When antipsychotics on decrease DA in mesostriatal, what are the effects on SZ?

A
  • Motor side effects, tardive dyskinesia (involuntary neurological movement disorder)
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11
Q

How do 2nd gen antipsychotics work?

A

1) Block D2 receptors, but less permanently, so less severe motor side effects
2) Block serotonin receptors, especially in frontal cortex
- Serotonin inhibits DA, so when serotonin is blocked, DA is increased
3) But, other negative side effects, include weight gain, diabetes, low blood pressure

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12
Q

Why would one prefer second generation medication if they do not appear to be more effective?

A
  • they have a reduced risk of extra-pyramidal side-effects and tardive dyskinesia
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13
Q

If many 2nd generation medications exist on the market but no evidence that one medication is better, then choice is based on two components. What are they?

A

1) effectiveness

2) side-effect profile for individual patients

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14
Q

What are the options for people who are not able to take meds reliably?

A
  • long-acting injectable forms are available
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15
Q

What are the benefits of medication?

A

1) Most people have reduced positive symptoms
2) Medications can prevent relapse, shorten relapse and reduce the risk of suicide
3) Can let people benefit from psychosocial treatments

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16
Q

In regard to the benefits of medication on reducing positive symptoms, which symptoms are we referring to?

A

1) Fewer hallucinations,
2) delusions less intense,
3) less likely to experience paranoia
4) May be less agitated

17
Q

Medications are not very effective for which types of symptoms?

A

negative symptoms, social impairments and cognitive deficits

18
Q

What are Extra-pyramidal symptoms?

A

1) Agitation
2) Involuntary movements (akathesia)
3) Parkinsonian symptoms
4) Tardive dyskinesia

19
Q

What are Involuntary movements (akathesia)?

A

1) twisting, head turning, eyes rolled up, tongue sticking out
2) Physical restlessness, not mental restlessness

20
Q

What are the common side effects of antipsychotics?

A

1) Extra-pyramidal symptoms

2) Parkinsonian symptoms

21
Q

What is an uncommon side effect of antipsychotics?

A

Tardive dyskinesia

22
Q

What are the Parkinsonian symptoms associated with the side effects of antipsychotics?

A

1) Slowness in walking, problems with balance
2) Tremor (shaking)
3) Bradykinesia ( slowness of movement)
4) Rigid face, stiff movements

23
Q

What is Tardive dyskinesia?

A
  • Severe involuntary movements,
  • twisting, stiffness
  • Cannot always be reversed
24
Q

Side effects are usually associated with ________treatment with antipsychotics

A
  • long-term
25
Q

In terms of side effects, symptoms develop ______, which is why it’s important to ________

A
  • slowly

- monitor carefully

26
Q

What are the two side effects on bodily regulation?

A
  • Metabolic and hormonal changes are common in second-generation medications
  • Hyper- or hypo-tension (high or low blood pressure)
27
Q

Explain the Metabolic and hormonal changes which are common in second-generation medications

A
  • Severe weight gain
  • Glucose dysregulation that can lead to diabetes
  • Hormonal changes (loss of sexual function)
28
Q

Explain the Hyper- or hypo-tension (high or low blood pressure) side effect of antipsychotics

A
  • Can be reversed by medication changes

- Can be severe and carry high risk of medical complications

29
Q

How can side effects be managed?

A
  • Rating scales
  • Monitoring
  • Supervised medication reviews, gradual changes
30
Q

Managing side effects highlights the importance for _______________________

A

all types of clinicians to understand medications

31
Q

What are the treatment guidelines for SZ? (for medication)

A

1) Start with the lowest recommended dose
2) Larger initial doses are not beneficial
3) A person in relapse may be started at their previous dose level (if known)
4) Increasing dosage acutely to control current behavior is not effective
5) Greatest positive effects seen in the first month
6) Positive effects level off after first year
7) Medications should not usually be combined – although this is common

32
Q

What are the cautions with starting with the lowest recommended dose?

A
  • Monitor for 2 weeks

- Increase dose by small amounts

33
Q

Drug treatment is almost always long-term or short-term?

A

long term

34
Q

Why is the evidence that medications appear to protect against relapse?

A
  • Approximately 70% of those withdrawn from medication will relapse within 1 year
35
Q

People with SZ who have had long periods without symptoms may be temped to ____________

A

discontinue meds

36
Q

Why is there evidence that medications should be continued for at least 1-2 years?

A
  • Gives time for adjustment, psychosocial interventions to take effect

PSYC 441 - FINAL (13 decks)

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