M14 - Schizophrenia and Other Psychotic Disorders; Antipsychotic Medication Flashcards
- when the only pathology is the psychotic disorder itself.
Primary Psychosis
- when the symptoms are a result of a general medical condition or substance-induced.
Secondary Psychosis
- has rapid onset and generally follows an identifiable stressor; characterized by emotional
turmoil, mood changes and confusion, along with the presence of one or more of the following symptoms: delusions, hallucinations, disorganized speech or grossly disorganized or catatonic behavior. - lasting at least one day; < than one month.
Brief Psychotic Disorder
- involves the presence of sometimes elaborate, non-bizarre delusions
Delusional Disorder
- with features of both schizophrenia and a mood component such as depression or mania.
- does not strictly meet criteria for either schizophrenia or a mood disorder alone.
Schizoaffective Disorder
- “short-episode of schizophrenia”, lasting at least one month, but less than six months
Schizophreniform
- involves psychotic phase characterized by prominent psychotic features, such as delusions, hallucinations and gross impairment in reality testing; persists for at least six months.
- has significant genetic component.
- onset is influenced by psychosocial and environmental factors
- age of onset: 18-20 for men, and mid-twenties for women.
- 11-15 years old: adolescent age
Schizophrenia
- from a neurophysiological perspective, several neurotransmitters – most notably dopamine and
glutamate.
Etiology
delusions, hallucinations, exaggerations in language and communication, disorganized
speech and behaviors.
Positive Symptoms
anhedonia, emotional withdrawal, passivity, apathy, dulled affect, or emotional
flattening
Negative Symptoms
- incoherence, loose associations, impaired attention, impaired
Cognitive Symptoms
These must be ruled out in order to make an accurate diagnosis of schizophrenia.
- Infections 5. Dementias
- Tumors 6. Stroke
- End-Stage Renal Disease 7. Head injuries
- Hypoglycemia 8. Vitamin deficiencies, particularly thiamine
They are effective in treating mania but ineffective in managing bipolar depression. They are are responsible for a group of neurological adverse events known as Extrapyramidal Symptoms.
Conventional Agents/ Dopamine-Receptor Antagonists (First-Generation Anxiolytics)
- Antipsychotics block dopamine receptors in the central nervous system.
- the blocking actions on dopamine receptors in the limbic system are thought to underlie the effectiveness of these
agents in managing the “positive symptoms” of schizophrenia. - may or may not be sedating, depending on product
How Antipsycotic Medications Work
Conventional Agents/ Dopamine-Receptor Antagonists (First-Generation Antipsychotics)
Indications:
- Acute psychotic episodes
- Maintenance treatment
- Mania
- Depression with psychotic symptoms
- Delusional disorder
- Borderline personality disorder
- Substance-induced disorder
- Delirium and dementia
- Mental disorders caused by medical condition
- Childhood schizophrenia
- Pervasive developmental disorder
- Tourette’s disorder
- Huntington’s disease
Drugs influencing psychotic features:
- Cannabis 4. Alcohol
- Amphetamines 5. Opiates
- Hallucinogens
Extrapyramidal Symptoms: 3. - motor-restlessness, a need to move and an inability to sit still
Akathisia
Extrapyramidal Symptoms: 1. - characterized by muscle-tightening in the neck and shoulders, accompanied by spasms.
Dystonia
Extrapyramidal Symptoms: 2. - produces muscle rigidity, mask-like facies, tremor, shuffling gait and diminished arm-swingi
Parkinsonian
- involuntary facial movements involving the tongue, eyes, lips an
Tardive Dyskinesia
When an (blank) develops, one treatment is to lower the dosage of the offending drug.
Extrapyramidal Symptoms (EPS) manifestation
- Neuroleptic Malignant Syndrome
- Sedation
- Central Anticholinergic Effects
- Cardiac Effects
- Sudden Death
- Sexual Adverse Effects
- Skin and Eye Effects
- Jaundice
adverse effects of EPS
Other side effects of Conventional Agents:
- Dry mouth, blurred vision, constipation, sedation and memory problems
- Weight gain
- Grand mal seizures
- Increased levels of prolactin
- Neuroleptic malignant syndrome
- Orthostatic hypotension
- developed to meet the treatment needs of those unresponsive to the conventional agents and to improve the overall
tolerability of antipsychotic use. - not a single, homogenous class of drugs - strong serotonin blockers
- carry a lower risk of EPS
Atypical Antipsychotic Agents/ Serotonin-Dopamine Antagonists (Second-Generation Antipsychotics
- the most effective, but also the most dangerous
Clozaril (clozapine)
- treatment for agitation and aggression in dementia; for minimizing temper tantrums, aggression and self-injury associated with autism, as well as disruptive behavior disorders in children and adolescents (ages
5-16).
Risperdal (risperidone)
- provides calming action for agitation associated with schizophrenia; sedating and likely
produces the most weight gain; increased risk of diabetes type 2.
Zyprexa (olanzapine)
- for the management of aggressive, cognitive and affective symptoms of schizophrenia;
essentially no EPS; has been increasingly prescribed as a sleeping pill.
Seroquel (quetiapine)
- least likely cause weight gain and least sedating; advantage for associated anxiety and
depression, although the drug is associated with agitation at lower doses; has been linked to cases of fatal cardiac
arrythmia.
Geodon (ziprasidone)
- augmenting agent in treatment-resistant unipolar depression and is increasingly being
employed as augmentation to the selective serotonin reuptake inhibitors; associated with minimal weight gain and sedation;
not sedating enough to effectively manage acute agitation
Abilify (aripiprazole)
- an active metabolite of Risperdal (risperidone); it also carries some cardiac risk and is
metabolized primarily by the kidneys; not recommended for patients with liver disease.
Invega (paliperidone)
- must be titrated up slowly to minimize orthostatic hypotension and dizziness; cardiac effects
appear to be similar to those of Geodon (ziprasidone).
Fanapt (iloperidone)
- available only as sublingual tablet; significant for weight gain; oral numbness can be a problem
Saphris (asenapine)
most effective for positive symptoms and even negative symptoms
CBT
- causes very little weight gain but is significant for sedation; metabolic syndrome is minimal;
treatment for schizophrenia, major depressive episodes associated by bipolar I as monotherapy and as adjuctive therapy
with lithium or valproate; very expensive.
Latuda (lurasidone)
Common Side effects of Atypical Antipsychotic:
- Weight gain
- Sedation
- Insomnia
- Agitation
- Constipation
- Dry Mouth
- Increased Risk of Type II diabetes (Clorazil and Zyprexa
- involves bringing together several families, including the identified patients, for educational
get-together - families reach consensus that treatment begins with getting out of bed at a regular time each morning, then
grooming oneself, eating breakfast and deciding on the steps to be stressed for maintaining structure for the rest of the day.
Family Therapy
