M14 - Schizophrenia and Other Psychotic Disorders; Antipsychotic Medication

Question 1

• when the only pathology is the psychotic disorder itself.

Answer 1

Primary Psychosis

Question 2

• when the symptoms are a result of a general medical condition or substance-induced.

Answer 2

Secondary Psychosis

Question 3

• 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.

Answer 3

Brief Psychotic Disorder

Question 4

• involves the presence of sometimes elaborate, non-bizarre delusions

Answer 4

Delusional Disorder

Question 5

• 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.

Answer 5

Schizoaffective Disorder

Question 6

• “short-episode of schizophrenia”, lasting at least one month, but less than six months

Answer 6

Schizophreniform

Question 7

• 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

Answer 7

Schizophrenia

Question 8

• from a neurophysiological perspective, several neurotransmitters – most notably dopamine and
  glutamate.

Answer 8

Etiology

Question 9

delusions, hallucinations, exaggerations in language and communication, disorganized
speech and behaviors.

Answer 9

Positive Symptoms

Question 10

anhedonia, emotional withdrawal, passivity, apathy, dulled affect, or emotional
flattening

Answer 10

Negative Symptoms

Question 11

• incoherence, loose associations, impaired attention, impaired

Answer 11

Cognitive Symptoms

Question 12

These must be ruled out in order to make an accurate diagnosis of schizophrenia.

Answer 12

1. Infections 5. Dementias
2. Tumors 6. Stroke
3. End-Stage Renal Disease 7. Head injuries
4. Hypoglycemia 8. Vitamin deficiencies, particularly thiamine

Question 13

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.

Answer 13

Conventional Agents/ Dopamine-Receptor Antagonists (First-Generation Anxiolytics)

Question 13

• 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

Answer 13

How Antipsycotic Medications Work

Question 13

Conventional Agents/ Dopamine-Receptor Antagonists (First-Generation Antipsychotics)

Indications:

Answer 13

1. Acute psychotic episodes
2. Maintenance treatment
3. Mania
4. Depression with psychotic symptoms
5. Delusional disorder
6. Borderline personality disorder
7. Substance-induced disorder
8. Delirium and dementia
9. Mental disorders caused by medical condition
10. Childhood schizophrenia
11. Pervasive developmental disorder
12. Tourette’s disorder
13. Huntington’s disease

Question 13

Drugs influencing psychotic features:

Answer 13

1. Cannabis 4. Alcohol
2. Amphetamines 5. Opiates
3. Hallucinogens

Question 14

Extrapyramidal Symptoms: 3. - motor-restlessness, a need to move and an inability to sit still

Answer 14

Akathisia

Question 14

Extrapyramidal Symptoms: 1. - characterized by muscle-tightening in the neck and shoulders, accompanied by spasms.

Answer 14

Dystonia

Question 14

Extrapyramidal Symptoms: 2. - produces muscle rigidity, mask-like facies, tremor, shuffling gait and diminished arm-swingi

Answer 14

Parkinsonian

Question 15

• involuntary facial movements involving the tongue, eyes, lips an

Answer 15

Tardive Dyskinesia

Question 16

When an (blank) develops, one treatment is to lower the dosage of the offending drug.

Answer 16

Extrapyramidal Symptoms (EPS) manifestation

Question 17

1. Neuroleptic Malignant Syndrome
2. Sedation
3. Central Anticholinergic Effects
4. Cardiac Effects
5. Sudden Death
6. Sexual Adverse Effects
7. Skin and Eye Effects
8. Jaundice

Answer 17

adverse effects of EPS

Question 18

Other side effects of Conventional Agents:

Answer 18

1. Dry mouth, blurred vision, constipation, sedation and memory problems
2. Weight gain
3. Grand mal seizures
4. Increased levels of prolactin
5. Neuroleptic malignant syndrome
6. Orthostatic hypotension

Question 19

• 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

Answer 19

Atypical Antipsychotic Agents/ Serotonin-Dopamine Antagonists (Second-Generation Antipsychotics

Question 20

• the most effective, but also the most dangerous

Answer 20

Clozaril (clozapine)

Question 21

• 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).

Answer 21

Risperdal (risperidone)

Question 22

• provides calming action for agitation associated with schizophrenia; sedating and likely
  produces the most weight gain; increased risk of diabetes type 2.

Answer 22

Zyprexa (olanzapine)

Question 23

• for the management of aggressive, cognitive and affective symptoms of schizophrenia;
  essentially no EPS; has been increasingly prescribed as a sleeping pill.

Answer 23

Seroquel (quetiapine)

Question 24

• 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.

Answer 24

Geodon (ziprasidone)

Question 25

• 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

Answer 25

Abilify (aripiprazole)

Question 26

• 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.

Answer 26

Invega (paliperidone)

Question 27

• must be titrated up slowly to minimize orthostatic hypotension and dizziness; cardiac effects
  appear to be similar to those of Geodon (ziprasidone).

Answer 27

Fanapt (iloperidone)

Question 28

• available only as sublingual tablet; significant for weight gain; oral numbness can be a problem

Answer 28

Saphris (asenapine)

Question 29

most effective for positive symptoms and even negative symptoms

Answer 29

CBT

Question 30

• 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.

Answer 30

Latuda (lurasidone)

Question 31

Common Side effects of Atypical Antipsychotic:

Answer 31

1. Weight gain
2. Sedation
3. Insomnia
4. Agitation
5. Constipation
6. Dry Mouth
7. Increased Risk of Type II diabetes (Clorazil and Zyprexa

Question 32

• 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.

Answer 32

Family Therapy