Neural System 5: Schizophrenia and Bipolar Flashcards
what is Schizophrenia?
psychotic illness w/periods of psychosis
chronic dysfunction of mood, cognition, and social behavior
Etiology of Schizophrenia
Unknown
possible genetic disposition and birth complications
Possible pathophysiology of Schizophrenia
Possible cause
reduced prefrontal blood flow during cognitive tasks along with dopamin “dysregulation” (imbalance with overactivity and underactivity in various brain regions)
what are the types of symptoms (categories) that Schizophrenic patients can have?
- Positive - presence of behaviors
- Negative - diminished/absent behaviors
- Cognitive - impaired behaviors
what are some positive symptoms of schizophrenia?
- hallucinations
- disturbed reality
- abnormal motor behaviors
What are some negative symptoms of schizophrenia?
- diminished speech
- flattened emotions
- social withdrawal
what are some cognitive symptoms of schizophrenia?
- reduced attention
- decreased executive function
what is the overall goal for treatment in schizophrenia?
reduce symptoms and mediate AE while improving function and QOL
what schizophrenic symptoms are easier/harder to treat?
easier = positive symptoms
harder = negative symptoms
what types of medications are typically used to treat schizophrenia?
antipsychotics
at a min takes 4-6 weeks to observe changes
what are the classifications of antipsychotics?
- First generation (FGA) = older, more AE
- Second generation (SGA) = newer, less EPS and TD AEs
what is the 1st line trx for schizophrenia and why?
SGA = there are less extrapyramidal symptoms and tardive dyskinesia
what are extrapyramidal symptoms?
collection of symptoms that are drug induced movement disorders. include:
- actue dystonia
- akathesia
- delayed tardive dyskinesia
- acute parkinsonism
what is tardive dyskinesia?
repetitive and involuntary movements such as grimicing and eye blinking
*orofacial dyskinesia
T/F: tardive dyskinesia can be irreversible if left untreated and unnoticed?
TRUE
what is acute dystonia?
spasm of muscles of tongue, face, neck and back
what is akathesia?
restlessness and inability to stay still, manifests with finger-tapping, pacing
MOA of first generation antipsychotics?
block dopamine receptors in mesolimbic tract where excess dopamine may contribute to postive symptoms
SGA drugs on our list
quetiapine (Seroquel)
quetiapine (Seroquel) MOA
block D2 receptors but less than FGA; more affinity for 5-HT receptors
*variable effect on histamine, muscarinic and alpha receptors = more variable AE
SGA binding to D2 receptors AEs
- Motor = bradykinesia, and possible EPS
- Endocrine (higher risk for metabolic syndromes)
- Neuroleptic malignant syndrome
if SGAs bind to other receptors what possible AEs can occur?
- H1 receptors
- sedation and wt gain
- Muscarinic receptors
- ABCDs
- a1 receptors
- hypotension, dizziness
Rehab concerns for FGAs
- CV risks
- caution with UV exposure
- imapired thermoregulation = caution with overexertion
- monitor for EPS
Rehab concerns for SGAs
- wt gain, hyperglycemia, and lipid abnormalities
- CV abnormalities risk
- risk for heat intolerance
what are the types of Bipolar Disorder?
- Bipolar I disorder
- Bipolar II disoder
what is Bipolar I disorder (aka manic-depression illness)
one manic episode accompanied by history of one or more major depressive episodes
what is Bipolar II disoder?
major depressive disorder accompanied by at least one hypomanic or milder manic phases
what is hypomania?
at least 4 days of elevated/irritable mood combined with over-activity
Pathogenesis of Bipolar Disoder?
Unknown
appears to be dysregulation in dopamine and serotonin systems
what regions of the brain are altered in Bipolar disoder and how?
- limbic-cortical dysfunction
- hippocampus and prefrontal cortex have diminished acitivty w/smaller volumes
- amygdala is hyperactivity leading to emotional sensitivity
how is Bipolar disorder treated?
- acute depressive episode = SSRI, bupropion
- acute manic episode = lithium
- maintenance trx = lithium
what is the role of Lithium in treatment of Bipolar Disorder?
- Management of acute manic or hypomanic episode
- prevention of further manic and depressive episodes
If lithium is so effective in lots of patients what is the drawback?
Lots of AEs
Common AEs of Lithium?
- GI
- weight gain
- polydipsia and polyuria
- CNS issues
- mental dullness, decreased memory and concentration, fine hand tremor, fatigue and muscle weakness
why does lithium require plasma concentration monitoring?
can be toxic and toxicity can occur at doses close to therapeutic levels
what are signs of Lithium toxicity?
- persitent diarrhea
- vomiting
- coarse tremor
- mild ataxia
- drowsiness
- muscular weakness
what circumstances can alter lithium concentrations and increase the risk of toxicity?
- medial illness
- crash diets and Na+ restriction diets
- strenuous exercise
- very hot climate
- surgery
- advanced age
- prenancy and delivery
T/F: Lithium is assocaited with many DDIs?
TRUE
What other medication class can be used in the treatment of Bipolar Disorder?
Anticonvulsant medications
- Valproic acid (VPA
- Carbamazepine
what boxed warnings are there for anticonvulsants meds used to treat Bipolar Disorder?
- Valproix acid = hepatotoxicity
- Carbamazepine = Stevens-Johnson Syndrome and toxi epidermal necrolysis (TEN)
