PBL 6 Flashcards
What does olazapine mean
an antipsychotic drug that is used to treat schizophrenia.
what is the definition of schizophrenia
major mental illness that affects how one thinks, feels and perceives.
- it can significantly impair functioning and has both acute and chronic effects on cognition
what is the hallmark symptom of schizophrenia
o Psychosis is the hallmark symptom.
i.e. experiencing auditory hallucinations (voices)/delusions (fixed false beliefs).
when does the onset of scizophrenia usually occur
• Onset: usually adolescence/early adult life.
o Onset can be insidious/acute (possibly after emotional event).
How do you classify schizophrenia
These types were:
• Paranoid (prominent hallucinations/delusions).
• Disorganized (behaviour without purpose).
• Catatonic (unusual movements between being very active/still).
• Undifferentiated (have signs of different types and doesn’t fit into one).
• Residual (history of psychosis but only negative symptoms).
- these have since been removed as they are not helpful in treatment
how do you diagnose schizophrenia
you have to have at least two of the following
Delusions
• Of control, influence or passivity.
• Persistent delusions of any other kind (i.e. superhuman powers/abilities).
Hallucinations: voices commentating.
• Persistent hallucinations in any modality.
Disturbance in Thought/Speech
• Echo, insertion or withdrawal.
• Breaks in train of thought resulting in incoherent/irrelevant speech.
Catatonic Behaviour
• Variety of abnormal motor postures.
o Mutism, stupor.
Negative Symptoms
• Marked apathy, low self-esteem, introversion, personal neglect.
or you can have one very clear symptom of delusion, hallucination, disorganised speech
- these symptoms have to be ongoing for 6 months or nearly present for most of the time during a period of 1 or more month
- have to have exclusion of mood disorder, substance misuse
what are the three types of symptoms of schizophrenia`
- positive
- negative
- cognitive
describe what the they types of systems are and give examples
- Positive Symptoms: hallucinations, delusions, agitation, disorganized thinking (psychotic symptoms).
- Negative Symptoms: introversion, apathy, low self-esteem, personal neglect (decreased emotions).
- Cognititive Symptoms: poor memory, attention deficit, executive dysfunction (making decisions).
what symptoms has a major outcome on schizophrenia
(!) Cognitive deficits have a major impact on the outcome of schizophrenia and social reinsertion of patients.
• As few as 10% of patients with schizophrenia work full time/20% can work part time.
how can you test for a cognitive dysfunction
Frontal Cortical Dysfunction Testing: Wisconsin Card Sorting Test.
what does the patient in this case present with
- Auditory Hallucinations: 2nd person command auditory hallucinations.
- Delusions: paranoid persecutory delusional beliefs.
- Isolated/social withdrawal and self-absorbed: significant change in aspects of her personal behaviour.
describe the epidemiology of schizophrenia
• Most common type of psychotic disorder (general population occurrence around 1%).
• Constant prevalence throughout the world with no difference between males vs females
o Although onset is earlier in males.
describe the pathophysiology of schizophrenia
• Associated with decreased synaptic spines/decreased dendritic complexity in the cortex.
o Creates abnormalities in formation/maturation of brain circuits
what provides evidence that there is a genetic factor for schizophrenia
there is a concordance rate in monozygotic twins of 50%
what is the biggest risk factor for developing schziophrenia
having a close relative with psychosis and schizophrenia
what genes have been associated with schizophrenia
o Dysbindin: may affect D2 receptors levels/glutamate and GABA transmission
o Neuregulin: neuroplasticity.
o DISC 1: neurodevelopment and signalling in Corticolimbic areas.
o DAOA: glutamatergic transmission
o COMT: dopaminergic transmission.
o BDNF: neurotrophic factor
o RGS4: G-protein coupled receptor signalling.
what environmental factors can lead to schizophrenia development
• Events that occur during gestation may be critical. Higher risk if:
o Born in winters.
o After viral epidemics.
• Other risk factors include:
o Excessive cannabis use in adolescence.
describe the structural and functional changes that are seen in schizophrenia
• Increased rate of gray matter loss
o Larger ventricles and smaller mesial temporal lobes.
• Event-related potentials (ERPs) (increased reactions to stimulation).
• Hypofrontality (decreased frontal activation)
o Leads to excessive striatal dopamine release (explains psychotic symptoms).
- Overall brain volume loss
- Altered brain connectivity
what is treatment for schizophrenia based upon
Treatment is based on the “dopamine theory of schizophrenia”.
• Believed to be an imbalance between dopaminergic projections.
o Hyperactivity in the mesolimbic pathway.
o Hypoactivity in the mesocortical pathway.
what is the major pharmacological target of all drugs used to treat schizophrenia
Dopamine D2 receptors are major pharmacological target of all drugs used to treat schizophrenia:
- acts as antagonists.
name two types of drugs used to treat schizophrenia
- Typical Neuroleptics/First Generation Antipsychotics
- Atypical Neuroleptics/Second Generation Antipsychotics
name examples of the typical antipsychotics
- Chlorpromazine
- Thioridazine
- Fluphenazine
- Haloperidol
- Flupenthixol.
describe how typical antipsychotics work
- Block dopamine receptors as well as acting as antagonists at other receptors (e.g. muscarinic cholinergic, histamine H1 and alpha2-adrenergic receptors).
- Lack of selectivity of action
what was the first neuroleptic drug
• Chlorpromazine was the first neuroleptic drug.
what factor of typical antipsychotics can help schizophrenia in the community
• Some drugs can be given as depot slow release preparation (makes chronic SD manageable in community).
o Also, useful in non-compliance.
name the adverse effects of typical antipsychotics
• More extrapyramidal effects vs atypical (normally reversible) * o Tardive dyskinesia o Dystonia o Parkinsonism o Bradykinesia o Tremor
- Weight gain
- Postural hypotension
- Blurred vision
- Dry mouth (muscarinic)
- Hypothermia
- QT interval prolongation
- Sudden death
- Hyperprolactinaemia
Define and describe the symptoms of extrapyramidal side effects
- Dystonia: continuous spasms and muscle contractions
- Akathisia (restlessness)
- Parkinsonism (rigidity)
- Bradykinesia (slowness of movement
name some examples of atypical antipsychotics
- Risperidone
- Olanzapine
- Clozapine
- Quetiapine
- Paliperidone
- Aripiprazole
describe the mechanism of action of atypical antipsychotics
• Acts as antagonists at D2 receptors as well as antagonists 5-HT2 receptors
what Is the atypical antipsychotics clozapine used for
• Clozapine is used in patients that are drug resistant (30% of SD patients do not respond to treatment).
describe the adverse effects of atypical antipsychotics
- Less prone to give extrapyramidal effects.
- Improve negative effects/cognitive dysfunction
- Significant weight gain
- Dyslipidaemia
- T2D (insulin resistance)
- Metabolic disturbance
- Neutropenia (clozapine)
describe what is meant by tardive dyskinesia
- Involuntary movements of (lips, jaw, face, constant chewing etc…).
- Associated with typical antipsychotics, taken for longer than a few months/years (irreversible).
what is neuroleptic malignant syndrome
• Rare but potentially lethal complication. • It is a medical emergency • Characterized by: o Hyperpyrexia (high fever) o Tremor o Confusion o Autonomic instability.
what are the guidelines for taking the medication
• Whatever the choice of neuroleptic, treatment must be continued for several months/reviewed regularly by a psychiatrist.
• Patients who relapse after cessation of treatment require long-term medication.
o Minimum of 2 to 5 years.
what are the non pharmologcial approaches for treating schizophrenia
- Cognititive behavioral theraphy
* Family theraphy.
name a new approach for treating schizophrenia
• Schizophrenia is associated with decreased glutamatergic transmission.
o Possible to potentiate activity of NMDA receptor.
what does the prognosis depend upon
- Balance between positive and negative symptoms
- Complicating Factors (i.e. development of drug addiction, circumstances involving repeated high level of stress, lack of supporting structures etc…).
describe the risk of suicide in schizophrenia
risk of suicide will not disappear during the disease.
• May be made worse by presence of depression.
• 10-15% of schizophrenic patients die by suicide.
