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Therapeutics (Fall 2024) > Psychosis > Flashcards

Psychosis Flashcards

1
Q

What is schizophrenia?

A

A complex syndrome of disorganized bizarre thoughts,
hallucinations, delusions, inappropriate affect, and impaired
social functioning

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2
Q

What is the criteria for schizophrenia diagnosis in terms of the DSM-5 criteria?

A

DSM-5: ≥ 6 months + ≥ 1 month of ≥ 2 sxs. One must be:
delusions, hallucinations, disorganized speech. Other:
disorganized/catatonic behavior, negative symptoms (blunted
affect, alogia, avolition, anhedonia, amotivation). ↓
social/occupational function.

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3
Q

What is psychosis and how does it relate to psychosis?

A

Presence of gross impairment of reality testing (e.g. lose touch
with reality) as evidenced by delusions, hallucinations, markedly
incoherent speech, or disorganized and agitated behavior
without apparent awareness on the part of the patient of the
incomprehensibility of their behavior

  • Schizophrenia is one of MANY causes of psychosis
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4
Q

What is treatment resistant schizophrenia

A

No significant improvement in sxs despite tx with ≥ 2 APs from
2 different AP classes at optimal dose for 6-8w

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5
Q

What is shizophreniform disorder?

A

1-6 months, same sxs as schizophrenia, social/occupation functional impairment not required

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6
Q

What is Shizoaffective disorder?

A

≥2 wks of delusions or hallucinations without mood sxs +
uninterrupted period of illness containing either major
depressive or manic episode with concurrent sxs diagnostic of
schizophrenia. Social/occupation functional impairment not
required.

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7
Q

What is brief psychotic disorder?

A

1 day to 1 month of ≥ 1 of delusions, hallucinations,
disorganized speech. Return to premorbid function.

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8
Q

What is delusional disorder/

A

≥ 1 month of delusions. Hallucinations not prominent. Function
only mildly impaired, behavior not blatantly bizarre

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9
Q

What is substance induced psychosis?

A

Hallucinations or delusions development during or within 1
month of substance use/withdrawal.

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10
Q

What is the other psychotic disorders?

A

Bipolar or major depressive disorder with psychotic features,
psychotic illness due to general medical condition infection, TBI

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11
Q

What is the duration of untreated psychosis?

A

Time from the manifestation of the first psychotic symptom to
initiation of adequate treatment

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12
Q

What are the risk factors of schizophrenia?

A
  • immigrant ethnic groups
  • perinatal/early childhood (hypoxia, maternal infection/stress/malnutrition)
  • urban upbringing
  • cannabis use
  • life stress
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13
Q

What are the major considerations of schizophrenia?

A
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14
Q

What is the risk of death without treatment in schizophrenia?

A

Risk of death doubles

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15
Q

What is the genral nonadherence rate of schizophrenia patients?

A

50-60%

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16
Q

What is the theory with regards to the patho of schizophrenia?

A

Dopamine dysregulation, Serotonin dysregulation (That is modulated by dopamine)

Glutamate and Gaba also have a role, but not as known

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17
Q

What is the mesolimbic dopamine tract?

A

Origin Midbrain, Limbic areas,

Responsible for the Positive symptoms of schizophrenia

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18
Q

What is the mesocortical dopamine tract?

A

Negative symptoms

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19
Q

What is the nigrostriatal dopamine tract?

A
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20
Q

What is the tuberoinfundibular dopamine tract?

A
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21
Q

What is the prodomal features of schizophrenia?

A
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22
Q

What are the positive symptoms of schizophrenia?

A
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23
Q

What are the negative symptoms of Schizophrenia?

A
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24
Q

What are the cognitive symptoms of schizophrenia?

A
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25
Q

What are the mood symptoms of schizophrenia?

A
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26
Q

Next slide goes over the positive symptoms of schizophrenia

A
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27
Q

What is catanoia?

A

Rigid still

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28
Q

What are the negative symptoms of schizophrenia/

A
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29
Q

What are the associated clinical features of schizophrenia?

A
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30
Q

What are the clinical assessments of schizophrenia/

A
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31
Q

What are the Lab work up for someoen with schizophrenia?

A
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32
Q

What are the 5 hall mark symptoms schizophrenia that may lead to a diagnosis?

A
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33
Q

What are the main drug induced psychosis that can leadto a break in schizophrenia

A

Amphetamine and cocaine use
Withdrawal
Caffeine
Cannabis
Chloroquine
Efavirenz
Ketamine
Steroids
Bupropion

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34
Q

How can we measure schizophrenia?

A
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35
Q

What is the goal of therapy for someone living with schizophrenia?

A
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36
Q

What are the non-pharm treatments to schizophrenia?

A
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37
Q

What are our main receptor targets for schizophrenia?

A
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38
Q

What is the general spectrum of activity with out 1st generation therapies?

A

D2 receptor antagonism.

Dirty pharmacology for alpha, muscarinic, and histamine receptors too

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39
Q

What is the spectrum of 2nd generation antipsychotics?

A
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40
Q

What is the receptor spectrum of the third generation antipsychotics?

A
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41
Q

What are the main side effects of 1st generation antipsychotics.

A
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42
Q

WHat are the main side effects of 2nd generation antipsychotics

A
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43
Q

What are the main side effects of 3rd generation antipsychotics?

A
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44
Q

What is the uniqure profiles of antipsychotics

A
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45
Q

What are the AE of the dopamine blockade?

A
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46
Q

What is the serotonin antagonism affect and at which recpetors>

A
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47
Q

What is the serotonin antagonism affect and at which recpetors

A
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48
Q

Where does Dopamine blockade work?

A
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49
Q

What does serotonin antagonism work?

A
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50
Q

What are the side effects of the dopamine blockade?

A
51
Q

What is the affect of A12 antagonism>

A
52
Q

What is the affect of the muscarinic antagonism

A
53
Q

What is the affect of H1 antagonism?

A
54
Q

What are the low potency FGAs affects?

A

Strong anticholingeric effects, highly sedating,

55
Q

What is the most common First generation antipsychotics?

A
56
Q

What makes the atypical antipsychotics a little different from conventional antipsychotics?

A

has some activity against the 5HT2A antagonist.

57
Q

Picture of the receptor of the atypical antipsychotics?

A
58
Q

What are the second generation antipsychotics?

A
59
Q

What is the receptor efficacy of the 2nd generation

A

Decrease risk of movement disorders but increased metabolic adverse drug effects

60
Q

What is risperidone?

A
61
Q

When do we start having FGA features of rsiperidone occur?

A

8mg/day

62
Q

What are the adverse effects of risperidone?

A
63
Q

What are hte pharmacodynamic interactions of Risperidone?

A

3A4 and 2D6 interactions

64
Q

What is paliperidone?

A

Active metabolite of risperidone, Oros technology, but not on Sask formulary

65
Q

What are the adverse effects of paliperidone?

A
66
Q

What limits the intitial use of olanzapine?

A

Metabolic ADEs limit initial use

67
Q

What are the adverse effects of olanzapine?

A
68
Q

What are some DI with olanzapine?

A

Smoking (Cyp1A2)
Pharmacydynamic interactions with drugs of similar actions 1A2 inhibitors/inducers

69
Q

What types of doses of quetiapine are used?

A

High doses

70
Q

What are the AE of using quetiapine?

A
71
Q

What are the DIs of quetiapine?

A
72
Q

What is the special dosing considerations with ziprasidone?

A

Administer wit hatleast a 500kcal meal to maximize absorption

73
Q

What are the AE of ziprasidone?

A
74
Q

What are the DI of ziprasidone?

A

3A4 inducer/inhibitor

75
Q

WHat is the strange AEs of asenapine?

A
76
Q

What are the DIs of Asenapine?

A
77
Q

What is the evidence for asenapine mainly?

A

Bipolar disorder

78
Q

What is Lurasidone?

A
79
Q

What is the MOA of the 3rd generation antipsychotics?

A

Partial agonist, therefore it exhibitis some effect

80
Q

What was the thought process on the third generation AP?

A

Being a partial agonist they thought they could decrease the number of negative side effects

81
Q

What major side effect is higher these TGAP?

A

Decreased risk of metabolic and movement ADEs, but higher rates of akathisia.

82
Q

What is Akathisia?

A

an inability to remain physically still

83
Q

What is the MOA of Aripiprazole?

A

Partal agonist at the 5HT1A and D2, antagonist at 5ht2a site

84
Q

What does the goldilocks principle mean?

A
85
Q

Why do we utilize injectable formulations of aripriprazole?

A

Maintain patient ahderence. A bit easier to remember

86
Q

What are the AE of aripiprazole?

A
87
Q

What is the MOA of brepiprazole?

A
88
Q

What is the MOA of carprazine?

A
89
Q

What is the difference betwee carprazine and apripiprazole?

A

D3 antagonist instead of D2

90
Q

What is the issue with cariprazine?

A

Jus not enough evidence yet

91
Q

What is the overally summary of cariprazone?

A
92
Q

What are the key points to consider when selecting an antipsychotic?

A
93
Q

What is the issue with psychosis episodes?

A
94
Q

What are the goals of LAIAs?

A

Improve adherence given Q2-4 weeks

95
Q

What are the benefits of LAIA?

A
96
Q

What is important before switching to LAIAs?

A
97
Q

Summary of antipsychotic AE

A
98
Q

What is the importance of the first episode of psychosis and treatment?

A
99
Q

What are the steps to follow when there is an acute exacerbation of psychosis?

A
100
Q

What is the SUD usage in schizophrenia patients?

A

45%

101
Q

Is there a better evidence for one AP over another for SUD schizophrenia?

A

None, clozapine is preferred

102
Q

What is the treatment-resistant schizophrenia?

A
103
Q

What should be done prior to determining TRS?

A
104
Q

In TRS what is the first line therapy?

A
105
Q

What is considered the most effective antipsychotic for schizophrenia?

A
106
Q

What are some common side effects of clozaril?

A
107
Q

What are the serious side effects of antipsychotics?

A
108
Q

What are the big three clozapine adverse events?

A
109
Q

When is agranulocytosis most likely to occur in clozaril treatment?

A

first 6 months

110
Q

When is myocarditis most likely to occur in clozaril treatment?

A

4-8 weeks, monitoring tropinin and CRP weekly

111
Q

When is cardiomyopathy most likely to occur in clozaril treatment?

A

month to years

112
Q

What is the clinical presentation of myocarditis and cardiomyopathy?

A
113
Q

What is the general monitoring pattern of clozapine?

A
114
Q

What happens during clozapine missed doses?

A
115
Q

What is the green zone?

A
116
Q

What is the yellow zone?

A
117
Q

What is the red zone?

A
118
Q

When can clozaril not be rechallenged?

A
119
Q

What is important about clozapine dispensing?

A

Quantity dispensed must be limited to the frequency of clozapine blood work.

120
Q

What is important about clozapine brands?

A

Not interchangeable

121
Q

What is the impacts of smoking and clozapine?

A

Smoking will reduce effects of cloz.

NRT and e-cigarretes do not exhibit the same effect as smoking as the Cyp1a2 is not induced by this

122
Q

WHat is the NNT for reducing suicide risk?

A

13

123
Q

For TRS what does evidence support?

A
124
Q
A

Therapeutics (Fall 2024) (11 decks)

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