Psychotic Disorders- Dr. Campbell Flashcards
1
Q
Schizophrenia definition
A
- Two or more of the following symptoms
- Delusion
- Hallucination
- Disorganized speech
- Grossly disorganized
- Negative symptoms
2
Q
Schizoaffective disorder
A
- Presence of major mood episode (Mania)
- Presence of delusion or hallucination for 2 or more weeks
- Basically Schizophrenia + mood disorder
3
Q
Positive symptoms
A
- Not generally seen in healthy pts
- Hallucinations
- Delusions
- Thought disorders
- Movement disorders
4
Q
Negative symptoms
A
- Absent features generally present in healthy pts
- Blunted or flat affect
- Anhedonia
- Avolition
- Poverty of speech
5
Q
Cognitive Symptoms
A
- Not required for diagnosis
- Poor ability to process information to make a decision
- Difficulty paying attention
- Working memory impairment
6
Q
Treatment goals
A
- Reduce or eliminate symptoms
- Maximize quality of life
- Promote and maintain recovery
7
Q
Acute treatment goals
A
- Ensure safety
- Reduce agitation
- Relieve detrimental effects
- Improve thought processes
- Decrease social withdrawal
- Evaluate secondary health conditions
8
Q
Chronic treatment goals
A
- Minimize symptoms
- Improve social function
- Maintain safe living environment
- Manage chronic health conditions
- Minimize drug side effects
9
Q
Which FGAs come as long acting injectables
A
- Haloperidol
- Fluphenazine
10
Q
Which SGAs come as long acting injectables
A
- Aripiprazole
- Olanzapine
- Paliperidone
- Risperidone
11
Q
Therapeutic effects and side effects of D2 antagonist
A
- Reduce + Symptoms
- EPS
- Increased - symptoms
- Hyperprolactinemia
12
Q
Therapeutic effects and side effects of alpha 2 agonists
A
- Reduce nightmares
- Dizziness
- Sedation
- Hypotension
13
Q
Therapeutic effects and side effects of M1
A
- Reduces EPS
- Constipation
- Sedation
- Dry mouth
- Blurred vision
14
Q
Therapeutic effects and side effects of M2
A
- Reduces EPS
- Cardiometabolic
- Constipation
- Sedation
- Dry mouth
- Blurred vision
15
Q
Therapeutic effects and side effects of H1 antagonist
A
- Hypnotic
- Cardiometabolic
- Sedation
16
Q
Extrapyramidal Symptoms (EPS)
A
- More prevalent with FGAs> SGAs
- Akathisia: restlessness
- Pseudoparkinsonism
- Acute dystonia
17
Q
Tardive Dyskinesia
A
-Involuntary, repetitive, potentially irreversible
-Cause: induced D2 receptor hypersensitivity
(Clozapine or quetiapine are preferred alternatives)
18
Q
Which antipsychotics are least likely to cause QTc prolongation
A
- Aripiprazole
- Lurasidone
19
Q
Which antipsychotics are most likely to cause QTc prolongation
A
- Thioridazine
- Ziprasidone
20
Q
Metabolic Complications
A
- Increased weight
- Increased fasting lipids
- Increased fasting glucose
21
Q
Drugs with the Highest metabolic risk
A
- Clozapine
- Olanzapine
- Quetiapine
22
Q
Drugs with the lowest metabolic risk
A
- Aripiprazole
- Cariprazine
- Lurasidone
- Brexpiprazole
23
Q
Treatment of Metabolic complications
A
- Diet
- Exercise
- Prophylactic Metformin
- Possible statin therapy
24
Q
Acute control of psychotic agitation
A
- Provide environment with minimal stimulation
- Avoid physical restraints
- Attempt oral meds before IM
- Place on direct observation
25
Acute control of psychotic agitation 5-2-1 method
- 5mg haloperidol
- 2mg lorazepam
- 1mg benztropine
26
Acute control of psychotic agitation B52 method
- 50mg Benadryl
- 5mg Haloperidol
- 2mg Lorazepam
27
What can you use instead of haloperidol and anticholinergic for acute control of psychotic agitation?
-Olanzapine
28
Olanzapine benzo interaction
- IM olanzapine + IV benzos
- Leads to excessive sedation
- Avoid administration with in one hour of each other
29
Texas Medication Algorithm Project
- Stage 1: Single SGA
- Stage 2: Different SGA or FGA
- Stage 3: Clozapine
- Stage 4: Add SGA/FGA/ETC to Clozapine
- Stage 5: Try a single SGA/FGA that has not already been tried
- Stage 6: Combine any/all of the above
30
Special Considerations: First episode of psychosis
- Consider a SGA
| - Try using a lower dose
31
Special Considerations: when using Clozapine
- Indicated when:
- Comorbid Parkinson's
- Development of TD
32
Special Considerations: when using ETC
- Indicated when:
- Failure of Clozapine
- Catatonia
- Persistent suicidality
33
Special Considerations: when using long acting ejectable
-Indicated with repeated medication non adherence
34
Basics of Long acting injectables
- Prolonged absorption over several weeks
- Exhibit absorption dependent kinetics
- Must verify effect and tolerability with oral agent first!
35
Benefits of Long acting injectables
- Increased medication adherence
- Reduced relapse and readmission rates
- Impossible to intentionally overdose
- Facilitates routine follow up
36
Draw backs of long acting injectables
- Potentially painful
- Requires frequent clinic visits
- Negative stigma
- Harder to titrate
- Expensive
37
Haloperidol Decanoate
- FGA long acting injectable
- 10x PO daily dose = IM dose
- Titrate over 3 months
38
Fluphenazine deconoate
- FGA long acting Injectable
- 1.25x PO dose = IM dose
- Q3wks
- Bridge with PO for 2 to 6 weeks
39
Risperidone (Risperdal Consta)
- SGA long acting injectable
- Start at 25mg IM adjust PRN
- Oral bridge = 3wk minimum
- Renal and hepatic impairment = dose adjustment
40
Risperidone (Perseris)
- SGA long acting injectable
- Just FDA approved
- SubQ
- Dose 90mg or 120mg Q4weeks
- 3mg PO = 90mg SQ
- 4mg PO = 120mg SQ
41
Paliperidone (Invega Sustenna)
- SGA long acting injectable
- Dose 39 to 234mg IM Q4weeks
- 12mg PO = 234mg IM Q4week
- Requires loading dose
- No PO overlap needed
- Has dosing "windows" which helps with compliance
42
Paliperidone (Invega Trinza)
- SGA long acting injectable
- Ever 3 MONTHS WOW
- Must be on Invega sustenna for a minimum of 4 months prior to first Trinza dose
- No loading strategy
- No oral bridge
43
Aripiprazole (Abilify Maintena)
- SGA long acting injectable
- Usually 400mg q4wk
- Dose adjust dependent on pts other medications
- Oral bridge therapy = 2weeks (10 to 20mg daily)
44
Aripiprazole lauroxil (Aristada)
- SGA long acting injectable
- 441mg, 662mg q4weeks
- 882mg q4 to 6 weeks
- 1064mg q8weeks
- Dose adjust for CYP3A4/2D6 inhibitors/inducers
45
Olanzapine (Zyprexa Reprevv)
- SGA long acting injectable
- Black box warning: post injection delirium/sedation syndrome (PDSS)
- Must be administered within a facility
- Observation 3hrs post injection
- Must have a ride home from the clinic
46
Non-response
-6 weeks on therapy without improvement
