Schizophrenia Flashcards
Whats Schizophrenia
Schizophrenia is a chronic heterogeneous
syndrome of disorganized and bizarre thoughts,
delusions, hallucinations, inappropriate affect,
cognitive deficits, and impaired psychosocial
functioning.
• Increased ventricular size, decreased brain size,
and brain asymmetry have been reported.
Positive and Negative Symptoms are located where
Positive symptoms may be more closely
associated with DA receptor hyperactivity in
the mesocaudate, while negative symptoms
and cognitive symptoms may be most closely
related to DA receptor hypofunction in the
prefrontal cortex.
• What’s Glutamatergic dysfunction.
A deficiency of glutamatergic activity produces symptoms similar to those of dopaminergic hyperactivity and possibly symptoms seen in schizophrenia.
Schizophrenic patients with abnormal brain scans have Serotonin (5-HT) abnormalities. this means
higher whole blood 5-HT concentrations, and
these concentrations correlate with increased
ventricular size.
Schizophrenic patients have symptoms of the acute episode may include the following:
being out of touch with reality;
hallucinations (especially hearing voices);
delusions (fixed false beliefs); ideas of influence
(actions controlled by external influences);
disconnected thought processes (loose
associations); ambivalence (contradictory
thoughts); flat, inappropriate, or labile affect;
autism (withdrawn and inwardly directed
thinking); uncooperativeness, hostility, and verbal
or physical aggression; impaired self-care skills;
and disturbed sleep and appetite.
• After the acute psychotic episode has
resolved, the schizophrenic patient typically has
residual
features (e.g., anxiety, suspiciousness, lack of
volition, lack of motivation, poor insight,
impaired judgment, social withdrawal,
difficulty in learning from experience, and
poor self-care skills). Patients often have
comorbid substance abuse and are
nonadherent with medications.
Diagnosis of Schizophrenia
✓ Persistent dysfunction lasting longer than 6 months
✓ Two or more symptoms (present for at least 1 month), including
hallucinations, delusions, disorganized speech, grossly disorganized or
catatonic behavior, and negative symptoms.
✓ Significantly impaired functioning (work, interpersonal, or self-care).
Positive symptoms Of Schizophrenia
delusions, disorganized speech (association disturbance), hallucinations, behavior disturbance (disorganized or catatonic), and illusions.
Negative symptoms Of Schizophrenia
alogia (poverty of speech), avolition, affective
flattening, anhedonia, and social isolation.
Affects cognitive function
Prior to treatment
A thorough
mental status examination,
physical and neurologic examination,
acomplete family and social history,
vital signs
laboratory workup (complete blood
count, electrolytes, hepatic function, renal
function, electrocardiogram [ECG], fasting
serum glucose, serum lipids, thyroid function,
and urine drug screen) should be performed
prior to treatment.
First line of agents of Schizophrenia
Second-generation antipsychotics (SGAs) (also
known as atypical antipsychotics)- except Clozapine
Olanzapine, risperidone, quetiapine,
ziprasidone, and aripiprazole) -have superior
efficacy for treatment of negative symptoms,
cognition, and mood.
Why is clozapine not used?
Cause few or no acutely occurring
extrapyramidal side effects. Other attributes
ascribed include minimal or no propensity to
cause tardive dyskinesia (TD) and less effect on
serum prolactin than the FGAs
Selection of an antipsychotic should be based
on
(1) the need to avoid certain side effects,
(2) concurrent medical or psychiatric
disorders, and
(3) patient or family history of
response.
The goals during the first 7 days for Schizophrenic patients are
decreased
agitation, hostility, anxiety, and aggression and
normalization of sleep and eating patterns.
Dose and continuation of treatment
Most patients require a dose of 300 to 1,000 mg
of CPZ equivalents (of FGAs) daily
Dose titration may continue
• Medication should be continued for at least 12
months after remission of the first psychotic episode. • Continuous treatment is necessary in most patients
at the lowest effective dose.
• Antipsychotics (especially FGAs and clozapine)should be tapered slowly before discontinuation to
avoid rebound cholinergic withdrawal symptoms. •
