Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHA 333 > schizophrenia > Flashcards

schizophrenia Flashcards

1
Q

define schizophrenia

A

psychotic disorder involving disturbance of thought, emotion and behaviour
‘ a group of imperfectly understood brain disorders characterised by
alterations in higher functions related to perception, cognition,
communication, planning and motivation’

‘a chronic, debilitating and heterogeneous psychiatric brain syndrome that
manifests in a variety of abnormal mental functions and behaviours’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

when does schiophreinia usually diagnosed?

A

usually strikes young people just when they are maturing into adulthood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how does genetics link to schizophrenia?

A

evidence of a strong genetic component

people who have a close relative with schizophrenia are more likely to develop the disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the incidence of developing sxhizophrenia if you are a twin?

A

•~17% concordance rates among dizygotic (fraternal) twins
•~50% concordance rates among monozygotic (identical) twins
(therefore also environmental factors)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how does biological environmental factors influence schizophrenia?

A 
•Advanced paternal age (>45years)
•Prenatal and perinatal events
•Maternal infection
•Maternal malnutrition
•Pregnancy and birth complications – gestational diabetes, 
hypoxia, low birth weight, premature birth
•Season of birth
•Cannabis use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how does psychological environmental factors influence schizophrenia?

A
  • Urban birth and upbringing
  • Migration and migrant status
  • Social disadvantage
  • Exposure to negative life events
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the 3 models of schizophrenia?

A

1- the dopamine hypothesis
2- the glutamate hypothesis
3- neurodevelopmental model

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the dopamine hypothesis?

A

•Schizophrenia results from the dysregulation of the dopaminergic system in
parts of the brain
•Believed that positive symptoms are a result of over activity in the mesolimbic
dopaminergic pathway
•Negative symptoms from ↓ activity in the mesocortical dopaminergic pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the glutamate hypothesis?

A

•Schizophrenia results from the hypofunction of NMDA receptors in the brain
•↓ stimulation of GABA interneurons ⇒disinhibition & hyperactivity of the
mesolimbic dopamine pathway ⇒positive symptoms of schizophrenia
•↓ stimulation & hypoactivity of the mesocortical dopamine pathway ⇒
negative & cognitive symptoms of schizophrenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the neurodevelopmental model?

A

•Schizophrenia results from a structural & functional brain abnormality that
occurs early in utero or pre-adolescence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the clinical features of schizophrenia?

A

positive symptoms
negative symptoms
cognitive impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are positive symptoms?

A 
hallucinations- auditory, visual, tactile
•Delusions
•grandiosity, persecution, control
•Speech and thought disorder
•Disorganised motor behaviours
•movements/mannerisms etc.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are negative symptoms?

A

•Social withdrawal
•Anhedonia – inability to experience pleasure
•Flattening of emotional responses
•Loss of motivation & reluctance to perform everyday tasks
(Avolition)
•Impoverished speech and mental creativity (Alogia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what does cognitive impairment cause disturbances in?

A
  • Memory
  • Attention
  • Sensory information processing
  • Fluency of speech
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the diagnosing criteria for schizophrenia?

A
  • The International Statistical Classification of Diseases (ICD 10)
  • The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV/DSM-V)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the diagnostic criteria for ICD 10?

A

At least ONE of the following are present most of the time during a 1-
month period:
•Thought echo, insertion or withdrawal, or thought broadcast
•Delusions of control referred to body parts, actions or sensations
•Delusional perception
•Hallucinatory voices giving a running commentary or discussing the
patient or coming from some part of the body
•Persistent bizarre or culturally inappropriate delusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the alternate diagnosing criteria for ICD 10?

A

OR at least TWO of the following are present most of the time during a
1-month period:
•Persistent daily hallucinations, accompanied by delusions
•Incoherent or irrelevant speech
•Catatonic behaviour, such as stupor or posturing
•Negative symptoms, such as marked apathy, blunted or incongruous
mood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the DSM-V diagnostic criteria?

A

TWO or more of the following characteristic (Criterion A) symptoms, each
present for a significant portion of the time during a 1-month period. (At
least one of these should include the first 3 symptoms)
•Delusions
•Hallucinations
•Disorganised speech
•Grossly disorganised or catatonic behaviour
•Negative symptoms –diminished emotional expression, avolition
•Social or occupational decline
•Continuous signs of disturbance for at least six months, but at least one
month for the Criterion A symptom

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the two broad classes of antipsychotics?

A
  • First-Generation (FGA/Typical)
  • 1950-1970
  • e.g. chlorpromazine and haloperidol
  • Second-Generation (SGA/Atypical)
  • Late 1980s
  • e.g. clozapine and olanzapine
20
Q

how do antipsychotic drugs work?

A

Antagonists at dopamine receptors
•Suggests schizophrenia is associated with increased activity in the
mesolimbic and/or mesocortical dopaminergic pathways
•Most effective against positive symptoms e.g. hallucinations and delusions
•Less effective against negative symptoms e.g. social withdrawal and
emotional apathy

21
Q

what is the mechaninsim of clinical effect for the first generation antipsychotics?

A

Block dopamine D2receptors
•Common features of all drugs in this class
•D2receptor blockade in the mesolimbic pathway is believed to be
responsible for antipsychotic action
•Clinical potency correlates with D2receptor affinity
D2receptor blockade in other CNS pathways responsible for
major adverse effects:
•Basal ganglia – acute extrapyramidal symptoms (EPS), movement
disorders
•Hypothalamus-Pituitary glad – increased prolactin secretion
(endocrine effects)

22
Q

how do antipsychotics block other neurotransmitters?

A

Blockage of other neurotransmitters
•Responsible for other major adverse effects
•Block α-adrenoceptor – postural hypotension, sexual dysfunction
•Block histamine H1receptors – sedation, weight gain
•Block muscarinic receptors – dry mouth, blurred vision, constipation,
urinary retention, memory deficits

23
Q

what are the acute extrapyramidal side effects?

A

•D2blockade in the basal ganglia
•Early onset in 50-90% of patients
•May take several forms
•Akathisia (motor restlessness) – repetitive purposeless actions, pacing,
rolling etc.
•Reduce dose
•Dystonic reactions (abnormal movements of face and body)
•Procyclidine
•Pseudoparkinsonism – tremor, bradykinesia and rigidity. Gradual onset
over several weeks

24
Q

what is the side effect tardive dyskinesia?

A
  • Late onset movement disorder
  • Prolonged use of antipsychotic
  • Rhythmical, involuntary movements
  • Can sometimes worsen on treatment withdrawal
25
Q

what was the hyperprolactinaemia and sexual dysfunction s/e associated with antipsychotics?

A

•D2receptor blockade in the pituitary gland
•Increased prolactin and reduced gonadotropin release
•Men – Gynaecomastia, failure of ejaculation, decreased libido,
impotence
•Women – Lactation/galactorrhoea, anovulation, amenorrhoea,
decreased libido, infertility

26
Q

what is NMS?

A

Neuroleptic Malignant Syndrome (NMS)
•Rare but life-threatening syndrome
•90% cases occur within 10 days after starting therapy
•Most commonly associated with high potency agents
•Characterised by catatonia, rigidity, stupor, fever and autonomic instability
•Myoglobinaemia and death in 10% cases
•Related to dopamine D2 receptor polymorphism
•Possibly due to D2 receptor blockade in the corpus striatum and hypothalamus

27
Q

what is the mesolibic pathway and how does it affect dopamine antagonism?

A

•Emotion and sensations of pleasure
•Hyperactivity is thought to be
responsible for psychosis
Reduction in positive symptoms

28
Q

what is the mesocortical pathway and how does it affect DA antagonism?

A 
•Cognitive function
•Hypoactivity may cause negative and 
cognitive symptoms
Worsening of negative and cognitive 
symptoms
29
Q

what is the nigrostraital pathway and how does it affect DA antagonism?

A

controls movemenet
Extrapyramidal symptoms, akathisia,
dystonia and tardive dyskinesia

30
Q

what is the tuberoinfubdubular pathway and how does it affect DA antagonism?

A

Controls prolactin release
Hyperprolactinaemia and sexual
dysfunction

31
Q

what are the off target adverse effects?

A

•Blockade of muscarinic receptors
memory deficits & sedation, constipation, dry mouth, blurred vision,
urinary retention, tachycardia, etc.
•Blockade of α-adrenoceptors
postural hypotension, failure of ejaculation, sedation, etc.
•Blockade of central histamine receptors
sedation, weight gain

32
Q

what are some second generation antipsychotic drugs licensed in UK?

A
  • Clozapine
  • Risperidone
  • Olanzapine
  • Quetiapine
  • Aripiprazole
  • Paliperidone
  • Amisulpride
33
Q

how would you classify them?

A

•Serotonin-dopamine antagonists (SDA)
•high selectivity for 5-HT2A& D2receptors (& α1-adrenoceptors)
•risperidone, paliperidone
•Multi-acting receptor-targeted antipsychotics (MARTA)
•affinity for 5-HT2A& D2receptors and receptors of other systems
(cholinergic, histaminergic, 5-HT1A, 5-HT1C, etc.)
•clozapine, olanzapine, quetiapine
•Combined D2/D3dopamine receptor antagonists
•preferentially block D2& D3subtypes of D2-like receptors
•amisulpride
•Partial dopamine receptor antagonists
•aripiprazole

34
Q

what is the mechanism of clinical effect for 2nd generation antipsychotic drugs?

A

•Block D2receptors - antipsychotic effects
•Block of 5-HT2receptors - antipsychotic effects (? relief of negative
symptoms)
•Low affinity for binding or rapid dissociation from D2receptors in the
basal ganglia - significantly milder extrapyramidal symptoms
•Better adverse effect profile and patient compliance

35
Q

what are the 4 major groups of adverse effects?

A

•Neurological side effects (EPSE)
•Associated with most FGAs & some SGAs
•Most pronounced with high-potency FGAs (e.g. haloperidol) & some
SGAs (e.g. risperidone)
•Cardiometabolic side effects (weight gain, induction of diabetes,
hyperlipidaemia)
•Associated with both FGAs & SGAs
•Most pronounced with some SGAs (esp. clozapine, olanzapine,
quetiapine, risperidone)
•Prolactin elevation & sexual dysfunction
•Most pronounced with high-potency FGAs & some SGAs (esp.
amisulpride & risperidone)
•Cardiovascular side-effects (ECG-abnormalities, QT-prolongation,
tachycardia, orthostatic hypotension)
•Associated with both FGAs & SGAs
•Significant QT prolongation with some SGAs (sertindole & ziprasidone)

36
Q

how does the choice of antipsychotic vary?

A

The choice of antipsychotic medication should be made by the service user
and healthcare professional together, taking into account the views of the
carer if the service user agrees. Provide information and discuss the likely
benefits and possible side effects of each drug, including:
•metabolic (including weight gain and diabetes)
•extrapyramidal (including akathisia, dyskinesia and dystonia)
•cardiovascular (including prolonging the QT interval)
•hormonal (including increasing plasma prolactin)
•other (including unpleasant subjective experiences)

37
Q

what should you do before starting antipsychotic medication?

A
  • weight (plotted on a chart)
  • waist circumference
  • pulse and blood pressure
  • fasting blood glucose, HbA1c, blood lipid profile and prolactin levels
  • assessment of any movement disorders
  • assessment of nutritional status, diet and level of physical activity
38
Q

when do you offer the person with shizophrenia/pyshosis an ECG?

A

•specified in the summary of product characteristics (SPC)
•a physical examination has identified specific cardiovascular risk (such
as diagnosis of high blood pressure)
•there is a personal history of cardiovascular disease or
•the service user is being admitted as an inpatient.

39
Q

what are Depot or Long-Acting Antipsychotic

Formulations (LAIs)?

A

•Slow-release formulations given by deep IM injection every 1-4 weeks
•Used in maintenance treatment of schizophrenia – for symptom control
& relapse prevention
•Both FGA & SGA formulations currently available
•FGA LAIs – haloperidol, flupenthixol, fluphenazine, zuclopenthixol,
pipothiazine
•SGA LAIs – olanzapine, risperidone, paliperidone, aripiprazole

40
Q

what are the advantages of LAIs?

A

•consistent bioavailability & predictable dosage-plasma drug level relationship
•improved pharmacokinetic profile, lower dosage & reduced risk of adverse-
effects
•enhanced medication adherence & avoidance of covert non- adherence
•help rule out poor medication adherence as possible cause of any
exacerbation of patient’s symptoms or relapse
•reduced risk of inadvertent or deliberate overdose
•regular contact with healthcare professional, opportunity for review of
symptoms & medication side-effects, and provision of psychosocial support

41
Q

what are the disadvantages of LAIs?

A

•mainly related to pharmacokinetics properties
•dose titration against response is a protracted process
•increased risk of relapse following reduction in dosage or extension of the
injection interval not immediately evident
•long elimination half-life , lack of flexibility in dealing with emergent side-
effects
•uncomfortable local reactions at the injection site – pain, inflammation, etc.

42
Q

what are importat practice guidance points with antipsychotics?

A

•Avoid high dose antipsychotic drug therapy – except after adequate
sequential trial of ≥2 different agents
•Avoid antipsychotic drug combination therapy – except for short periods
during antipsychotic drug switching
•When switching antipsychotic medication, consider a gradual cross-
tapering of dosages of the two drugs
•Ensure regular monitoring of the effect of antipsychotic treatment on
the physical health of patients

43
Q

who do you offer clozapine to?

A

Offer clozapine to people with schizophrenia whose illness has not responded
adequately to treatment despite the sequential use of adequate doses of at least 2
different antipsychotic drugs. At least 1 of the drugs should be a non-clozapine
second-generation antipsychotic (NICE)

44
Q

what are some serious adverse effects of clozapine?

A
  • Agranulocytosis (0.8%) – neutropenia (2%)

* Myocarditis – full physical and MHx before initiation

45
Q

what is the clonazpine patient monitoring service?

A
  • Stick to the same brand
  • Report signs of infection
  • Leucocyte and differential blood counts must be normal before starting;
  • every week for 18 weeks
  • then at least every 2 weeks
  • after 1 year at least every 4 weeks (and 4 weeks after discontinuation)
46
Q

what happens if leucocyte count is below 3x10>9/L or if absolute neurtophil count below 1.5?clozapine

A

discontinue permantely and refer to haemtologist

PHA 333 (42 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions