Schizophrenia Flashcards
Etiology of schizophrenia
largely unknown
evidence supports a genetic basis
environmental stimuli or triggers may contribute to expression
intrauterine exposure to viral or bacterial infections also possible
Wat neurochemicals are involved in schizophrenia?
Dopamine and Glutamine
Positive symptoms of schizophrenia
hallucinations (auditory, visual, olfactory, gustatory, and tactile). Often threatening or commanding, patient feels compelled to perform the task or experience anxiety when they don’t
Delusions (fixed false beliefs despite validating evidence. May be bizarre in nature) paranoid themes
Thought disorder: loosening of associations, tangentiality, thought blocking, concreteness, circumstantiality, and preservation.
Incomprehensible/illogical speech and thinking
Negative symptoms of schizphrenia
Impoverished speech and thinking Lack of social drive Flatness of emotional expression Apathy Difficult to evaluate because they occur in a continuum with normality and an be due to secondary causes
Characteristic symptoms of schizophrenia
Delusions Hallucinations Disorganized speech Grossly disorganized/catatonic behavior Negative symptoms Must have 2+ symptoms present for a large portion of a month
Diagnostic criteria for schizophrenia
2+ characteristic symptoms present for a large part of a month
social/occupational dysfunction - one or more major functioning areas is below level achieved previously for a significant part of time since onset of disturbance
Duration: continuous signs of disturbance for at least 6 months
nonpharmacologic therapies available for schizophrenia
psychosocial support
social skills training
cognitive-behavioral therapy
cognitive remediation
Advantages of second generation antipsychotics
greater affinity for serotonin receptors than dopamine
lower propensity for EPS and TD
moderate risk adverse effects of risperidone
dose-dependent EPS, orthostatic hypotension, weight gain
Severe risk adverse effects of risperidone
prolactin elevation (hormonal problems and sexual dysfunction)
moderate risk adverse effects of olanzapine
glucose dysregulation
severe risk adverse effects of olanzapine
weight gain and lipid abnormalities
moderate risk adverse effects of quetiapine
orthostatic hypotension, sedation, weight gain, and lipid abnormalities
Use ziprasidone in caution when…
patient has increased risk of prolongation of QTc interval, including comorbid diabetes, electrolyte disturbances, heavy alcohol consumption, being female, and congenital QTc disorders
Aripiprazole Mechanism
D2 partial agonist, deemed the “dopamine system stabilizer”
Antagonist in hyperdopaminergic states
Agonist in hypodopaminergic states
What should patients expect on paliperidone
see the shell of the tablet in stool because it won’t resolve
Potential dose-related EPS and prolactin elevation
why should iloperidone be titrated?
risk of orthostatid hypotension
How should asenapine be administered?
sublingually! do not chew or swallow
do not eat or drink for 10 minutes after administration
1st generation antipsychotics available as depot formulations
haloperidol fluphenazine invega (paliperidone) risperidone
What is akathesia?
motor/subjective restlessness
What is dystonia
muscle spasms
What is pseudoparkinsonism
akinesia, tremor, and rigidity
What is TD?
movement disorder characterized by abnormal choreiform (rapid, objectively purposeless, irregular, and spontaneous movement) and athetoid (slow and irregular) movements occurring late in onset in relation to initiation of antipsychotic therapy
What is Neuroleptic Malignant Syndrome (NMS)
LIFE THREATENING EMERGENCY!!! severe muscular rigidity, autonomic instability, and altered consciousness
Caused by rapid dose escalation, use of high potency first generation antipsychotics at high doses, and use in younger patients
