Schizophrenia Flashcards
1
Q
Monitoring schedule with antipsychotic medication for:
A
2
Q
What is a genetic abnormality associated with schizophrenia?
A
- DiGeorge syndrome
- 22q1.2
- 25% have schizophrenia
3
Q
Normal QTc values
A
- < 450 ms for men
- < 460 ms for women
4
Q
What are the Tranulis 2006 conclusions for Treatment-Resistant Schizophrenia?
A
5
Q
What should be the minimal length of maintenance of antipsychotic after a first episode of schizophrenia?
A
- 18 months
6
Q
Recommended actions for yellow and red range for Clozapine?
A
7
Q
What is an adequate antipsychotic medical trial for
an ORAL antipsychotic
A
- 6 weeks at midpoint or greater of the licensed therapeutic dose range
8
Q
What are the gender differences in the epidemiology of delusional disorder?
A
9
Q
What is the DSM scale for psychotic symptoms severity?/
A
- DSM clinician-rated dimensions of psychosis symptom severity
- Measuring all 5 criteria A items + cognition, depression, and mania
10
Q
What is Fregoli syndrome?
A
- False identification of strangers as being familiar people (hyperidentification)
11
Q
What are the criteria for catatonia?
A
12
Q
What are the findings of the CUTLASS study?
A
13
Q
What are the psychosocial treatments with strong evidence for recommendation in schizophrenia?
A
- Family interventions
- Supported employment programs
- Cognitive-behavioral therapy
14
Q
What are the Schneiderian symptoms?
A
15
Q
Monitoring schedule with antipsychotic medication for:
- Prolactin
A
- As clinically indicated
16
Q
What is the most common comorbidity axis I in individual at clinical high-risk for psychosis?
A
- Depression (40%)
- also common are anxiety and SUD
17
Q
Monitoring schedule with antipsychotic medication for:
- History and examination for EPS
A
- Baseline
- 1 month
- at 3 months
- Annually
18
Q
Monitoring schedule with antipsychotic medication for:
- BMI / weight / waist circumference
A
- Baseline
- At 1 month
- At 3 months
- Annually
19
Q
What are the values of WBC/neutrophile for green/yellow/red for Clozapine?
A
20
Q
What percentage of individuals with first-episode psychosis have their onset < 18 yo?
A
- 1/3
21
Q
What is the length of an adequate antipsychotic trial?
A
- 4-6 weeks
22
Q
How long should an antipsychotic medication in an acute episode of psychosis be kept before changing (despite dose optimisation)?
A
4 weeks
23
Q
Monitoring schedule with antipsychotic medication for:
- HbA1c / fasting glucose
A
- Baseline
- At 1 month (as clinically indicated)
- At 3 months
- Annually
24
Q
What is the percentage of individuals who will only have one episode of psychosis?
A
- 1 to 20% based on older longitudinal studies
25
What are two important things to consider where there is poor response to medication before lack of response can definitely be established?
* Medication adherence
* Substance use
26
What are factors associated with the highest risk of relapse in schizophrenia?
27
What is an adequate antipsychotic medical trial for
an LAI antipsychotic
* 6 weeks of treatment following reaching steady state (according to product monograph)
28
What is the percentage of relapse at 5 years in first-episode patients who had responded to treatment?
* 82%
* Risk of first or second relapse was 5 times greater in those not taking medication as compared with those who were
29
What are the recommended doses for maintenance antipsychotic?
* Low to moderate dosing of
- 300 to 400 chlorpromazine equivalents
- 4 to 6 mg of risperidone or other equivalents daily
30
Percentage of individuals with treatment-resistant schizophrenia
* 25-30%
31
How long following resolution of positive symptoms of an acute episode of schizophrenia should patients continue their antipsychotic medication as maintenance treatment?
* 2-5 years or longer
32
What is the definition of metabolic syndrome?
* High blood pressure (≥ 130/85 mm Hg, or receiving medication)
* High blood glucose levels (≥ 5.6 mmol/L, or receiving medication)
* High triglycerides (≥ 1.7 mmol/L, or receiving medication)
* Low HDL-Cholesterol (\< 1.0 mmol/L in men or \< 1.3 mmol/L in women)
* Large waist circumference (≥ 102 cm in men, 88 cm in women; ranges vary according to ethnicity)
33
What pharmacological agents have the most evidence for smoking cessation in schizophrenia?
* Bupropion (most evidence)
* Varenicline
* NRT has very low evidence
\*\* Varenicline is recommended second to Bupropion\*\*
34
What is the most common subgroup of individuals with clinically high-risk for developing psychosis?
* Attenuated positive symptom syndrome (APSS) is the most common syndromal subgroup of a risk for developing psychosis
35
What are 2 scales for Clinical high risk for psychosis?
* CAARMS (comprehensive assessment of at-risk mental states) and
* SIPS (Structured Interview of prodromal syndromes)
36
Management of clozapine-induced tachycardia
37
What is the range of patients with treatment-resistant schizophrenia who respond to Clozapine?
30-60%
38
What is the CPA defined symptom severity despite treatment for treatment-resistant schizophrenia?
* 2 or more positive symptoms with at least moderate severity
* A single positive symptom with severe or greater severity
39
What are recommend interventions for clinical high-risk state for psychosis?
* CBT with or without family intervention
40
Monitoring schedule with antipsychotic medication for:
* Random lipids / fasting lipids
* Baseline
* 1 month (as clinically indicated)
* 3 months
* Annually
41
What is defined as a failed clozapine trial?
(or \>= 250 mg for equal divided dosing)
42
Monitoring schedule with antipsychotic medication for:
* Smoking history
* Baseline
* At 3 months
* Annually
43
What are the Kane criteria for treatment-resistant schizophrenia?
44
Antipsychotics not associated with significant QTc prolongation
* Aripiprazole
* Asenapine
* Lurasidone
* Paliperidone
45
What is the age cut-off for childhood onset-schizophrenia?
* 12 yo
* Affecting 1.6-1.9 per 100,000 in the child population
46
What are the 3 psychosis subsyndromal subgroups?
* Attenuated positive symptom syndrome (most common)
* Brief Intermittent psychotic symptom syndrome (BIPS) - 1 or more threshold positive psychotic symptoms too brief to meet criteria for psychosis
* Genetic risk and deterioration (GRD) (having schizotypal PD or 1st degree relative with schizophrenia spectrum disorder)
47
What is Capgras syndrome?
* Belief that another person, often a relative, has been replaced by a double, an imposter (hypoidentification)
48
What is a maximum allowable treatment response for schizophrenia?
* Greater or equivalent to 20% reduction on the PANSS
49
Monitoring schedule with antipsychotic medication for:
* Blood pressure
* Baseline
* At 1 month (if clinically indicated)
* At 3 months
* Annually
50
Health Canada recommendation as when to discontinue an antipsychotic medication based on QTc
* QTc \> 500 ms
* Increase in \> 60 ms from baseline
51
What is the TRIPP definition for treatment-resistant schizophrenia?
52
What is the role of antipsychotics in the treatment of individuals with clinical high risk for psychosis?
* Can be used for stabilization when psychological interventions have proved ineffective, but NOT for primarily preventive purpose
53
Scale for EPS
* \*\*ESRS\*\* scale (extrapyramidal symptom rating scale)
- -\> 4 subscales and 4 clinical global impression severity scales for
- Parkinsonism
- Akathisia
- Dystonia
- Tardive dyskinesia
* AIMS (for tardive dyskinesia)
* SAS (parkinsonism)
* Barnes akathisia scales (akathisia)
54
What are the findings of the CATIE study?
55
Monitoring schedule with antipsychotic medication for:
* Individual and family history of physical illness
* At baseline
* Annually
56
What are psychosocial treatments to consider (under specified circumstances) for schizophrenia according to the CPA guidelines?
* Cognitive remediation
* Social skills training
* Life skills training
57
What is the appropriate duration of treatment for potentially substance-induced psychoses that do not resolve rapidly with abstinence?
* Same as FEP recommendations
