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Nik essentials guidelines > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

Monitoring schedule with antipsychotic medication for:

A
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2
Q

What is a genetic abnormality associated with schizophrenia?

A
  • DiGeorge syndrome
  • 22q1.2
  • 25% have schizophrenia
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3
Q

Normal QTc values

A
  • < 450 ms for men
  • < 460 ms for women
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4
Q

What are the Tranulis 2006 conclusions for Treatment-Resistant Schizophrenia?

A
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5
Q

What should be the minimal length of maintenance of antipsychotic after a first episode of schizophrenia?

A
  • 18 months
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6
Q

Recommended actions for yellow and red range for Clozapine?

A
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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
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8
Q

What are the gender differences in the epidemiology of delusional disorder?

A
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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
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10
Q

What is Fregoli syndrome?

A
  • False identification of strangers as being familiar people (hyperidentification)
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11
Q

What are the criteria for catatonia?

A
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12
Q

What are the findings of the CUTLASS study?

A
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13
Q

What are the psychosocial treatments with strong evidence for recommendation in schizophrenia?

A
  • Family interventions
  • Supported employment programs
  • Cognitive-behavioral therapy
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14
Q

What are the Schneiderian symptoms?

A
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15
Q

Monitoring schedule with antipsychotic medication for:

  • Prolactin
A
  • As clinically indicated
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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
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17
Q

Monitoring schedule with antipsychotic medication for:

  • History and examination for EPS
A
  • Baseline
  • 1 month
  • at 3 months
  • Annually
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18
Q

Monitoring schedule with antipsychotic medication for:

  • BMI / weight / waist circumference
A
  • Baseline
  • At 1 month
  • At 3 months
  • Annually
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19
Q

What are the values of WBC/neutrophile for green/yellow/red for Clozapine?

A
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20
Q

What percentage of individuals with first-episode psychosis have their onset < 18 yo?

A
  • 1/3
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21
Q

What is the length of an adequate antipsychotic trial?

A
  • 4-6 weeks
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22
Q

How long should an antipsychotic medication in an acute episode of psychosis be kept before changing (despite dose optimisation)?

A

4 weeks

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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
Q

What are two important things to consider where there is poor response to medication before lack of response can definitely be established?

A
  • Medication adherence
  • Substance use
26
Q

What are factors associated with the highest risk of relapse in schizophrenia?

A
27
Q

What is an adequate antipsychotic medical trial for
an LAI antipsychotic

A
  • 6 weeks of treatment following reaching steady state (according to product monograph)
28
Q

What is the percentage of relapse at 5 years in first-episode patients who had responded to treatment?

A
  • 82%
  • Risk of first or second relapse was 5 times greater in those not taking medication as compared with those who were
29
Q

What are the recommended doses for maintenance antipsychotic?

A
  • Low to moderate dosing of
  • 300 to 400 chlorpromazine equivalents
  • 4 to 6 mg of risperidone or other equivalents daily
30
Q

Percentage of individuals with treatment-resistant schizophrenia

A
  • 25-30%
31
Q

How long following resolution of positive symptoms of an acute episode of schizophrenia should patients continue their antipsychotic medication as maintenance treatment?

A
  • 2-5 years or longer
32
Q

What is the definition of metabolic syndrome?

A
  • 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
Q

What pharmacological agents have the most evidence for smoking cessation in schizophrenia?

A
  • Bupropion (most evidence)
  • Varenicline
  • NRT has very low evidence

** Varenicline is recommended second to Bupropion**

34
Q

What is the most common subgroup of individuals with clinically high-risk for developing psychosis?

A
  • Attenuated positive symptom syndrome (APSS) is the most common syndromal subgroup of a risk for developing psychosis
35
Q

What are 2 scales for Clinical high risk for psychosis?

A
  • CAARMS (comprehensive assessment of at-risk mental states) and
  • SIPS (Structured Interview of prodromal syndromes)
36
Q

Management of clozapine-induced tachycardia

A
37
Q

What is the range of patients with treatment-resistant schizophrenia who respond to Clozapine?

A

30-60%

38
Q

What is the CPA defined symptom severity despite treatment for treatment-resistant schizophrenia?

A
  • 2 or more positive symptoms with at least moderate severity
  • A single positive symptom with severe or greater severity
39
Q

What are recommend interventions for clinical high-risk state for psychosis?

A
  • CBT with or without family intervention
40
Q

Monitoring schedule with antipsychotic medication for:

  • Random lipids / fasting lipids
A
  • Baseline
  • 1 month (as clinically indicated)
  • 3 months
  • Annually
41
Q

What is defined as a failed clozapine trial?

A

(or >= 250 mg for equal divided dosing)

42
Q

Monitoring schedule with antipsychotic medication for:

  • Smoking history
A
  • Baseline
  • At 3 months
  • Annually
43
Q

What are the Kane criteria for treatment-resistant schizophrenia?

A
44
Q

Antipsychotics not associated with significant QTc prolongation

A
  • Aripiprazole
  • Asenapine
  • Lurasidone
  • Paliperidone
45
Q

What is the age cut-off for childhood onset-schizophrenia?

A
  • 12 yo
  • Affecting 1.6-1.9 per 100,000 in the child population
46
Q

What are the 3 psychosis subsyndromal subgroups?

A
  • 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
Q

What is Capgras syndrome?

A
  • Belief that another person, often a relative, has been replaced by a double, an imposter (hypoidentification)
48
Q

What is a maximum allowable treatment response for schizophrenia?

A
  • Greater or equivalent to 20% reduction on the PANSS
49
Q

Monitoring schedule with antipsychotic medication for:

  • Blood pressure
A
  • Baseline
  • At 1 month (if clinically indicated)
  • At 3 months
  • Annually
50
Q

Health Canada recommendation as when to discontinue an antipsychotic medication based on QTc

A
  • QTc > 500 ms
  • Increase in > 60 ms from baseline
51
Q

What is the TRIPP definition for treatment-resistant schizophrenia?

A
52
Q

What is the role of antipsychotics in the treatment of individuals with clinical high risk for psychosis?

A
  • Can be used for stabilization when psychological interventions have proved ineffective, but NOT for primarily preventive purpose
53
Q

Scale for EPS

A
  • **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
Q

What are the findings of the CATIE study?

A
55
Q

Monitoring schedule with antipsychotic medication for:

  • Individual and family history of physical illness
A
  • At baseline
  • Annually
56
Q

What are psychosocial treatments to consider (under specified circumstances) for schizophrenia according to the CPA guidelines?

A
  • Cognitive remediation
  • Social skills training
  • Life skills training
57
Q

What is the appropriate duration of treatment for potentially substance-induced psychoses that do not resolve rapidly with abstinence?

A
  • Same as FEP recommendations

Nik essentials guidelines (6 decks)

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