Schizophrenia Flashcards
What is Schizophrenia
Thought disorder with ↑Dopamine, abn serotonin
Impairs:
Judgement
Behaviour
Interpreting reality
Etiology of Schizophrenia
Males
15-25yrs
Prevelence of Schizophrenia in
1. General population
2. Single parent+
3. First degree relative
4. Dizygotic twins
5. Monozygotic twins
6. two parents+
7. Second degree relative
- General population - 1%
- Single parent+ - 12%
- First degree relative - 12%
- Dizygotic twins - 12%
- Monozygotic twins - 47%
- two parents+ - 40%
- Second degree relative - 6%
Diagnostic criteria for Schizophrenia
2 or more present
At least 1 present in first 3 points
For 6 months
- Delusions
- Hallucinations
- Disorganised speech
- Catatonic behaviour (disorganised)
- Negative symptoms
R/O illicit drugs
DD for Schizophrenia
- Amphetamine
- Hallucinogens (LSD)
- Marijuana
Mx of Schizophrenia
First line - Atypical antipsychotics
Olanzepine 5mg (or)
Risperidone 0.5mg
If not improved in 3wks ↑Dose
If not improved in 4-6 wks
1. Change drug same class (or)
2. Typical antipsychotic - Haloperidol/Chlorpromazine/Trifluperazine
If necessary - IV Haloperidol/Olanzepine
Preventing relapse of Schizophrenia
- Olanzepine
- Risperidone
- Quetiapine
as low dose as possible
Drug resistant Schizophrenia
Cause could be drug abusers
Schizophrenia not controlled even with 3 different antipsychotics
…
Trial with Clozapine (S/E blood dyscrasias, Cardiotoxicity) or olanzepine
…
Consider ECT
S/E of chlorpromazine
1st gen Antipsychotic
Photosensitivity reactions
Movement disorders from Antipsychotic medications
- Acute dystonia
- Akathisia
- Parkinsonian gait
- Tardive dyskinesia
- NMS - Neuroleptic malignant syndrome (vs serotonin syndrome)
- Cardiac dysfunction
Acute dystonia, Mx
S/E of antipsychotic medication
Bizarre muscle spasm of
face
neck
tongue
trunk
opisthotonous
Laryngeal spasm
Oculogyric crisis
Mx: Benztropine 1-2mg IV/IM
Akathisia, Mx
S/E of Antipsychotics
Motor restlessness of feet and legs
1. ↓Dose
2. Substitute Thioridazine
3. Propranolol
4. Diazepam
5. Benztropine
Parkinsonian gait
S/E of Antipsychotics
1. ↓Doze
2. Benztropine
3. Benzehexol
Tardive dyskinesia
S/E of longterm Antipsychotics - Metoclopromide esp
1. Stop drug
2. Tetrabenazine
NMS, Mx
Neuroleptic Malignant syndrome
1. Stop drug
2. IV fluids
3. Bromocriptine
4. Dantrolene
