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3 > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

organic disorder

A

eplielpsy
cerebral lesions
nervous system illness: infection, GC
endocrine disorders
metabolic disorders/physiological disturbances altering nervous system
IATROGENIC
PSYCHOSIS RELATED TO ALCOHOL/PSYCHOACTIVE SUBSTANCE MISUSE
parkinson disease
dementia

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2
Q

affective

A

mania
psychotic depression
post-partum depression

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3
Q

schizophrenia

A

psychosis sx

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4
Q

what is the primary pathophysiology of schizophrenia

A

dysfunction in DA, 5HT & glutamatergic function

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5
Q

what can precipitate schizophrenia?

A

drug, substance use

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6
Q

what can prolong course of disorder?

A

non adherence

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7
Q

DSM-5 criteria

A

2 or more of the following for at least 1 month:
1. delusions
2. hallucinations
3. disorganized speech
4. grossly disorganized/catatonic behaviour
5. negative symptoms
social/occupational dysfunction
duration: continuous, at least 6 months
schizoaffective/mood disorder excluded
exclude other medical conditions and substance use

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8
Q

non-pharm?

A

individual CBT
neurostimulation: electroconvulsive therapy (ECT), reptitive transcranial magnetic stimulation (rTMS)
psycosocial rehabilitation programs

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9
Q

pharm treatment goal for acute stabilization?

A

minimize threat to self & others
minimize acute symptoms
(improve role functioning, identify appropriate psychosocial interventions, collab w fam & caregivers)

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10
Q

pharm treatment goal for stabilization

A

minimize/prevent relapse
promote medical adherence
optimize dose & manage adverse effects

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11
Q

pharm treatment goal for maintenance

A

improve function & QoL
(maintain baseline functioing, optimise dose vs adverse effects, monitor for prodromal Sx of relapse, monitor & manage adverse effects

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12
Q

antipsychotics?

A

generally tranquilize without impairing consciousness & without causing paradoxical excitement
in short term, they are useful to calm disturbed patients

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13
Q

common indication for antipsychotics

A

schizophrenia
adjunct for MDD (esp SGA)
short term adjunctive management of severe anxiety/psychomotor agitation, violent behaviour
mania

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14
Q

what happens if you block dopamine receptors in mesolimbic tract?

A

improve +ve symptoms
overactivity in this region responsible for +ve symptoms in schizophrenia

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15
Q

what happens if you block dopamine receptors in mesocortical tract

A

cause/worsen -ve symptoms
hypofunction in this region results in -ve symptoms

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16
Q

what happens if you block dopamine receptors in nigrostriatal pathway

A

EPSE
tract modulates body movement

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17
Q

what happens if you block dopamine receptors in tuberoinfundibular tract

A

hyperprolactinemia
in anterior pituitary

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18
Q

affinity to D2 receptors? (antagonism)

A

improve +ve symptoms
causes EPSE, hyperprolactinemia

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19
Q

5HT1A receptor agonism?

A

anxiolytic

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20
Q

5HT2A receptor antagonism?

A

improve -ve symptoms

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21
Q

5HT2c receptor antagonism?

A

weight gain

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22
Q

H1 receptor antagonism?

A

sedation, weight gain

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23
Q

a1 adrenoreceptor antagonism

A

orthostatic hypotension, sedation

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24
Q

M1 receptor antagonism

A

dry mouth, blurred vision, constipation

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25
Q

IKr antagonism

A

QTc prolongation

26
Q

when do you consider clozapine?

A

treatment resistant - those that had fail 2 or more adequate trial of different antipsychotics (at least 1 should be SGA)

27
Q

long acting IM injection?

A

risperidone microspheres
haloperidol decanoate
aripiparazole LAI
paliperidone prolonged, release suspension

28
Q

precautions for antipsychotic use includes?

A

CVD: QTc prolongation, ECG monitoring
parkinson disease: cause EPSE
epilepsy, conditions predisposing to seizures
depression
myasthenia gravias
acute angle glaucoma
severe respiratory disease
prostatic hypertrophy
blood dyscrasia - esp clozapine
hx of jaundice
elderly with dementia

29
Q

what to do during aucte agitation?

A

pt cooperative –> PO lorazepam 1-2mg
pr uncooperative –> IM lorazepem 1-2mg/IM olanzapine/IM aripiparazole/IM haloperidol/ IM promethazine

30
Q

if patient is catatonic?

A

bezondiazepine: PO/IM lorazepem

31
Q

what are the antipsychotic that require divided doses?

A

chlorpromazine
clozapine
quetapine
sulpride
amisulpride
siprasidone

32
Q

FGA?

A

chlorpromazine
sulpride
trifluoperazine
perphenazine
haloperiodl

33
Q

SGA?

A

amisulpride
brexpiparazole
cariprazine
lurasidone
paliperidone
risperidone
aripiparazole
clozapine
quetapine
olanzapine

34
Q

which should be administer with/after food to increase bioavailability?

A

lurasidone, ziprasidone

35
Q

EPSE SE?

A

dystonia, pseudo-parkinsonism, akathisa, tardive dyskinesia

36
Q

dystonia how manage

A

IM anticholinergivs

37
Q

what is dystonia

A

muscle spasms

38
Q

risk factor for dystonia?

A

high potenscy antipsychotic, neuroepileptic-naive, young male

39
Q

management for pseudo-parkinsonism

A

decrease antipsychotic dose/switch to lower risk
anticholinergic PRN

40
Q

what is akathisia?

A

EPSE, restleness, onset hr-weeks

41
Q

risk factor for akathisia?

A

high potency anti-psychotic
risp > olanz > quet/cloz

42
Q

management for akathisia

A

decrease antipsychotic dose/switch to SGA
clonazepam low dose PRN
proponalol 20mg tds
anticholinergic unhelpful

43
Q

what is tardive dyskinesia?

A

ororfial movements (eg lip chewing, tongue protrusion)
irreversible
onset months to year

44
Q

risk factor for tardive dyskinesia

A

FGS > SGA
worsen with anticholinergic drug

45
Q

management for tardive dyskinesia

A

discont any anticholinergic
decrease antipsychotic dose/switch to SGA
Valbenazine (vestibular monoamine transporter 2 reversible inhibitor) 40-80mg/day
clonazepem PRN

46
Q

which antipsychotic has higher risk for hyperprolactinaemia?

A

FGAs, Pali >/= Risp >other SGAs

47
Q

management for hyperprolactenemia

A

decrease FGA dose
Dopamine agonist (e.g. amantadine,
bromocriptine)
Switch to Aripiprazole

48
Q

which anti psychotic has higher risk for metabolic side effects

A

high : olan cloz
mod: CPZ, quiet, risp
low: aripiparazole, lura, zip, halo

49
Q

management for metabolic SE

A

Lifestyle modification: diet, exercise
Treat diabetes (e.g. with metformin),
hyperlipidemia
Switch to lower risk agents

50
Q

what is Neuroleptic malignant
syndrome (NMS):

A

Muscle rigidity, fever, autonomic dysfunction (increase PR, labile BP, diaphoresis), altered consciousness, increase CK

51
Q

management for NMS

A

IV Dantrolene 50mg TDS
Oral dopamine agonist (e.g. amantadine, bromocriptine), supportive measures.
Switch to SGA

52
Q

how to manage agranulocytosis?

A

discon antipsychotic if severe
mostly with clozapine

53
Q

what are the monitoring parameter?

A

BMI, FBG, Lipid panel, BP, EPSE
WBC & ANC (for clozapine)

54
Q

what to be caution in pregnancy?

A

olanzapine & clozapine watch out for gestational diabetes

55
Q

what drugs for breastfeeding?

A

olanzapine & quetapine suitable
any pt on clozapine should cont drug & not breastfeed

56
Q

what drugs for renal impairment?

A

Oral Aripiprazole preferred; Avoid sulpiride and Amisulpride

57
Q

what drugs for hepatic impairment?

A

Sulpiride, Amisulpride preferred.

58
Q

what to caution in elderly?

A

Avoid drugs with high propensity for alpha-1 adrenergic blockade
(orthostatic hypotension) or anticholinergic side effects (constipation,
urinary retention, delirium); start low go slow; simplify regime ; avoid
adverse interactions; avoid long T ½ drugs
Precaution: FGAs and SGAs reported to increase mortality and CVAs in dementia patients

59
Q

when does agitation decrease?

A

in 1st week

60
Q

when does paranoia & hallucinations decrease?

A

2-4 weeks

61
Q

when does delusion & -ve symptoms improve?

A

6-12 weeks

62
Q

when does cognitive symptoms improve?

A

3-6 months

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