Schizophrenia

Question 1

Effect of schizophrenia on mortality

Answer 1

-shortened life expectancy
-2-4x shorter than general population
-substance use, reduced physical health, suicide, health disparities, other psychiatric disorders

Question 2

Effect of schizophrenia on morbidity

Answer 2

-increased obesity, diabetes, hyperlipidemia, CVD, smoking
-decreased engagement in health maintenance
-antipsychotics ADEs

Question 3

acute therapeutic goals of the treatment of schizophrenia

Answer 3

-IDENTIFY THE LOWEST EFFECTIVE DOSE AND MINIMIZE ADVERSE EFFECTS OF TREATMENT
-prevent hospitalization
-decrease severity of psychotic thoughts and behaviors
-alter course of illness

Question 4

long term therapeutic goals of treating schizophrenia

Answer 4

-minimize symptoms
-promote recovery
-slow neurodegeneration
-prevent relapse
-reduce significant psychosocial and health consequences
-prevent mortality and morbidity

Question 5

How to diagnosis schizophrenia?

Answer 5

-more than two symptoms for a significant portion of a 1 month period
-Delusions*
-hallucinations*
-disorganized speech*
-disorganized or catatonic behavior-negative symptoms

Question 6

true or false: antipsychotics are most effective at treating negative symptoms

Answer 6

False-positive symptoms, not effective for treating negative symptoms

Question 7

First episode psychosis(FEP)

Answer 7

-first experiance of positive symptoms
-critical treatment point
-duration of untreated psychosis
-LONGER DURATION OF UNTREATED PSYCHOSIS=WORSE LONG TERM BEHAVIOR AND COGNITIVE SYMPTOMS, MORBITITY AND MORTALITY, QOL, FUNCTIONAL CAPACITY

Question 8

Goal of identifying patients with schizophrenia

Answer 8

-identify individuals during prodromal period or FEP and initiate treatment early to alter course of illness

Question 9

guideline recommended approach to meds for schizophrenia

Answer 9

1) SGA(more safe that FGA)
2) Switch SGA or FGA
3) Clozapine
4) Combo tx/adjunct therapies

Question 10

Long acting injectable antipsychotics

Answer 10

-FGA: fluphenazine, haloperidol
-SGA: ariprazole, olazapine, paliperidone, risperidone

Question 11

true or false: pharmacist can administer LAIA in WI

Answer 11

true

Question 12

Dosing of LAIAs

Answer 12

-varies based on product and patient/provider preference
-2, 4, 8, 12 weeks up to 6 months

Question 13

Benefits of LAIAs compared to oral dosing

Answer 13

-regular contact time between patients and care team
-better medication taking rates
-lower rates of discontinuation, relapse, and hospitalization

Question 14

Cobenfy (xanomeline and trospium)

Answer 14

-selectively targets muscarinic receptors without blocking D2 receptors
-may be effective in reducing BOTH positive and negative symptoms

Question 15

When to use clonzapine?

Answer 15

high risk of suicide

Question 16

shared adverse effects of antipsychotics

Answer 16

-sedation
-orthostatic hypotension
-anticholinergic effects
-QT prolongation
-EPS
-Tardive dyskinesia
-metabolic effects
-hyper-prolactenemia
-neuroleptic malignant syndrome

Question 17

Extrapyramidal Symptoms (EPS)

Answer 17

-movement disorders
-caused by blocking D2

Question 18

Akathisia

Answer 18

-feeling of inner restlessness
-very uncomfortable
-add on beta blocker to help

Question 19

Parkinsonism

Answer 19

-tremor
-rigity
-bradykinesia

Question 20

Dystonias

Answer 20

-involuntary contraction of major muscle groups

Question 21

how to manage symptoms of EPS?

Answer 21

-switch antipsychotics
-reduce dose
-add adjunct medication(anticholinergic medications)

Question 22

Tardive dyskinesia

Answer 22

-not reversible
0blinking, lip smacking
-movements of face, neck, back, trunk, extremities
-Monitoring and prevention are important
-use lowest dose for shortest duration
-FGAs highest risk

Question 23

AIMS (abnormal involuntary movement scale)

Answer 23

-used to assess for TD at regular intervols

Question 24

treatment of TD

Answer 24

-discontinue problamatic agent
-switch from FGA to SGA, or lowest risk agent among SGAs
-VMAT2 drugs
-benzodiazepines
-Botox
-anticholinergics

Question 25

examples of VMAT2 drugs

Answer 25

-Tetrabenazine
-Valbenazine (Ingrezza)
-Deutetrabenazine (Austedo)

Question 26

Neuroleptic malignant syndrome (NMS)

Answer 26

-quick onset
-requires hospitilization
-fever, mental status change, rigity

Question 27

Metabolic changes

Answer 27

-increased weight, lipids, glucose

Question 28

Metabolic monitoring

Answer 28

-weight
-BP
-fasting glucose or A1C
-fasting lipids

Question 29

prevention of metabolic changes

Answer 29

-select antipsychotic with lower metabolic risk
-diet, nutrition couseling
-olanzapine/samidorphan (Lybalvi)
-metformin
-GLP-1RAs? being studied

Question 30

treatment of metabolic changes

Answer 30

-switch to antipsychotic with lower metabolic risk

Question 31

prolactin elevation

Answer 31

-switch antipsychotic

Question 32

QT prologation

Answer 32

-all antipsychotics have potential
-Ziprasidone has highest risk
-ECG recomnded prior to starting if history of cardio issues

Question 33

antipsychotics with lowest risk for CYP interactions

Answer 33

-ziprasidone
-paliperidone
-asenapine

Question 34

Antipsychotics with CYP1A2 interactions

Answer 34

-olanzapine and clozapine
-induced bt cigarette and marijuana smoking
-may need to raise/lower dose

Question 35

acute treatment follow up

Answer 35

-rapid improvment in 2 weeks
-continues weeks to months

Question 36

long term treatment follow up

Answer 36

-first episode, use antipsychotic for 1 year
-suboptimal medication taking is common
-taper
-risk or relase with sudden discontinuation