schizophrenia Flashcards
What is schizophrenia?
A disorder involving psychosis and a complex mix of symptoms
Schizophrenia is characterized by a range of symptoms that can affect thinking, behavior, and emotions.
How many symptoms must be present for a schizophrenia diagnosis according to DSM-5?
At least two of the five symptoms must be present for at least 1 month
At least one of the symptoms should be delusions, hallucinations, or disorganized speech.
What are the five symptoms identified for schizophrenia diagnosis?
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms
Each symptom has specific characteristics that help in the diagnosis.
What is anosognosia in the context of schizophrenia?
Lack of awareness or insight into one’s illness, particularly during an acute episode
It is the most common predictor of nonadherence and relates to higher relapse rates.
When does schizophrenia typically onset?
Between adolescence and early adulthood
Onset occurs earlier in men (early 20s) than in women (late 20s to early 30s).
What are the four major phases of the lifetime course of schizophrenia?
- Prodromal
- Acute
- Stabilization
- Stable
Each phase has distinct characteristics regarding symptoms and functioning.
What neurotransmitters are believed to be involved in the cause of schizophrenia?
- Dopamine
- Serotonin
- Glutamate
The relationship between these neurotransmitters and schizophrenia symptoms is complex and not fully understood.
What is the Brief Psychiatric Rating Scale (BPRS)?
A rating scale used in the assessment of psychiatric symptoms
It helps in evaluating the severity of symptoms in patients with schizophrenia.
What are the two classes of antipsychotics?
- First-generation antipsychotics
- Second-generation antipsychotics
FGAs include older medications, while SGAs include newer agents with different side effect profiles.
What is EPS and with which class of antipsychotics is it most commonly associated?
Extrapyramidal symptoms, most common among first-generation antipsychotics
EPS includes symptoms like pseudoparkinsonism, dystonia, akathisia, and tardive dyskinesia.
What is tardive dyskinesia?
Abnormal involuntary movements that occur with long-term antipsychotic therapy
It is often irreversible and typically involves orofacial muscles.
What is neuroleptic malignant syndrome (NMS)?
A potentially life-threatening condition associated with antipsychotic use
It is characterized by muscle rigidity, fever, and autonomic instability.
What is hyperprolactinemia and which antipsychotics carry the highest risk?
Increased prolactin excretion leading to various side effects; risperidone and paliperidone carry the highest risk
Symptoms may include breast enlargement and menstrual changes.
Fill in the blank: The risk of weight gain and diabetes with antipsychotics is highest with _______ and _______.
[Clozapine] and [Olanzapine]
Weight gain can occur in up to 40% of patients on antipsychotics.
Which antipsychotic is available in an inhalable formulation for treating agitation?
Loxapine
It is used for agitation associated with schizophrenia or type I bipolar disorder.
What are the treatment goals for schizophrenia?
- Reduce acute symptoms
- Return patient to baseline level of function
- Prevent recurrence of symptoms
- Maximize functioning and quality of life
Goals are divided into acute and maintenance phases.
What nonpharmacologic treatments are beneficial for patients with schizophrenia?
- Cognitive behavioral therapy (CBT) for psychosis
- Psychoeducation
- Cognitive remediation
- Social skills training
- Supportive psychotherapy
These interventions aim to enhance self-management skills and recovery.
What should a comprehensive treatment plan for schizophrenia include?
Elements such as treatment setting, plans for addressing risks of harm, barriers to adherence, and goals of treatment
A person-centered approach is essential in developing the plan.
Which psychosocial interventions benefit patients with schizophrenia?
- Cognitive behavioral therapy (CBT) for psychosis
- Psychoeducation
- Cognitive remediation
- Social skills training
- Supportive psychotherapy
These interventions aim to enhance recovery and self-management skills.
What approach is crucial when assessing adherence in schizophrenia patients?
A patient-centered approach
This is particularly important if anosognosia exists.
What is the recommended first-line treatment for schizophrenia?
Second-generation antipsychotics (SGAs)
Most guidelines recommend either an FGA or an SGA.
What factors should be considered when individualizing antipsychotic treatment?
- Previous treatment experiences
- Responses to previous treatments
- Patient’s treatment preferences
- Risk-benefit discussions of medications
Tailoring treatment to the specific patient is recommended.
What is recommended for younger or treatment-naive patients during therapy initiation?
Start with a lower dose
This helps avoid adverse effects and improve adherence.
What dose may older individuals with physical health issues require?
Starting doses that are one-fourth to one-half the usual adult starting dose
This is to account for their unique health conditions.
How long may it take for patients to show an initial response to medication?
2–4 weeks
Conservative titration is often employed during the acute phase.
What should be assessed at 2–4 weeks after achieving a therapeutic dose?
Response to treatment
A less than 20% improvement in symptoms after 2 weeks indicates limited further improvement.
What is the typical duration of antipsychotic treatment for schizophrenia?
Lifelong treatment
Chronicity of schizophrenia usually necessitates long-term management.
What should be monitored during long-term therapy with antipsychotics?
- Metabolic complications
- Diabetes
- Weight gain
- Lipid abnormalities
- Abnormal movements
Monitoring is essential to manage potential side effects.
What is the agent of choice for treatment-resistant schizophrenia?
Clozapine
It is specifically indicated for patients who do not respond to other treatments.
True or False: Routine combination of antipsychotics is supported by current data.
False
Current data do not support the routine use of multiple antipsychotics.
What adjunctive medication may benefit patients with partial response to clozapine?
Lamotrigine
Other anticonvulsants like valproate, carbamazepine, and topiramate are not supported.
What is the role of benzodiazepines in treating schizophrenia?
Useful during the acute phase for agitation or anxiety
They are less effective for psychotic symptoms and must be used cautiously due to the risk of substance use disorder.
When are antidepressants indicated for patients with schizophrenia?
When they develop depression
Monitoring for comorbid conditions is important.
