Schizophrenia 2: Subtypes Flashcards
“-pines” and “-dones” are the suffix for which drug class?
second gen antipsychotics
(ex: clozapine)
Clozapine: mechanism of action
- Serotonin 2A and Dopamine 4 receptor antagonism
- Weak Dopamine 2 receptor antagonism
(poorly understood)
Why is Clozapine used as a last resort?
May cause a granulocytosis
(must monitor CBC regularly, some pharmacies require it to fill the prescription)
The “-Pines” are more potent at the ____receptor than the ____ receptor.
- H1
- D2
(olanzapine, quetiapine, asenapine)
_______ (2 second generation antipsychotic drugs) that have anticholinergic properties
Olanzapine and Quiteipine
the “-Dones” are potent ______ receptor antagonists. Some activity at ______ (2).
- D2
- Serotonin
- Alpha 1
(Risperidone, paliperidone, ziprasidone, lurasidone, iloperidone)
Aripiprazole, brexipiprazole, cariprazine are very potent _____antagonism with partial agonism at_____.
- D2
- D2
Patients with a first-episode psychosis may be more responsive and require lower doses of medication than patients with_____.
multiple psychotic episodes
For patients with schizophrenia, you should provide the patient and family education on the potential side effects such as: metabolic syndrome, diabetes, weight gain and obesity, _______ (3)
- dyslipidemia
- extrapyramidal symptoms (i.e. tardive dyskinesia)
- neuroleptic malignant syndrome
Antipsychotic medicine monitoring includes: _______ (5)
- Glucose
- Lipids
- BMI
- Weight
- Abnormal movements
If patients have problems reliably taking oral medication, _____may be indicated.
a long-acting depot medication
(depot med: injection formulation of a medication which releases slowly over time )
How long should patients who have had two psychotic episodes in five years or multiple psychotic episodes have antipsychotic treatment?
maintenance management
CATIE 1 study investigated ____
Clinical antipsychotic effectiveness
Resulat of CASTIE 1 study for: olanzapine, perphenazine, risperidone
- Olanzapine: most efficacious, but had the most AE
- Perphenazine: comparable efficacy & tolerability
- Risperidone: hyperprolactinemia
(no single drug is consistently effective or tolerable for all patients, must do a trial and error for each individual patient)
Psychosocial interventions of schizophrenia include case management, social skills training and _____ (3)
- psychosocial rehabilitation
- cognitive rehabilitation
- family therapy (they need to be involved in their care and understand and support them)
(case managers make sure they get their meds, make it to appointments)
A schizophrenic patient may need to be hospitalized with a new onset to clarify diagnosis and stabilize medication, as well as ____ (5).
- Disabling side effects (meds)
- Unable to care for themselves
- Combativeness
- Suicidal
- ECT
Define schizophreniform disorder: for at least one month, but less than 6 months, they have:
Core symptoms and at least two of the following:
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms
(the difference between schizophreniform is at least one month, but less than 6 months; its greater than 6 months for schizophrenia.)
Good prognostic factors for schizophreniform disorder include onset within 4 weeks of change in behavior, as well as _____ (2).
- Confusion or perplexity at the height of the episode
- Good premorbid functioning (socially & at work)
- Absence of blunted or flat affect
During the period with core symptoms of schizoaffective disorder, one of the following will be present also: (3)
- Major Depressive Episode
- Manic Episode
- Mixed Episode
(with or w/o mood symptoms)
Symptoms that meet criteria for a mood episode are present for the majority of the total duration of the _____ periods of the schizoaffective disorder.
active and residual
Schizoaffective disorder is bipolar type if the disturbance includes a _____ or _____.
It is a depressive type if the disturbance includes only _____.
- Manic or Mixed Episode
- Major Depressive Episodes
What is the difference between bizarre and non-bizarre delusions?
- bizarre: unbelievable
- non-bizarre: understandable that they would believe it even though it is not typically acceptable
The long-term outcome for a patient with schizophrenia is better when treatement is ______.
initiated rapidly (acute episode)
Prevalence and onset of delusional disorder
- 0.1%
- Middle-aged or later
The course of delusional disorder can be remission without relapse or ______ (2).
- Remission alternating with relapse
- Chronic waxing and waning
Diagnostic criteria for delusional disorder (2).
- One or more delusions of at least one month
- Brief mood episodes
Delusional disorder does not have at least two of the schizophrenia symptoms and is not _____.
Functionally impaired
(behavior is not obviously bizarre or impaired either)
Persecutory Type: delusions that the person (or someone they are close to) is _____.
being malevolently treated in some way
Somatic Type: delusions that the person has _______.
some physical defect or general medical condition
Mixed type: delusions characteristic of persecutory or somatic type of delusions, but no ______.
one theme predominates
Erotomanic Type: delusions that_____.
another person, usually of higher status, is in love with the individual
Grandiose Type: delusions of ____.
inflated worth, power, knowledge, identity, or special relationship to a deity or famous person
Jealous type: delusions that_______.
the individual’s sexual partner is unfaithful
After the patient’s first psychotic episode is successfully treated, how long will they require antipsychotic treatment?
At least a year after full remission of the symptoms of schizophrenia
Brief Psychotic Disorder lasts for at least one day, but less than one month, with eventual return to premorbid functioning. It inludes the presence of one (or more) of the following symptoms:
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
(The disturbance is not better accounted by another psychiatric condition, the effects of a substance, or a medical condition)
Brief Psychotic Disorder Management (2):
- Supportive therapy in hospital milieu
- Antipsychotic if agitation or emotional distress
Subtypes of Brief Psychotic Disorder (3):
- With marked stressors
- Without marked stressors
- With postpartum onset
Management of delusional disorder includes attempts to build a relationship with the patient and _____ (2).
- Help them understand how symptoms interfere w/function
- Medications
Which medications are appropriate for delusional disorder (3)?
- Antipsychotics (mostly ineffective)
- Pimozide (somatic delusions)
- SSRIs
When attempting to build a relationship with a delusional disorder patient, you must be patient, _____ and do NOT ______
- Ensure confidentiality
- Condemn or collude with delusions (i.e. I believe that you believe this, but I can’t see it myself)
Onset and course of brief psychotic disorder
- Onset: late 20’s to early 30’s
- Course: can resolve within a few days
(prevelence unknown)
Define Charles Bonnet syndrome symptoms
(patients know that they are not real)
- Complex recurrent visual hallucinations (faces)
(Occurs in patients with visual impairment)
Capgras syndrome occurs in patients with ______ (3 comorbidities).
- Schizophrenia
- Brain injury
- Dementia
Capgras syndrome is a delusion that _____.
someone close to the patient has been replaced by an imposter; due to a change in how they feel about the person
(i.e. friend, spouse, parent or close family member)
Antipsychotics with a D2 occupancy of _____ % correlates with maximal antipsychotic efficacy, anything more than that will lead to extrapyramidal symptoms
65 – 70
(you don’t want it to bind too tightly)
Antipsychotic drugs also block ______ (3) receptors to different degrees, giving each a unique side effect profile
- noradrenergic
- cholinergic
- histaminic
Hyperactivity in the mesolimbic system tract causes ______ symptoms, and hypoactivity in the mesocortical tract causes ______ symptoms.
- positive
- negative
_________ now exists as a specifier for neurodevelopmental, psychotic, mood and other mental disorders; as well as for other medical disorders.
Catatonia
(catatonia due to another medical condition)
Describe the symptoms of catatonia
