Schizophrenia

Question 1

Define: neurosis

Answer 1

a characteristic ( a little odd but not that big of a deal)

Question 2

Define: psychosis

Answer 2

a mental state or symptom, a now descriptor ( responding to inner voices, hallucinations, aggression)

Question 3

Define: schizophrenia

Answer 3

a diagnosis of a complex and usually chronic illness

Question 4

What is the first goal of treatment?

Answer 4

ensure safety

Question 5

What is the second goal(s) of treatment?

Answer 5

• reduce agitation, hostility, anxiety, tension, aggression
• normalize sleeping and eating pattern
• convey empathy and caring

Question 6

What are the MAJOR goals of therapy?

Answer 6

• prevent harm
• bring thoughts under the patient’s control
• restore contact with reality
• maximize functional recovery
• prevent relapse

Question 7

Is schizophrenia the same as split or multiple personality syndrome?

Answer 7

NO NO NO

Question 8

What is the difference between an odd characteristic, a disordered state, and a chronic condition?

Answer 8

neurosis - psychosis - schizophrenia

Question 9

Describe who this disease affects and when

Answer 9

0.5 to 1% of population
M = F

Onset:
M: 19-25 yrs old
F: 24-32 yrs old

Question 10

In what many ways can this disease originate (etiology) ?

Answer 10

• genetic - 45% if both parents are positive, 5-10% if one parent is positive
• biologic - dopamine imbalance
• developmental - 2nd trimester
• psychosocial - stress, socioeconomic
• brain asymmetry - abnormal neuronal pruning

Question 11

List the criteria for diagnosing someone with SZP

Answer 11

• deterioration of function
• 6 month duration of symptoms
• onset before 45 years old
• first must rule out affective disorders developmental disorders, organic disorders and substance abuse

Question 12

List some SZP positive symptoms

Answer 12

hallucinations
ideas of reference
delusions
illusions
agitation
anxiety
hostility
restlessness
bizarre actions/statements
distractible
paranoia
suicidal!!

Question 13

What makes a symptom positive?

Answer 13

Things that are there that should NOT be there or they should not be there to that extent

Question 14

What is a neologism?

Answer 14

A made up word

Question 15

What makes a symptom negative?

Answer 15

Things that should be there but aren’t or are there in only minimal amounts

Question 16

List some negative symptoms associated with SZP

Answer 16

• immobile facial expression
• monotonous voice
• lack of pleasure in everyday life
• cannot initiate or sustain planned activity
• speaking infrequently and with minimal and simplistic content
• anhedonia (lack of finding enjoyment in things)
• poor insight and judgement
• poor hygiene
• not motivated
• withdrawn
• cannot concentration
• antisocial
• SUICIDAL

Question 17

List some cognitive symptoms associated with SZP

Answer 17

• cognitive impairment (means they can’t remember)

- impaired of executive function, sustained attention, working, memory, etc.

Question 18

Chlorpromazine is a drug (antipsychotic) used in treating SZP. Why does it work?

Answer 18

this drug blocks the stimulant-induced movement. Dopamine blockage populated as a key mechanism.

Question 19

Any drug that is a dopamine ______ has potential to be an antipsychotic.

Answer 19

antagonist

Question 20

What do all first generation antipsychotics do??

Answer 20

• all primarily target blockade of dopamine, specifically the D2 receptor
• vary in receptor affinity and in affinity for other receptors
• continue to be optimal therapy for people with schizophrenia

Question 21

_____ is the first target of antipsychotic drugs

Answer 21

DOPAMINE

Question 22

What type of neurotransmitter is dopamine?

Answer 22

It is an inhibitory neurotransmitter, meaning that when it finds its way to its receptor sites, it blocks the tendency of that neuron to fire.

Question 23

What other neurotransmitter systems does dopamine interface with?

Answer 23

• noradrenaline
• norepinephrine

etc??

Question 24

T or F: patient needs to have blood work done regularly if on clozapine

Answer 24

True

Question 25

What is the main receptor involved in second generation antipsychotics ?

Answer 25

5HT2 receptor (serotonin) and many more

Question 26

What makes an antipsychotic medication very favourable and effective?

Answer 26

if it has affinity for BOTH serotonin and dopamine receptors

Question 27

What is the affinity for serotonin receptor key for?

Answer 27

reducing the movement disorders

Question 28

What drug can induce a psychotic state and upon repeated use, individuals can acquire a chronic state that is very similar with SZP?

Answer 28

crystal meth (methamphetamine)

Question 29

How do we ensure maximal safety of the use of antispychotics ?

Answer 29

• appropriate dosages

- monitor: HR, BP, sedation, movement, weight, waist circumference, lipids, blood sugar, prolactin

Question 30

Do antipsychotics and benzo’s work quickly or slowly when receiving positive symptoms?

Answer 30

can work quickly!

Question 31

Approximately how long does it take for these drugs to releive all anti-schizophrenia effects?

Answer 31

anywhere from 4 to 8 weeks, but improvement may continue over months or years

Question 32

Why is optimal management of this disease so difficult to achieve?

Answer 32

• voices tell them to quit
• there could be side effects
• people stop taking medication when they feel better even though they should stay on meds to prevent any further problems
• long-term adherence is difficult for many reasons

Question 33

What 2 things does adherence do?

Answer 33

1. allows for ongoing improvements

2. reduces risk of relapse

Question 34

What is a pharmacist’s role in SZP?

Answer 34

• help pt give the meds a chance to help
• educate on importance of adherence
• ease their fears
• manage side effects
• reduce stigma!