Schizophrenia Flashcards
A Criteria Symptoms of Schizophrenia
Negative Sx: Alogia, Affective Flattening, Avolution, Anhedonia
Positive Symptoms of Schizophrenia
Delusions, Disorganized Thinking, Hallucinations
Which gender is more likely to have A Criteria Sx of Schizophrenia?
Males >Females
A Criteria Sx = Negative Sx
A Criteria Sx for Schizophrenia for 1 to 6 months
Dx?
Schizophreniform Disorder
What must be done before diagnosing Schizphrenia?
Rule out other diagnosis: other psychotic disorders, childhood developmental disorders, medical/neurological disease, substance abuse, medication induced, personality disorder, mood disorders
Cognitive Symptoms of Schizophrenia
SMART: Speed Memory Attention Reasoning Tact (Social Cognition)
What A Criteria Negative Sx of Schizphrenia is also a sx of major depression
Anhedonia
Criteria to meet DSM-5’s A Criteria of Schizophrenia
Of 2 sx, 1 needs to be :
Delusion, Hallucination, Disorganized thinking/speech
What is catatoni
Stupor, waxy flexibility, mutism, negativsm, echolalia
Seen in schizophrenia and other disorders
What is hyponopompic hallucinations?
Auditory hallucinations heard when patient is waking up from sleeping
Which symptoms of schizophrenia present early in the illness?
Negative/Cognitive Sx
Do negative symptoms worsen or improve during hte active periods of schizophrenia?
Worsen
Do antipsychotic medications work well for negative symptoms of schizophrenia?
No
What % of schizophrenics get married and why?
Only 30-40% due to limited social contacts
What % of schizphrenic patients experience only a single active episode?
10%
30% intermittent course, 60% chronic course
What sign is seen in 85% of patients prior to first psychotic episode? How long does it last?
Prodrome: Lasts several months to years
This is a negative prognostic sign
Why do females and males have the same peak age of onset (mode) but different average age of onset?
2nd smaller peak age of onset peak seen in females after age 40
Why do schizophrenics have a life expectancy that is 25 years less than the general population?
Cardiovascular Disease
When does the functional decline begin in a patient with schizophrenia
Prodrome
Which gender is the average course of schizophrenia more severe in? Why?
Males >Females
Males generally develop illness earlier
What is the main goal of continuous antipsychotic treatment in patients with schizophrenia
Prevent relapse into active phase
What happens when decreasing antipsychotic medication dose to use lowest effective dose?
Increased risk of relapse
Most common reason patients with schizophrenia are hospitalized
Psychosis/Active Phase
Most antipsychotic medications are unlikely to work by 4 weeks if what? What medication is the exception
If a patient does not show a response wtihin 2 weeks
EXCEPTION: Clozapine (Clozaril)
Why are lower doses of antipsychotics used to treat patients with first active phase of schizophrenia
Greater sensitivity to med SE
Which medications have the unique benefit for decreasing risk of suicide?
Clozapine (Clozaril) for schizophrenia
Lithium for Bipolar Disorder
Indications for Clozapine (Clozaril) Trial
Persistence of Positive Sx
Failure of >2 antipsychotic trials
Comorbid Substance Abuse
Recurrent Suicidality/Violence
What % of dopamine receptors need to be blocked with FGAs to see SE?
75-80%
What % of dopamine receptors need to be blocked in what pathway to have the desired antipsychotic effect?
At least 65% blocked
Mesolimbic Tract
Low Potency Antipsychotics SE
Anticholinergic: dry mouth, constipation, blurry eyes, urinary hesitancy
What is dystonia and who is at higher risk than general population?
EPS Side Effect of muscle spasm
Younger Males are at greater risk
Once a patient develops Tardive Dyskinesia, the most common course is:
Remain Static/Unchanged
What is the first choice medication for treating akathisia?
What other drugs can be used?
1st Line: Propranolol
Others:
Amantadine, Lorazepam (Ativan), Clonidine, Mirtazepine (Remeron)
Can diphenhydramine (Benadryl) be used to treat EPS? Why or why not?
YES
Due to anticholinergic effects
Which FGA has less chance of developing EPS symptoms in patients?
Low Potency FGA: Chlorpromazine (Thorazine)
About half of the patients with tardive dyskinesia show a 50% symptom reduction from treatment with
this medication
Clozapine (Clozaril)
What age group has 50% of developing tardive dyskinesia after taking FGAs for 2 years
Geriatric (>70)
What is Akathisia
EPS SE: subjective sense of restlessness
Which SGA have the least risk of EPS SE
Clozapine (Clozaril)
Quetiapine (Seroquel)
Which SGA is most likely to cause akathisia?
Aripipraole (Abilifty)
Which SGA has long half life and low risk of metabolic syndrome?
Aripiprazole (Abilify)
Which SGA are available in long acting injectable form but with risk of dose dependent EPS and hyperprolactinemia?
Risperidone (Risperdal)
Palliperidone (Invega)
Name the SGA
Low Risk of Metabolic Syndrome
Needs to be taken with food
Causes QTc prologation
Ziprasidone (Geodon)
Which SGA was shown by the CATIE study that patients were highly likely to be compliant? What is the downside of this drug?
Olanzapine (Zyprexa)
SE: High risk of metabolic syndrome, very sedating
Which SGA is an active metabolite of risperidone (Risperdal)
Palliperidone (Invega)
Properties of Quetiapine (Seroquel)
SGA:
No risk of EPS or Agranulocytosis
Sedating
Moderate risk of metabolic syndrome
Unique property of Aripiprazole (Abilifty) amongst SGA
Partial Agonist
SE of Clozapine (Clozaril)
SGA
SE: Sialorrhea, Weight Gain, Sedation, Anticholinergic, Myocarditis, Lower Seizure Threshold
