Schizophrenia Flashcards
Schizophrenia
Heterogeneous syndrome of disorganized and bizarre thoughts
Etiology of Schizophrenia
Abnormality in brain structure Not consistent amongst individuals Multifactorial causes Neuro development model Genes
What drug is associated with schizophrenia?
Dopamine
Positive symptoms
Hallucinations Delusions Disorganized speech Psychomotor agitation Bizarre behavior
Classic symptoms
Negative symptoms
Less responsive to drug therapy
Antipsychotics
1st to appear
Alogia- brief response to question
Flattened affect
Avolition- lack in self initiated goal directed activity
Anhedonia- lack of interest and motivation in other people or activities
Attentional impairment- psychomotor retardation
Poverty of speech- decreased speech
Prodromal system
Negative symptoms
Social withdrawal, loss of interest in work or school, and deterioration in hygiene
Onset is late teens early 20s
Treatment
Blockade of dopamine receptors in Mesolimbic area
D2- antipsychotic activity
D1- movement side effects, EPS symptoms
Receptor activity
D1,2,3,4,5 Serotonin Alpha 1 Muscarinic Histamine
Course of treatment
Atypical
Typical
Clozapine
Atypical or typical with clozapine
Haldol
Most common antipsychotic for schizophrenia
Black Box Warning
Elderly dementia related psychosis
Do not treat with atypical antipsychotics
Haldol effective for delirium
Clozapine (clozaril)
First atypical and best
Watch WBC, wipe out immune system (agranulocytosis)
Last resort
Most potent
Zyprexa (olanzapine)
Highest risk of metabolic syndrome
Low on movement disorder
Seroquel (quetiapine)
Also used for major depression
Drug of choice in Parkinson’s patients
Risperdal (risperidone)
Watch secondary symptoms
If greater than 6mg dose, Parkinson’s like symptoms
Used for sundowners
Highest black box risk
Geodon (ziprasidone)
Avoid if cardiac arrhythmia
Do not start if QTc is greater then 450
Abilify
Best side effect profile of all
Used 1st or for major depression
Typical/ Atypical
T- movement
A- metabolic
A- also cleaner, 1st line, and less movement issues
EPS
Extrapyramidal symptoms
“Abnormal involuntary movements”
Reversible if discovered early
Instant onset
Acute Dystonia
EPS Occurrence usually within 5 days Life threatening Typicals Large doses Treat- anticholinergic
Pseudoparkinsonism
EPS
Treat- anticholinergic
Reversal dope blockade
Taper or Psychotic episode
Akathisia
EPS 20% of all typicals Treat- decrease dose Add beta blocker- inderal (crosses into CNS) Benzodiazepine also beta blocker
Tardive Dyskinesia
EPS
DO NOT GIVE ANTICHOLINERGICS - will make symptoms permanent
lip smacking most common among other facial movements
Decrease dosage
Neuroleptic Malignant Syndrome NMS
Rare but fatall
Due to blockade of dope receptor
Muscle rigidity!!! Treat with muscle relaxant
Hypothermia
Die from kidney failure because of breakdown of creatine
Treat- dopamine antagonist (reverse block)
Adverse effects
Metabolic syndrome Obesity Hypertension Impaired fasting glucose Decrease HDL Elevated triglycerides