Schizophrenia

Question 1

Schizophrenia

Answer 1

Heterogeneous syndrome of disorganized and bizarre thoughts

Question 2

Etiology of Schizophrenia

Answer 2

Abnormality in brain structure
Not consistent amongst individuals
Multifactorial causes
Neuro development model 
Genes

Question 3

What drug is associated with schizophrenia?

Answer 3

Dopamine

Question 4

Positive symptoms

Answer 4

Hallucinations
Delusions
Disorganized speech
Psychomotor agitation
Bizarre behavior

Classic symptoms

Question 5

Negative symptoms

Answer 5

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

Question 6

Prodromal system

Answer 6

Negative symptoms
Social withdrawal, loss of interest in work or school, and deterioration in hygiene

Onset is late teens early 20s

Question 7

Treatment

Answer 7

Blockade of dopamine receptors in Mesolimbic area

D2- antipsychotic activity
D1- movement side effects, EPS symptoms

Question 8

Receptor activity

Answer 8

D1,2,3,4,5
Serotonin
Alpha 1
Muscarinic
Histamine

Question 9

Course of treatment

Answer 9

Atypical
Typical
Clozapine
Atypical or typical with clozapine

Question 10

Haldol

Answer 10

Most common antipsychotic for schizophrenia

Question 11

Black Box Warning

Answer 11

Elderly dementia related psychosis
Do not treat with atypical antipsychotics
Haldol effective for delirium

Question 12

Clozapine (clozaril)

Answer 12

First atypical and best
Watch WBC, wipe out immune system (agranulocytosis)
Last resort
Most potent

Question 13

Zyprexa (olanzapine)

Answer 13

Highest risk of metabolic syndrome

Low on movement disorder

Question 14

Seroquel (quetiapine)

Answer 14

Also used for major depression

Drug of choice in Parkinson’s patients

Question 15

Risperdal (risperidone)

Answer 15

Watch secondary symptoms
If greater than 6mg dose, Parkinson’s like symptoms
Used for sundowners
Highest black box risk

Question 16

Geodon (ziprasidone)

Answer 16

Avoid if cardiac arrhythmia

Do not start if QTc is greater then 450

Question 17

Abilify

Answer 17

Best side effect profile of all

Used 1st or for major depression

Question 18

Typical/ Atypical

Answer 18

T- movement
A- metabolic
A- also cleaner, 1st line, and less movement issues

Question 19

EPS

Answer 19

Extrapyramidal symptoms
“Abnormal involuntary movements”
Reversible if discovered early
Instant onset

Question 20

Acute Dystonia

Answer 20

EPS
Occurrence usually within 5 days
Life threatening
Typicals
Large doses
Treat- anticholinergic

Question 21

Pseudoparkinsonism

Answer 21

EPS
Treat- anticholinergic
Reversal dope blockade
Taper or Psychotic episode

Question 22

Akathisia

Answer 22

EPS
20% of all typicals
Treat- decrease dose
Add beta blocker- inderal (crosses into CNS)
Benzodiazepine also beta blocker

Question 23

Tardive Dyskinesia

Answer 23

EPS
DO NOT GIVE ANTICHOLINERGICS - will make symptoms permanent
lip smacking most common among other facial movements
Decrease dosage

Question 24

Neuroleptic Malignant Syndrome NMS

Answer 24

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)

Question 25

Adverse effects

Answer 25

Metabolic syndrome
Obesity
Hypertension
Impaired fasting glucose
Decrease HDL
Elevated triglycerides