Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychiatry > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

What are the positive sx of schizophrenia?

More common in M or F?

A

Delusions, Hallucinations, Disorganized thinking, Disorganized speech

Females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the negative sx of schizophrenia?

More common in M or F?

A

Alogia, affective flattening, avolition, anhedonia

Males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is avolition?

A

The decrease in the motivation to initiate and perform self-directed purposeful activities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is alogia?

A

Poverty of speech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the difference between a bizarre and non-bizarre delusion?

A

Non-bizarre delusion has element of plausibility;

bizarre delusion is completely implausible.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What’s the lifetime risk of schizophrenia?

What is the prevalence of schizophrenia?

A

Lifetime risk: 0.05-0.10%

Prevalence: ~1% (recent reviews say 0.55%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Review the different subtypes of paranoid schizophrenia.

A 
Persecutory 48% 
Jealousy 11% 
Mixed 11%
Somatic 5%
NOS 23%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What’s the most common age-range of onset of schizophrenia.

A

16-25

schizophrenia.com

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Is onset of schizophrenia usually acute or gradual?

A

Onset may be acute; less common develops gradually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What proportion of schizophrenia cases will go into remission vs. not (lifelong)?

A

1/3 remission; 2/3 lifelong

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the DSM-5 criteria for delusional disorder?

A

– 1 or more delusions, > 1 month
– Schizophrenia Criteria A never met
– Aside from delusion, function not markedly impaired
– If hallucinations, not prominent, related to delusional theme
– If mania/depression, brief relative to delusional periods

(r/o: Substance, Med illness, OCD, Body Dysmorphic Disorder)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the tx for delusional disorder?

A

Antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which of the following require medication tx: hypnogogic and hypnopompic hallucinations, single voice hallucination, and multiple voices hallucinations?

A
  • Hypnogogic and hypnopompic hallucinations do not
    require medication treatment
  • Single voice hallucination and multiple voices hallucinations will typically result in medication treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the cognitive deficits of schizophrenia?

A

SMART

  • Speed
  • Memory (working, visual, verbal)
  • Attention
  • Reasoning
  • Tact (social cognition)

(Pts are moderately to severely impaired compared w/ general population. Appear early in course of illness, persists, and is stable)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What A Criteria symptoms do the “SMART” cognitive deficits of schizophrenia impact?

A

Disorganized thinking

Disorganized behavior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

W/r/t the positive sx of schizophrenia:

  • Do they occur early or late in dz?
  • Are they correlated with functional improvement?
  • Do they respond well to antipsychotics?
A

– Often when illness is first diagnosed, but actually occurs later in development of illness
– May wax and wane w/ illness exacerbation and improvement
– Correlated w/ hospitalization, but not functional improvement
– Respond well to anti-psychotics
– May stabilize or improve later in life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

W/r/t the negative sx of schizophrenia:

  • Do they occur early or late in dz?
  • Are they correlated with functional improvement?
  • Do they respond well to antipsychotics?
A

– Occur early-prodrome
– May precede psychosis by up to 5-10 years
– Tend to progress w/ course of illness, especially in early years
– Progress most during acute psychotic periods
– Moderately correlated w/ functional improvement
– Fair/poor response to anti-psychotic medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

W/r/t the cognitive sx of schizophrenia:

  • Are they correlated with functional improvement?
  • When are they first seen?
  • Do they respond well to antipsychotics?
A

– Present from early age
– Moderate progression w/ illness course
– Most progression during episodes of acute psychosis
– Highly correlated w/ functional IMPAIRMENT
– Poor response to anti-psychotic treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the B Criteria of Schizophrenia?

A

Social occupational dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What specifically is referred to in the B criteria of schizophrenia?

A

Work

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What % of schizophrenic patients can’t work or are unemployed?

A

75%

- Among top 10 common causes of disability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What % of schizophrenics marry?

A

30-40%

- Most have limited social contacts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What proportion of schizophrenic patients live independently?

A

1/3

Quality of life a/w schizophrenia ranks among the worst of chronic medical illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the 4 phases of schizophrenia?

A
  1. Premorbid (e.g.: 0-10)
  2. Prodromal (e.g.: 10-20)
  3. Progression (e.g.: 20-30)
  4. Stable relapsing (e.g. 30+)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

About what % of schizophrenic cases will have a single episode?
Intermittent course?
Chronic course?

A

Single episode: 12%
Intermittent course: 32%
Chronic course: 56%

(#s estimated from graph)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the downward drift hypothesis, w/r/t schizophrenia?

A

Are the poor at higher risk of schizophrenia?
Downward drift hypothesis says “no, those with
schizophrenia become ‘poor’ due to their social
occupational dysfunction”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the prodrome phase of schizophrenia? (give e.g.’s)

A

Time, several months to years, prior to initial diagnosis where diagnostic criteria not met.

  • IoR or magical thinking, but not of delusional intensity
  • Impaired perceptions
  • Negative symptoms: mood, subjective cognitive decline
  • Much of functional decline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What % of schizophrenics have the prodrome phase?

A

80-85%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Is the presence of a prodrome a positive or negative prognostic sign?
- How does this change the prognosed difficulty of their course of illness?

A
  • Negative

- More likely the patient will have a difficult course of the illness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the time duration criteria for diagnosing schizophrenia? (How much of that time must criteria A be clearly med?)

Schizophreniform disorder?

Brief Reactive psychosis?

Psychosis NOS?

A

> 6 months*
*with 1 month clearly meeting A criteria
~50% have a (+) or (-) symptom of moderate or greater severity after an adequate med trial.

> 1 month, < 6 months

< 1 month

< 1 month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the peak age of onset of schizophrenia in males? Females? Explain.

A

M: 15-25
F: 25-35
F have 2nd smaller peak after age 40; 3-10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Which sex is more likely to have schizophrenia?

A

M=F (actually, M > F but only very slightly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

In working up a patient for schizophrenia, what other diagnosis or groups of diagnoses need to be ruled out?

A
  • Schizoaffective/other psychotic disorders
  • Mood disorders
  • Medical/Neurological illness
  • Substances/Medications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the rates of alcohol abuse/dependence in schizophrenia?
Marijuana?
Cocaine?

A

30-50% alcohol abuse/dependence
15-15% marijuana abuse/dependence
5-10% cocaine abuse/dependence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Autism is __x more common than schizophrenia

A

10x

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the baseline risk of having schizophrenia?

A

~1%

same as prevalence? Before they said lifetime risk was 0.05-0.10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Risk if your identical twin has schizophrenia?

A

~50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Is schizophrenia caused by a single gene?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Prenatal and perinatal risks factors for schizophrenia?

A

– In utero (especially 2nd trimester): Viral infections, Winter births, Starvation, Toxic exposure
– Perinatal anoxia
– Advance paternal age

(all increase risk a small amount)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Overall what factors can contribute to the development of schizophrenia?

A

 Genetic disposition
– Early environmental insults: Prenatal, perinatal,
 Neurodevelopmental abnormalities
– Later environmental insults: Subst abuse, psychosocial stressors
 Further brain dysfunction
– Periods of psychosis
 Neurodegeneration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is anosognosia?

A

Lack of awareness one is ill; lack of insight into illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How does anosognosia affect the care of patients with schizophrenia?

A

Lack of compliance w/tx recommendations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

General population average lifespan is 78. What is the average lifespan for someone with schizophrenia?
(What % shorter than general pop is this?)

A

48-53 years

30% shorter than general population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What % of schizophrenic pts attempt suicide?
What % complete?

What % of general pop complete suicide?

A
  • 20-40% attempt suicide (BD: 25-40%)
  • ~8-10% complete (BD: ~20%!)
  • Gen pop ~1% complete
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the highest risk factors for schizophrenics completing suicide?

A
  • young
  • male
  • higher functioning
  • good insight
  • med non-compliance
  • past history of violence
  • excessive substance use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What % of schizophrenics die of CV dz?

What % of gen pop dies from CV dz?

A

~75%

~50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Review the different rates of smoking, diabetes, and obesity in schizophrenics vs. the gen pop.

What are the reasons for this discrepancy?

A
  • smoking 80-90%, gen pop 25%, (2-3x’s more common)
  • diabetes 13%, gen pop 3% (2-4x’s more common)
  • obesity 42%, gen pop 27% (1.5-2x’s more common)

Reasons for metabolic syndrome:
- poor self care and poor health care (untreated diabetes 30%; untreated HTN 62%; Untreated dyslipidemia 88%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Review some of the reasons that schizophrenia cost the US economy $63 bil in 2002.

A 
– Illness begins early in life
– Significant, long lasting impairment
– Heavy demands for hospital care
– Ongoing clinical care, rehab, support services
– 75% can’t work, on disability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Name some dopamine-agonist drug of abuse that can cause psychosis.

A
  • Cocaine

- Amphetamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Where is the nigrostriatal tract?

A

(extrapyramidal pathway) substantia nigra (midbrain) to caudate + putamen of the basal ganglia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Where is the mesolimbic tract?

A

Midbrain tegmentum to nucleus accumbens and

adjacent limbic structures

52
Q

Where is the mesocortical tract?

A

Midbrain tegmentum to anterior cortical areas

53
Q

Where is the tuberoinfundibular tract?

A

Arcuate and periventricular nuclei of the hypothalamus to the pituitary

54
Q

Does the D1 (D1, D5) or D2 (D2, D3, D4) have a higher correlation with antipsychotic activity?

A

D2

55
Q

Name some high potency FGAs.

A
  • Haloperidol (Haldol)
  • Fluphenazine (Prolixin)
  • Perphazine (Trilafon)
  • Thiothixine (Navane)
56
Q

Name some low potency FGAs.

A
  • Chlorpromazine (Thorazine)
  • Thioridazine (Mellaril)
  • Mesoridazine (Serentil)
57
Q

__% D2 receptor occupancy is required for efficacy

__% D2 receptor occupancy is correlated with EPS

A

65% (60?)

80%

58
Q

*Normal subjects: __% DA receptors occupied at baseline

Schizophrenic subjects: __% DA receptors occupied at baseline

A

10%

20%

59
Q

Besides DA, what other NT system dysfunction is linked to schizophrenia?

A

Glutamate

60
Q

~__% pts no sig. response to anti-psychotic treatment.

A

30

61
Q

What are some EPS side effects?

A
  • Dystonia
  • Parkinsonism (TRAP)
  • Akathisia
  • Tardive dyskinesia
62
Q

Which dopamingeric pw is blocked to cause EPS side effects?

A

Nigrostriatal tract

63
Q

Which dopaminergic pw is blocked to cause an antipsychotic effect?

A

Mesolimbic tract

64
Q

Which dopaminergic pw causes negative sx? (theory)

A

Mesocortical tract

65
Q

Which dopaminergic pw is blocked to cause endocrine sx? (theory)

A

Tuberoinfundibular tract

66
Q

What are some endocrine sx a/w antipsychotics?

A
  • Prolactin elevation
  • Galactorrhea
  • Gynecomastia
  • Menstrual changes
  • Sexual dysfunction
67
Q

*Do positive or negative sx of schizophrenia progress most rapidly during early acute phases of illness?

A

Negative

*Positive: most common reason for hospitalization

68
Q

In schizophrenia, how correlated (low/med/high) is functional impairment with cognitive sx?
w/ negative sx?

A
  • High w/cognitive sx

- Med w/negative sx

69
Q

Review this antipsychotic algorithm for schizophrenia.

A 
• Stage 1: SGA (2nd generation antipsychotic)
  - Partial or non-response?
• Stage 2: different SGA or FGA
  - Partial or non-response?
• Stage 3: Clozapine trial
• Stage 4: Clozapine + SGA or FGA
• Stage 5: New FGA or SGA
• Stage 6: 2 FGA’s, 2 SGA’s or FGA+SGA
70
Q

In treating schizophrenia, Iif patient does not achieve a __% reduction in symptoms in the first 2 weeks, outcome is likely to be poor at 4 weeks.

A

25%

- More improvement occurs in the first two weeks than the second two weeks

71
Q

Schizophrenics having their first episode are more or less susceptible to side effects of meds?

A

More sensitive (give lower dose)

72
Q

When are some situations that you might use clozapine?

A

• Pts with recurrent suicidality or violence
• Pts with substance abuse
• Persistence of positive symptoms
- if > 2 years, consider trial
- if > 5 years, almost have to justify not doing a trial

73
Q

What are the receptors, other than DA, that are responsible for the side effects of FGAs?

A

H1 (histamine), M1 (muscarinic), a1 (adrenergic)
receptors

(High risk of Dopamine system side effects)

74
Q

Which have greater anticholinergic (muscarinic) side effects, low or high potency FGAs?

A

Low

75
Q

Which have greater EPS side effects, low or high potency FGAs?

A

High

76
Q

Are EPS side effects usually reversible?

A

Yes (often tx response)

77
Q

What are some adjunctive meds that can help treat antipsychotic EPS?

A
  • Benztropine, Trihexyphenidyl (anticholinergic)
  • Diphenhydramine (antihistamine)
  • Amantadine (for dopamine)
78
Q

Describe tardive dyskinesia.

A

• Adverse reaction to antipsychotic medications
• Irregular, choreoathetotic movements
- Chorea - irregular, spasmodic movements
- Athetosis - slow writhing movements
• May occur in any muscle group
• Most common in facial, oral, and truncal muscles

79
Q

Does tardive dyskinesia occur more commonly in older or younger adults?

A

Younger adults

80
Q

What’s most common for tardive dyskinesia sx: worsen, remain the same, or improve?

A

Remain the same

  • Spontaneous improvement least common
  • About half of patients experience relief of symptoms within 3 months of antipsychotic discontinuation
81
Q

What are 2 temporary strategies for reducing tardive dyskinesia sx?

*Long-term?

A

Temporary

  • Increase antipsychotic dose temporarily suppresses symptoms
  • Benzodiazepine my bring about a modest reduction in symptoms

Long-term

  • Reduce antipsychotic dose and time of exposure
  • Clozapine
82
Q

Do SGAs have a greater or lower rate of EPS than FGAs?

A

Lower rates

Paliperidone/Risperidone > Aripiprazole/Olanzapine/Ziprasidone > Quetiapine/Clozapine

83
Q

Do SGAs have a greater or lower rate of tardive dyskinesia than FGAs?

A

Lower rates

High potency > low potency > SGAs
clozapine: none reported

84
Q

Advantages of high-potency FGAs?

  • Haloperidol (Haldol)
  • Fluphenazine (Prolixin)
  • Perphazine (Trilafon)
  • Thiothixine (Navane)
A
  • Injectable formulations (including IV)
  • Depot formulations (Haldol + Prolixin)
  • Inexpensive
85
Q

Disadvantages of high-potency FGAs?

  • Haloperidol (Haldol)
  • Fluphenazine (Prolixin)
  • Perphazine (Trilafon)
  • Thiothixine (Navane)
A

• High risk of Dopamine system side effects

- EPS + Tardive Dyskinesia

86
Q

Advantages of low-potency FGAs?

  • Chlorpromazine (Thorazine)
  • Thioridazine (Mellaril)
  • Mesoridazine (Serentil)
A
  • Highly sedating
  • Injectable formulations
  • Inexpensive
87
Q

Disadvantages of low-potency FGAs?

  • Chlorpromazine (Thorazine)
  • Thioridazine (Mellaril)
  • Mesoridazine (Serentil)
A
  • Highly sedating
  • Risk of QTc prolongation
  • Risk of tardive dyskinesia
88
Q

In addition to decreasing positive sx of schizophrenia, SGAs also have some effect on these 2 categories of sx:

A

Negative + cognitive symptoms

[Also beneficial for tx-refractory pts (clozapine only)]

89
Q

Review some different SGAs (atypicals).

A
  • Aripiprazole (Abilify)
  • Risperidone (Risperdal)
  • Paliperidone (Invega)
  • Ziprasidone (Geodon)
  • Asenapine (Saphris)
  • Quetiapine (Seroquel)
  • Olanzapine (Zyprexa)
  • Clozapine (Clozaril) – Second-line use only
90
Q

What are some unique characteristics of aripiprazole (Abilify)?
(T1/2)
(weight change?)

A
  • Unique pharmacology (partial agonist)
  • Disintegrating tablet & injectable formulations
  • Long half-life
  • 15 mg superior to 30 mg; no advantage to ^ dose
  • Minimal risk of metabolic syndrome
91
Q

What are the unique side effects more commonly seen in risperidone (Risperdol) than in other SGAs?

A

• Dopamine system side effects
- Dose-dependent EPS + PRL elevation

(also mod risk of weight gain)

Advantages: experience w/ drug, tablet or depot preparations, relatively low cost.

92
Q

*What are the advantages of paliperidone (Invega)?

A

• Does not require hepatic metabolism
- 80% renally excreted; *use in pts with liver disease
• Extended-release formulation: Invega Sustenna, monthly

93
Q

What are the unique side effects more commonly seen in paliperidone (Invega) than in other SGAs?

A

• Dopamine system side effects
- Dose-dependent EPS + Prolactin elevation
• Mod risk of weight gain
• Avoid if pt has impaired renal clearance capacity

(limited clinical experience)

94
Q

What are some advantages of using ziprasidone (Geodon)?

A
  • Low risk of weight gain or sexual dysfunction
  • Relatively low cost
  • Injectable formulation
95
Q

What are some DISadvantages of using ziprasidone (Geodon)? (*2)

A

• Twice-daily dosing WITH MEALS
• QTc prolongation
- Avoid if EKG shows qTc >500 milliseconds
- Check pulse. Low pulse risks Torsades. Is pt on a drug that lowers pulse? (eg beta-blocker?)

96
Q

*What are some advantages to using quetiapine (Seroquel)? (4)

A
  • *Lowest EPS risk
  • Sustained Release formulation (once daily)
  • Rapid onset of action
  • Sedating
97
Q

What are some disadvantages to using quetiapine (Seroquel)?

A
  • Moderate risk of weight gain
  • May cause insomnia
  • Longer dose titration
  • Moderate-high cost
98
Q

What are some advantages to using olanzapine (Zyprexa)?

A
  • Extensive clinical experience
  • Superior retention in maintenance treatment (CATIE)
  • Disintegrating tablet and injectable forms
99
Q

What are the main disadvantages to using olanzapine (Zyprexa)?

A

• HIGH risk of weight gain and metabolic syndrome
- ^ triglycerides, ^ lipids, ^ HgbA1C; ^ risk diabetes. 30% pt ^ >7% body weight
• Sedation
• Liver irritation–be cautious in hepatitis pt or of pt on other meds that irritate liver (statins, depakote, carbamazepine, naltrexone)
• High cost

100
Q

What are some potential disadvantages of asenapine (Saphris), which are still being elucidated?

A

New drug, many unknowns
• Risk of DA system side effects: EPS + TD, ^ Prolactin, NMS
• Orthostasis, hypotension, syncope, QTc prolongation,
• Weight gain

101
Q

*What are some advantages to using clozapine (Clozaril)?

A

• Effective for 30-50% of *tx-refractory pts
- *Suicidal risks, *substance problems
• *Most effective for negative symptoms
• Only proven treatment for TD

102
Q

*What are some disadvantages to using clozapine (Clozaril)?

A
  • Risk of agranulocytosis

* Unfavorable side effect profile (myocarditis, ^ risk seizures)

103
Q

Recall: what sx to look for if EPS (D2 blockade)?

A
  • Tremor
  • Akinesia/bradykinesia/hypokinesia
  • Rigidity (cogwheel)
  • Dystonia, akathisia
  • Tardive dyskinesia from long-term tx.
  • Hyperprolactinemia from lack of D2 inhibition in tuberoinfundibular tract (milk in men, fertility/menses issues in women; osteopenia).
104
Q

Recall: what sx to look for if anticholingeric (M1 blockade)?

A
  • Can’t see (blurred vision)
  • Can’t pee (urinary retention)
  • Can’t spit (dry mouth)
  • Can’t shit (constipation)
105
Q

Recall: what sx to look for a1 adrenergic blockade?

A

Orthostatic hypotension (weakness, dizziness)

106
Q

Recall: what sx to look if antihistamine (H1 blockade)?

A
  • Sedation
  • Weight gain
  • (also many others like blurred vision, tinnitus, N/V/D, dry mouth…)
107
Q

Which FGAs (2) and SGAs (2) are available in depot forms?

A
  • Haloperidol (Haldol) decanoate
  • Fluphenazine (Prolixin) decanoate
  • Risperidone depot (Risperdal Consta)
  • Paliperidone palmitate (Invega Sustenna)
108
Q

What’s the main advantage of depot formulation of antipsychotics?

A

Increased compliance

109
Q

What are some disadvantages of using depot formulations of antipsychotics?

A
  • Decreased flexibility of dosing

- Patient’s don’t accept it

110
Q

Recall/review the metabolic syndrome effects more a/w SGAs.

“Prevalence of obesity and diabetes in patients with schizophrenia is ___-___ times higher than the general population”

A
  • Weight gain
  • Type 2 diabetes
  • Elevated LDL cholesterol
  • Elevated triglycerides
  • Decreased HDL cholesterol
  • Diabetic ketoacidosis

“1.5-2.0”x higher than general pop

111
Q

*Which antipsychotics carry the highest risk of metabolic syndrome?

Which carry the lowest risk?

A

Highest: Clozapine/Olanzapine/Low Potency FGA Neuroleptics

Lowest: Aripiprazole/Ziprasidone

112
Q

How would you monitor for metabolic syndrome in a patient on higher risk antipsychotics?

A
  • Personal/family hx
  • Weight (BMI)
  • Waist circumference
  • Blood pressure
  • Fasting plasma glucose
  • Fasting lipid profile
113
Q

*The FGA low potency drugs ___________ and ___________ are associated with qTc prolongation and increased risk of cardiac death.

A
  • Thioridazine (Mellaril)

- Mesoridazine (Stelazine)

114
Q

Does ziprasidone increase risk of sudden cardiac death?

A

No (just carries a “bold” warning regarding QTc prolongation + associated cardiac risk,)

115
Q

What is the black box warning seen on all ATYPICAL antipsychotics?

A

Increased mortality in elderly patients with dementia-related psychosis

(Risk is comparable among all conventional and atypical antipsychotics)

116
Q

What is the incidence of NMS w/D2 blockade?

A

0.2% (usually occurs w/in 30 days or sooner)

117
Q

Besides typical and atypical antipsychotics, what are some other drugs that can cause D2 blockade –> NMS?

A
  • Anti-emetics: prochlorperazine (Compazine)
  • Pro-peristaltic agents: metocloperamide (Reglan)
  • Anesthetics: droperidol (Innovar)
  • Sedatives: promethazine (Phenergan)
118
Q

Review the actual criteria for dx’ing NMS (name the major sx)

A
  1. D2-blockers (no use in past 30 days)
  2. Hyperthermia (>38C)
  3. *Muscle rigidity
  4. 5 of the 9 following sx: ^HR, ^+v BP, ^RR/hypoxia, ^CPK, metabolic acidosis, tremor, incontinence, ^ WBC, diaphoresis/sialorrhea.
  5. R/O other hyperthermia causes
119
Q

What is the tx for NMS?

A
  1. Stop D2 blocker
  2. Supportive (fluids, antipyretic, monitoring)
    • No consensus on other treatment options
    - Lorazepam (Ativan)-useful in reversing catatonia
    - Amantadine (Symmetrel)-may release dopamine from terminals
    - Bromocriptine (Parlodel)- d2-agonist
    - Dantrolene (Dantrium)-causes direct muscle relaxation
    - ECT
120
Q

NMS:

  • Mortality rate?
  • Recurrence risk w/restarting D2 blocker?
A
  • 5-12% (improving)

- 30% (most can do it w/precautions)

121
Q

Very generally, what’s a good medication dosing strategy when treating schizophrenia w/antipsychotics?

A
  • Continuous, full-dose antipsychotic treatment is the key to good outcome in schizophrenia
  • “Lowest effective dose” strategies are associated with higher relapse rates and poorer outcomes

(weak justifications for using more than 1 antipsychotic drug to treat, but 1/4 get multiple- costly, + additive side effects)

122
Q

In the CATIE trial, which antipsychotic was shown to have superior patient compliant/retention in maintenance tx?

A

Olanzapine (Zyprexa)

123
Q

Which antipsychotic is thought to have the lowest risk of extrapyramidal sx?

A

Quetiapine (Seroquel)

124
Q

Which antipsychotic is the only proven tx for tardive dyskinesia?

A

Clozapine (Clozaril)

125
Q

Which antipsychotic is thought to be most effective for the negative sx of schizophrenia?

A

Clozapine (Clozaril)

126
Q

Which SGAs act more like FGAs when given at high doses (via increased D2 blockade)?

A
  • Risperidone (Risperdol)

- Paliperidone (Invega)

127
Q

Which antipsychotic must be taken with meals?

A

Ziprasidone (Geodon)

Psychiatry (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions