Schizophrenia

Question 1

onset

Answer 1

male 19-25

female 24-32

Question 2

causes

Answer 2

genetic
dopamine imbalance
virus in 2nd trimester
abnormal neuronal pruning

Question 3

what neuronal pruning

Answer 3

transitioning from infancy to child need to prune some neurons
in schiz too many pruned

Question 4

problems with neuronal ____

Answer 4

communication

Question 5

dopaminergic excess in

Answer 5

mesolimbic and mesocortical areas correlate with psychotic symptoms

Question 6

dopaminergic shortfall in

Answer 6

frontal lobes correlates with negative and cognitive symptoms

Question 7

positive symptoms

Answer 7

things that shouldnt be there
hallucination, delusion(false beliefs)
paranoria, agitation

Question 8

negative symptoms

Answer 8

should be there but missing

lack ofpleasure, immobile facial expression, poverty of speech, cognitive impairment

Question 9

functional impairment often related to

Answer 9

impact of negative and cognitive symptoms

Question 10

first ___ years after diagnosis critical

Answer 10

5 years bc impairment corrlated with time and severity of porrly controlled symptoms

Question 11

major goals of therapy

Answer 11

prevent harm
patient control
restore contact with reality
prevent relapse

Question 12

components to treatement

Answer 12

pharamcotherapy 
vocational therapy 
socail therapy 
support for housing 
substance abuse

Question 13

initial treatment for psychosis

Answer 13

benzos
antipsychotics maybe
positive symptoms are the targets - anxiety, agitation, harm reduction

Question 14

acute agitation medication

Answer 14

benzos
potentially FGA and benzo
FGA + benzo

Question 15

FGA used in acute agitation

Answer 15

haloperidol - works quickly, reliable

zuclopenthixol - sedating

Question 16

stabilization phase timeline for improvement of positive symptoms

Answer 16

slow erratic and gradual improvement over 6-12 weeks
in 1-3 weeks decreased intensity of hallucinations, paranoria, improved self care, anxiety, and socialization
3-12 weeks further improvement can discharge when safe

Question 17

stabilization phase improvement for negative symptoms

Answer 17

much slower response compared to positive
more resistant to meds
improvement attained with sustained improvement (keeping someone from becoming acutely ill)

Question 18

which drugs come as depot meds

Answer 18

haloperidol, flupheazine, zuclopenthixol
RISPERDONE-microspheres
paliperidone

Question 19

benefit of injection

Answer 19

enable adherence

Question 20

first gen antipsychotics block

Answer 20

dopamine receptor D2

Question 21

second generation antipsychotics block

Answer 21

serotonergic and dopaminergic transmission

Question 22

second gen antipyschotic side effect difference

Answer 22

less movement disorders but more metabolic disorders

Question 23

examples of low/med potency first gen antipsychotics

Answer 23

chlorpromazine
loxapine
perphenazine

Question 24

examples of high potency first gen antipsychotic

Answer 24

haloperidol

fluphenazine

Question 25

what does potency refer to and idicate

Answer 25

refers to D2 receptor binding affinity for FGA | all equally effective just require a diff dose

Question 26

first gen antipsychotic AE

Answer 26

``` anticholinergic - muscarinic antagonist cardiovascular - alpha 1 sedation - histamine antagonist neurologic - movement disorder from D2 antagonism in nigrostriatum. decreased seizure threshold prolactin elevation - D2 antagonism ```

Question 27

problems with prolactin elevation in males and females

Answer 27

men - gynecomastia, sexual disfunction | women - menstrual disturbance, breast enlarged, hirsutism

Question 28

what is neuroleptic malignant syndrome

Answer 28

rigid, tachycardia increased temp, altered consciousness can be life threatening

Question 29

examples of some extrapyramidal movement disorders

Answer 29

``` dytonic reactions - uncoordinated akathisia - pacing cant sit still akinesia - decreased muscualr movement rigidity pisa syndrome - tilted tremor tardive (late appearing) dyskinesia ```

Question 30

drugs to manage EPS

Answer 30

anticholinergics - benztropine propranolol for akathisia benzo

Question 31

why is PK not that useful for antipsychotics

Answer 31

little relevance to antipsychotic effects, these effects due to marinating effect of prolonged presence of the drug in the body not based on levels

Question 32

PK can be useful for detecting

Answer 32

side effects

Question 33

problems with FGA

Answer 33

treatment resistance negative and cognitive symptoms porrly respond EPS and other adverse effects

Question 34

benefits of SGA

Answer 34

``` less EPS improved impact on negative symptoms different adverse effects more indications no prolactin effects no upregulation of D2 receptors bc loose binder comes on and off ```

Question 35

examples of SGA

Answer 35

``` cloazapine risperidone olanzapine quetiapine ziprasidone ```

Question 36

affinity for clozapine

Answer 36

high 5HT2 affinity and low D2 affinity offsets to EPS effect HI, 5Ht2, alpha1, muscarinic, D4, beta, D1, D2, alpha2

Question 37

short comings of clozapine

Answer 37

``` agranulocytosis seizure risk weight gain and metabolic issues weekly blood work high cost ```

Question 38

clozapine agranulocytosis monitoring

Answer 38

must have mandatory CBC weekly reaction is idiosyncratic reversible if detected early

Question 39

AE of clozapine

Answer 39

``` drowsy hypersalivation tachycardia hypotension dry mouth tremor nausea fever weight gain ```

Question 40

is there a therapeutic serum range for clozapine

Answer 40

yes

Question 41

role of clozapine

Answer 41

not 1st line NOT FIRST LINE best results in treatment resistance and suicide risk try for at least 6 months