Schizophrenia Flashcards
Males are more likely than females to have these A Criteria symptoms of schizophrenia
negative symptoms (alogia, affective flattening, avolution, anhedonia)
What are the positive symptoms of schizophrenia?
delusions, disorganized
thinking, and hallucinations
If the A criteria for Schizophrenia have been met for between 1 & 6 months, the diagnosis is this
schizophreniform disorder
Before diagnosing schizophrenia, exclusionary diagnoses that must
be ruled out include:
other psychotic disorders,
childhood developmental disorders, medical or neurological illness,
substance abuse or medication induced, personality disorders, & this
Mood disorders
Regarding the cognitive symptoms of schizophrenia, the mnemonic SMART refers what?
speed, memory, attention, reasoning, and tact (social cognition)
This A criteria negative symptom of schizophrenia is also a symptom of major depression
Anhedonia
To meet DSM5’s A criteria of Schizophrenia, of the 2 symptoms 1 needs to one of the following:
a delusion, a hallucination, or disorganized thinking/speech
Seen in schizophrenia (& other disorders) - stupor, waxy flexibility, mutism, negativism, stereotypy, & echolalia are motor activities that are part of a clinical picture of this
Catatonia
Voices that are only heard when a patient is just waking up from sleeping are called this
hypnopompic hallucinations
These symptoms of schizophrenia present early in the illness, worsen during the active periods, & do not respond well to anti-psychotic medications
negative symptoms (or cognitive symptoms)
It is “proposed” that because most patients with schizophrenia have limited social contacts, only
30-40% do this
Get married
What is the percentage of patients with schizophrenia who experience a single active episode?
10%
~30% have an intermittent course, ~60% have a chronic course
Seen in ~85% of patients prior to the 1st psychotic episode, this negative prognostic sign lasts several months to years
Prodrome
For ♂ &♀ with schizophrenia, the peak age of onset (the mode) is the same but the average age of onset is different due to what?
There is a 2nd smaller peak age of onset peak for females after age 40
Patients with schizophrenia have a life expectancy that is about 25 years less than the general population primarily
due to what?
Cardiovascular disease
The functional decline for a patient with schizophrenia begins during this phase of
the illness
The prodrome
Due to their many problems as outlined in the B criteria, only 33% of those with schizophrenia are able to do this on July 4th
Live independently
The average course of schizophrenia tends to be more severe in males than females because of this.
males generally develop the illness earlier
For patients with schizophrenia, the main goal of continuous pharmacologic treatment with antipsychotics is this
prevent relapse into the active phase
Decreasing the antipsychotic medication in an attempt to use the “lowest effective dose” is associated with this
increased risk of relapse
The most common reason patients with schizophrenia are psychiatrically hospitalized is this
psychosis/active phase of illness
Except for clozapine (Clozaril), all anti-psychotic medications are unlikely to work by 4 weeks if a patient does not show a response within this number of week(s).
2 weeks
Lower doses of antipsychotics are used to treat patients with the first active phase of schizophrenia because of this
greater sensitivity to medication side effects
Clozapine (Clozaril) for patients with schizophrenia and lithium for patients with bipolar disorder both have this same unique benefit
decreases risk of suicide
Common indications for a clozapine (clozaril) trial include these 4 reasons:
- persistence of positive symptoms
- failure of > 2 antipsychotic trials
- co-morbid substance abuse
- recurrent suicidality/violence
In treating patients with FGA’s, often titrating the dose up until side effects emerge corresponds to blocking
this percentage of
dopamine receptors
75-80%
In order to have the desired antipsychotic effect, medications need to block at least 65% of dopamine receptors in this pathway
Mesolimbic tract
Low potency antipsychotics have common side effects of dry mouth, constipation, blurred vision, & urinary hesitancy
due to this
anti-cholinergic activity (cholinergic blockade)
Young males may be at higher risk than the rest of the population for this EPS side effect of muscle spasms
Dystonia
Once a patient develops tardive dyskinesia, the most common course of the symptoms is this
Symptoms remain static/unchanged (ongoing symptoms
While amantadine (symmetrel), lorazepam (ativan),
clonidine (catapres),
even mirtazepine (remeron),
can be used for treating akathisia, the first choice of medication for treatment is this
propranolol (indural)
Name treatments for akathisia.
propranolol (indural), amantadine (symmetrel), lorazepam (ativan),
clonidine (catapres), mirtazepine (remeron)
Diphenhydramine (benadryl) is used to treat EPS because of this effect
Benadryl is anticholinergic
While there is still a significant risk of EPS, patients are less likely to complain of EPS symptoms from this type of FGA
low potency FGAs, like chlorpromazine (thorazine)
About half of the patients with tardive dyskinesia show a 50% symptom reduction from treatment with this medication
clozapine (clozaril)
50% of patients in this age are at risk of tardive dyskinesia if they FGA’s for 24 months
older adults/geriatrics (>70 y/o)
An EPS side effect often described as a subjective sense of restlessness (the person can’t sit still) is this
akathisia
These two SGA’s are least likely to have EPS side effects
clozapine (clozaril) and quetiapine (seroquel)
This SGA has a particularly long half life and a low risk of metabolic syndrome, but is the SGA most likely to cause akathisia
aripiprazole (abilify)
These 2 SGA’s are available in long acting injectable form but can cause dose dependent EPS & prolactin elevation
risperidone (risperdal) & palliperidone (invega)
This SGA has a low risk of metabolic syndrome, needs to be taken with food, and is the most likely SGA to cause qTc prolongation
ziprasidone (geodone)
This SGA has the highest risk
of metabolic syndrome, is very sedating, and the CATIE study showed patients are highly
likely to be compliant
olanzapine (zyprexa)
This SGA does not require hepatic metabolism because it is an active metabolite of risperidone (risperdal)
paliperidone (invega)
This SGA has almost zero risk of EPS or agranulocytosis, is
often sedating & has a
moderate risk of metabolic syndrome
quetiapine (seroquel)
This SGA is unique since it
is a partial agonist
aripiprazole (abilify)
This SGA may cause side effects of sialorrhea, weight gain, sedation, anticholinergic effects, myocarditis, and a lower seizure threshold
clozapine (clozaril)
