Schizophrenia Flashcards
Iatrogenic causes of Schizophrenia can be due to __.
excessive thyroid or corticosteroids
The misuse of __ and __ can cause Schizophrenia.
alcohol and psychoactive substances
All antipsychotics work by __.
post-synaptic block of dopamine receptors
Drugs, particularly __ may precipitate Schizophrenia
dopamine agonists
A lack of __ and __ may prolong the course of schizophrenia.
support and adherence
Under the DSM-5 Criteria for diagnosis of Schizophrenia, there must be __ with each persisting for a significant portion of at least 1 month. Continuous signs of the disorder should occur for at least __.
- 2 or more symptoms (DHDGN)
2. 6 months
*Under the DSM-5 Criteria for diagnosis of Schizophrenia patients will present with DHDGN symptoms. The 1st ‘D’ refers to __.
Delusions
*Under the DSM-5 Criteria for diagnosis of Schizophrenia patients will present with DHDGN symptoms. The ‘H’ refers to __.
Hallucinations
*Under the DSM-5 Criteria for diagnosis of Schizophrenia patients will present with DHDGN symptoms. The 2nd ‘D’ refers to __.
Disorganized speech
*Under the DSM-5 Criteria for diagnosis of Schizophrenia patients will present with DHDGN symptoms. The ‘G’ refers to __.
Grossly disorganized or catatonic behavior
*Under the DSM-5 Criteria for diagnosis of Schizophrenia patients will present with DHDGN symptoms. The ‘N’ refers to __.
Negative symptoms e.g. Affective flattening, Alogia , Anhedonia, Avolition
(AAAA)
It is important to rule out __, __, __ and __ as causes of Schizophrenia.
Schizoaffective, Mood disorder, Medical disorder and substance use.
(SMMS)
The effects of relapse often occur only __ after stopping treatment.
several weeks
*Methods to improve compliance in schizophrenic patients include: ICP. ‘I’ refers to __.
IM long acting injections
*Methods to improve compliance in schizophrenic patients include: ICP. ‘C’ refers to __.
Community psychiatric nurse
*Methods to improve compliance in schizophrenic patients include: ICP. ‘P’ refers to __.
Patient and family (caregiver) education
An antipsychotic blocking dopamine receptors in the Mesolimbic tract leads to __.
reduction of positive symptoms of Schizophrenia (efficacy)
An antipsychotic blocking dopamine receptors in the Mesocortical tract leads to __.
negative symptoms (adverse effect)
An antipsychotic blocking dopamine receptors in the Nigrostriatal tract leads to __.
Extrapyramidal Side Effects (EPSE) (adverse effect)
An antipsychotic blocking dopamine receptors in the Tuberoinfundibular tract leads to __.
hyperprolactinemia (adverse effect)
The main dopamine receptor modulated by antipsychotics is the __.
dopamine 2 receptor
*An adequate trial of antipsychotics for Schizophrenia is generally defined as __ + __ + __.
compliance + at least 2-6wks + optimal therapeutic doses
*Clozapine should be considered for treatment resistant Schizophrenia. What defines ‘treatment resistant’?
failure of 2 or more adequate trials of different antipsychotics (at least 1 SGA)
Routine hematological monitoring is required for __ due to __.
patients on clozapine due to risk of agranulocytosis
Antipsychotics are to be used with caution in patients with cardiovascular disease due to __.
QTC prolongation (contraindication)
Antipsychotics are to be used with caution in __ due to EPSE.
patients with Parkinson’s Disease
Antipsychotics are to be used with caution in patients with blood dyscrasias, especially for __.
Clozapine
Antipsychotics are to be used with caution in __, due to increased risk (2-3x) for mortality and stroke.
Elderly patients with dementia
*In acute agitation (psychiatric emergency), what should be the treatment plan if the patient is cooperative?
Consider PO:
Lorazepam 1-2mg or
Antipsychotic i.e. risperidone 1-2mg
*In acute agitation (psychiatric emergency), what should be the treatment plan if the patient is uncooperative and remains agitated/aggressive?
Consider fast acting IM injection: Haloperidol 2.5-10mg /Lorazepam 1-2mg or both (common) Olanzapine (uncommon) Promethazine (sedating effect only) Aripriprazole (CHLOPA)
The use of haloperidol in acute agitation requires a __ which may be hard to do.
pre-treatment ECG
The concurrent use of __ and __ can lead to cardio-pulmonary collapse. Therefore, a lock out period of 1 hr in between use should be observed.
IM Olanzapine
IM Lorazepam
The use of __ is appropriate for a patient presenting with catatonia.
BZDs i.e. PO/IM Lorazepam
*For PO Haloperidol (serenance/haldol), state for adults:
The Usual starting dose
0.5-3mg BD/TDS or 3-5mg BD/TDS (severe symptoms)
*For PO Haloperidol (serenance/haldol), state for adults:
The Usual Dose range
5-15mg/day
*For PO Haloperidol (serenance/haldol), state for adults:
The Max dose
20mg/day
*For fast acting Haloperidol IM Injection, state for adults:
The Usual starting dose
2-5mg/dose
*For fast acting Haloperidol IM Injection, state for adults:
The Usual Dose range
2-10mg/dose/day
*For fast acting Haloperidol IM Injection, state for adults:
The Max dose
18mg/day
*For Clozapine (clozaril), state for adults:
The Usual Starting dose
12.5 MG on/bd (Day 1)
25-50 MG (day 2)
*increase gradually if well tolerated in steps of 25-50 mg/day
*For Clozapine, state for adults:
The Usual Dose range
200-450mg/day
*For Clozapine, state for adults:
The Max dose
900mg/day
*For Olanzapine, state for adults:
The Usual Starting dose
PO: 10 mg/day
IM: 2.5-10mg q2-4hrs, Max 3 doses/day.
*For Olanzapine, state for adults:
The Usual Dose range
5-20mg/day
*For Olanzapine, state for adults:
The Max dose
20mg/day
*For Quetiapine (seroquel), state for adults:
The Usual Starting dose
25 MG bd (Day 1), 50 MG bd (Day 2),
100 MG bd (Day 3), 150 MG bd (Day 4)
*For Quetiapine (seroquel), state for adults:
The Usual Dose range
150-500mg/day
*For Quetiapine (seroquel), state for adults:
The Max dose
800mg/day