Schizophrenia and Bipolar Flashcards
The most common cause of chronic psychosis
schizophrenia
Mental state in which the individual appears to have lost touch with reality
Psychosis
A belief not based on fact or reality
delusion
3 classes of symptoms seen in schizophrenia
- positive symptoms
- negative symptoms
- cognitive impairment
2 most consistent anatomical correlations to schizophrenia
- decreased brain volume (decreased brain volume)
2. enlarged ventricles
Area of the brain that is important in higher cognitive function and working memory and has decreased metabolic activity in schizophrenia
prefrontal cortex
First drug discovered to treat schizophrenia
chlorpromazine
Neurotransmitter most commonly associated with schizophrenia
dopamine
Antagonism at this receptor in the striatum is thought to increase striatal DA release and may help to counteract D2 blockade, theory for why SGAs have less EPS than FGAs
5HT2A receptor
Mechanism of antipsychotic drugs
D2 dopamine receptor antagonists
involuntary movements usually to the face and tongue but also to the trunk and limbs that develops after months to years of antipsychotic therapy and can be irreversible
tardive dyskinesia
A perception disturbance in sensory experiences of the environment
Hallucination
Brain system involved in the negative symptoms of schizophrenia
mesocortical
Drug that marked the transition the SGAs and differed from FGAs in its significant decrease in motor SEs
Clozapine
Assigning importance to things that aren’t important
aberrant salience
Antipsychotic that is a D2 receptor partial agonist and acts as a dopamine stabilizer
aripiprazole
Antipsychotic that has proven to be superior in treatment resistant patients
clozapine
A person diagnosed with schizophrenia must have at least 2 of the following 3 things
- delusions
- hallucinations
- disorganized speech
Length of symptoms needed for diagnosis of schizophrenia
6 months
2 low potency SGAs
- clozapine
2. quetiapine
Inhibition of these 2 receptors is thought to be lead to weight gain associated with antipsychotics
H1 and 5HT2C
Diagnosis of symptoms of schizophrenia have occurred for less than 6 months
schizophreniform disorder
schizophrenia + bipolar disorder
schizoaffective disorder
Symptom of psychosis that responds best to medications
hallucinations
Most common form of hallucination
auditory
minimum length of antipsycholic drug therapy for schizophrenia
1-2 years, usually lifelong
3 medium potency FGAs
- loxapine
- perphenazine
- thiothixene
3 extrapyrimidal SEs that result from disruption of DA signaling in the substantia nigra to the striatum, important for motor function
- akathisia (uncontrollable restlessness)
- dystonia (involuntary movements)
- parkinsonism (bradykinesia, tremor)
4 medications that can be used adjunctively in schizophrenia if aggression or hostility is present
lamotrigine, divalproex, topiramate, lithium
2 characteristics of drugs that have the highest risk of movement disorders
- high potency
2. slow dissociation (most FGAs)
SGA that has the highest risk of akathisia
aripiprazole
antagonism at this receptor results in side effects such as blurred vision, urinary retention, dry mouth, and constipation
M1
Antagonism at this receptor leads to sedation SE of antipsychotics
H1
3 high potency FGAs
- trifluoperazine
- fluphenazine
- haloperidol
The most activating antipsychotic (take in the morning)
aripiprazole
Potency of meds that have the most anticolinergic SEs and sedation
low potency
antagonism of this receptor results in hypotension SE of antipsychotics
alpha-1
antipsychotics that have the highest risk of hypotension
low potency and lloperidone
Minimum time needed to see full effect of antipsychotics
12 weeks
Antipsychotics that have the highest risk of hyperprolactinemia
FGAs and risperidone/paliperidone
3 receptors that are involved in metabolic issues associated with SGAs
5HT2C, M3 and H1
2 SGAs that have the highest risk of Torsades de Pointes
- ziprasidone
2. Iloperidone
Symptoms of schizophrenia that are new mental phenomena which unaffected people do not normally experience (hallucinations, delusions)
Positive symptoms
2 SGAs that have the highest risk of metabolic issues
- clozapine
2. olanzapine
5 SGAs that have intermediate risk of metabolic issues
quetiapine, risperidone, paliperidone, Iloperidone, asenapine
3 most important antipsychotics to not abruptly discontinue
- clozapine
- quetiapine
- Ilperidone
FGA that has an intermediate risk of metabolic issues
chlorpromazine
3 SGAs that have a low risk of metabolic SEs
ziprasidone, lurasidone, aripiprazole
All FGAs have a higher risk of Torsades de Pointes than SGAs but this FGA has the highest risk
Thioridazine
3 antipsychotics included in FDA warning for increased incidence of stroke in elderly patients with dementia
- risperidone
- olanzapine
- aripiprazole
Dietary restriction with ziprasidone
take with at least 500 calories
4 drug characteristics that lead to increased risk of neuroleptic malignant syndrome
- high dose
- high potency
- IV
- dehydration
Antipsychotic that has the highest risk of seizures
clozapine
4 SEs that clozapine has the highest incidence of
- metabolic changes
- sedation
- constipation
- sialorrhea (drooling)
Antipsychotic that has the lowest risk of seizures
Quetiapine
2 SEs that clozapine has the lowest incidence of
- movement disorders
2. NMS
2 drugs that can be used IM to treat dystonia
- benztropine
2. benadryl
Antipsychotic that is technically a FGA but has some 5HT2A activity and is often used in children
loxapine
Rare but life-threatening SE of antipsychotics that involves fever, encephalopathy, unstable vitals, elevated enzymes and muscle rigidity
Neuroleptic malignant syndrome
Schedule for CBC monitoring with clozapine
weekly for 6 months, then every 2 weeks for 6 months then monthly thereafter
2 antipsychotics that are long acting injections given every 1-4 weeks and are good for poor adherance
- fluphenazine decanoate
2. haloperidol decanoate
A potentially fatal drop in WBC associated with clozapine
agranulocytosis
Enzyme that tobacco induces and cloazpine is a substrate
CYP1A2
5 black-box warnings for clozapine
- agranulocytosis
- seizures
- myocarditis
- orthostasis
- antipsychotics in elderly
Dietary restriction with asenapine
no food or drink for 10-15 minutes
Brain system involved in the positive symptoms of schizophrenia
mesolimbic
Dietary restriction with lurasidone
take with at least 350 calories
2 low potency FGAs
- chlorpromazine
2. thioridazine
2 high potency SGAs
- risperidone
2. paliperidone
Symptoms of mania but less severe and episodes are not severe enough to cause marked impairment
hypomanic episode
Symptoms of schizophrenia in which the individual has a loss of normal mental functions (amotivation, social withdraw)
Negative symptoms
Route of elimination of lithium
kidney
therapeutic window of lithium
0.6-1.5 mM
Cation that lithium mimics in excitable tissues
Na+
Neurotransmitters whose release is inhibited by lithium
NE and DA
Second messenger created via PIP2 hydrolysis that activates calcium release from intracellular stores
IP3
Manic episode + major depressive episode
Bipolar I disorder
Duration of time in which a persistently elevated, expansive or irritable mood must occur to classify as a manic episode
7 days, but if hospitalization is required there is no minimum duration
4 AEDs that can be used in the management of bipolar disorder
Valproic acid, lamotrigine, carbamazepine, oxcarbazine
Only medication used in bipolar disorder that is truly a mood stabilizer
Lithium
Time required to see initial response in treatment of acute manic episode (see improvements in sleep and agitation first)
7-14 days
SE that is the reason why lamotrigine must be titrated slowly
Stephen-Johnson syndrome
Order of increasing risk of mood switch for antidepressants
Bupropion < SSRIs < Venlafaxine < MAOIs < TCAs
5 drugs that are not recommended as monotherapy for bipolar mania
- Gabapentin
- Lamotrigine
- Tiagabine
- Topiramate
- Verapamil
EKG abnormality seen with lithium toxicity
flat or inverted T waves
Amount of time that the acute phase lasts for bipolar disorder
sustained response >4 weeks
Time required to see full response in treatment of an acute manic episode
4-8 weeks
Second messenger generated via hydrolysis of PIP2 that activates protein kinase C
DAG
The most effective agent for classic euphoric mania
Lithium
3 SGAs that are both anti-manic and anti-depressive
- Quetiapine
- Lurasidone
- Olanzapine + fluoxatine
AED that has mostly anti-depressant effects and should not be used as monotherapy for manic episodes
Lamotrigine
Amount of time the continuation phase lasts in bipolar depression treatment
full response for 4-6 months
6 medications that have FDA approval for prevention of recurrence of bipolar disorder
- Lithium
- Lamotrigine
- Olanzapine
- Aripiprazole
- Risperdal consta
- ziprasidone (adjunct)
5 medications that are not recommended for monotherapy in bipolar depression
- Gabapentin
- Aripiprazole
- Ziprasidone
- Parozetine
- Levetiracitam
Drug class that tends to be best for disphoric mania
AEDs
Hypomania + major depressive episode
Bipolar II disorder
How often a patient on antipsychotic therapy should get an AIMS (abnormal involuntary movement scale) assessment
At baseline and every 6 months
How often a patient on anti psychotic therapy needs to get a lipid panel and glucose checked
every 3 months