Brainscape's Knowledge GenomeTM

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


See full index

Neurology > Schizophrenia and Other Psychotic Disorders > Flashcards

Schizophrenia and Other Psychotic Disorders Flashcards

1
Q

What are some positive symptoms?

A
  • Hallucinations
  • Paranoia
  • Delusions
  • Hostility
  • Disorganized speech
  • Ideas of reference
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some negative symptoms?

A
  • Affect
  • Alogia
  • Avolition
  • Asociality
  • Anhedonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Mesolimbic path of dopamine hypothesis

A
  • VTA–>
  • nucleus accumbens–>
  • D2 blockade–>
  • decrease in positive symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Mesocortical path of dopamine hypothesis

A
  • VTA–>
  • Prefrontal cortex–>
  • D2 blockade–>
  • Increase in negative symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Nigrostriatal path of dopamine hypothesis

A
  • SN–>
  • Basal ganglia–>
  • D2 blockade–>
  • Increase in EPS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Tuberoinfundibular path in dopamine hypothesis

A
  • Hypothalamus–>
  • Pituitary–>
  • D2 blockade
  • Increase in prolactin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some factors to consider when selecting a treatment?

A
  • Side effect profile
  • Past responses to treatment (symptom response and tolerability)
  • Physical health conditions that may be affected by medication side effects
  • Medication formulations
  • Drug-drug interactions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the antipsychotic treatment response in hours to days?

A
  • Agitation
  • Aggression
  • Motor activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the antipsychotic treatment response in 2 to 6 weeks?

A
  • Hallucinations
  • Disorganized thinking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the antipsychotic treatment response in months or longer?

A
  • Delusions
  • Negative symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the side effects of serotonin receptor antagonism?

A
  • Reduces EPS
  • Possibly improve cognition
  • Antidepressant properties
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the side effects of dopamine-D2 receptor antagonism?

A
  • Therapeutic effect
  • Extrapyramidal symptoms
  • Hyperprolactinemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the side effects of muscarinic-M1 receptor antagonism?

A
  • Anticholinergic effects (dry mouth)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some histamine-H1 receptor antagonism?

A
  • Sedation
  • Weight gain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the side effects of alpha 1 receptor antagonism?

A
  • Syncope
  • Orthostatic hypotension
  • Reflex tachycardia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some clinical pearls of haloperidol?

A

-IM:PO 1:2

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

What are some clinical pearls of fluphenazine?

A

-IM:PO 1:2
-Oral liquid should be diluted prior to use

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

What are some clinical pearls of chlorpromazine?

A

-Weight gain
-Sedation
-IM:PO 1:4

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

What are some clinical pearls of thiothixene?

A
  • Smoking may reduce levels (CYP1A2 induction)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are some clinical pearls of thioridazine?

A
  • Highest QTc prolongation risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some clinical pearls of trifluoperazine?

A
  • Smoking may reduce levels (CYP1A2)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the long-acting formulations of the first generation antipsychotics?

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

Dystonia

A
  • EPS symptoms
  • Within 24-96 hours of initiation
  • Involuntary muscle contraction resulting in slow repetitive movements or abnormal postures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the presentation of dystonia?

A
  • Facial grimacing
  • Involuntary upward eye movement
  • Muscle spasms of the tongue, face, neck, and back (back muscle spasms cause trunk to arch forward)
  • Laryngeal spasms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the risk factors of dystonia?

A
  • High potency antipsychotics
  • High antipsychotic dose
  • Young men
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the treatments of dystonia?

A
  • Diphenhydramine 25-50 mg IM/IV
  • Benztropine 1-2 mg IM/IV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Akathisia

A
  • EPS symptoms
  • Days to weeks
  • Inner motor restlessness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the presentations of akathisia?

A
  • Restlessness
  • Trouble standing still
  • Paces the floor
  • Feet in constant motion
  • Rocking back and forth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the risk factors of akathisia?

A
  • fast titration
  • middle-aged females
30
Q

What are the treatment options of akathisia?

A
  • Propranolol 20-120 mg/day
  • Anticholinergic agent
  • Benzodiazepine
31
Q

Pseudoparkinsonism

A
  • EPS symptoms
  • Days to weeks
  • Parkinsonian like symptoms
32
Q

What are the presentations of Pseudoparkinsonism?

A
  • Stooped posture
  • Shuffling gait
  • Rigidity
  • Bradykinesia
  • Tremors at rest
  • Pill-rolling motion of the hand
33
Q

What are some risk factors of pseudoparkinsonism?

A
  • High potency antipsychotics
  • High dose
  • Older age
  • Females
34
Q

What are some treatment options of pseudoparkinsonism?

A
  • Benztropine 1-6 mg/day or trihexyphenidyl 5-15 mg/day
  • Diphenhydramine 35-300 mg/day–> amantadine 100-400 mg/day
35
Q

Dyskinesia

A
  • EPS symptoms
  • Months to years
  • Rapid, repetitive involuntary movements
36
Q

What are some presentations of dyskinesia?

A
  • Protrusion and rolling of the tongue
  • Sucking and smacking movement of the lips
  • Chewing motion
  • Facial dyskinesia
  • Involuntary movements of the body and extremities
37
Q

What are some risk factors of dyskinesia?

A
  • Older age
  • Females
  • Other EPS especially early onset
  • Chemical abuse
  • Mood disorders
38
Q

What are some treatment options of dyskinesia?

A

VMAT inhibitors, switch to clozapine, pyridoxine 400-1200 mg/day

39
Q

What are some long acting injections of the second generation antipsychotics?

A
  • Aripiprazole
  • Olanzepine
  • Paliperidone
  • Risperidone
40
Q

What are some clinical pearls of Quetiapine?

A
  • XL formulation dosed once daily (IR dosed BID to TID)
  • XL formulation: < 300 calories
  • Sedation (XL formulation may assist)– take at bedtime
41
Q

What are some clinical pearls of Olanzepine?

A
  • High metabolic risk
  • Do not give IM olanzapine within 2-hours of IM lorazepam due to risk of cardiorespiratory depression and excessive sedation
  • Smoking (smoke hydrocarbons) induces CYP 1A2 metabolism by ~30%
42
Q

What are some clinical pearls of Risperidone?

A
  • Strong D2 affinity
  • Renal dose adjustments
    • CrCl 30-60 mL/min: 75% max dose
    • CrCl 10-30 mL/min: 50% max dose
    • CrCl < 10 mL/min: 25% of max dose
  • Hyperprolactinemia risk (gynecomastia, galactorrhea, amenorrhea, sexual dysfunction)
43
Q

What are the clinical pearls of paliperidone?

A
  • Active metabolite of risperidone
  • Renal dose adjustments
    • CrCl 50-80 mL/min: 6 mg/day
    • CrCl 10-50 mL/min: 3 mg/day
    • CrCl < 10 mL/min: avoid use
  • Hyperprolactinemia
  • Increased bioavailability when given with food
  • Ghost tablet (shell in stool)
44
Q

What are the clinical pearls of aripiprazole?

A
  • Activating at low doses
  • Low risk of weight gain
  • Dose adjustments for major CYP3A4/2D6
  • May assist in antipsychotic-induced hyperprolactinemia
45
Q

What are the clinical pearls of brexipiprazole?

A
  • Renal dose adjustment: max 3 mg if CrCl < 60 mL/min
  • Dose adjust in moderate/severe hepatic impairment
  • Dose adjustments for major CYP3A4/2D6 inhibitors
  • Treats in agitation associated with Alzheimer’s dementia
46
Q

What are the cariprazine?

A
  • Avoid in CrCl < 30 mL/min
  • Take with 350 calories
  • Dose adjustments for CrCl < 50 mL/min and hepatic impairment
  • Low weight gain risk
47
Q

What are the clinical pearls of ziprasidone?

A
  • Take with 500 calories
  • QT prolongation (particularly with IM formulation)
  • Low weight gain risk
48
Q

What are the clinical pearls of iloperidone?

A

Significant orthostasis – titrate by no more than 4 mg/day

49
Q

What are the clinical pearls of Pimavanserin?

A
  • Dosing 34 mg/day
  • Indication: Parkinson’s Disease
50
Q

What are the clinical pearls of Asenapine?

A
  • SL tablet: no food/drink for 10 minutes after taking
  • Contraindicated in severe hepatic impairment
51
Q

What are the clinical pearls of Lumateperone?

A
  • Only one dose available (42 mg)
  • Take with food
  • Dose adjustment in moderate/severe hepatic impairment (max 21 mg/day)
52
Q

What are criterias for metabolic syndrome:
* Waist circumference
* BP
* Fasting blood glucose
* HDL
* Triglycerides

A
  • Waist circumference:
    -M: > 40 inch
    -F: >35 inch
  • BP:
    - > or equal to 130/85
  • Fasting blood glucose:
    • > or equal to 110 mg/dL
  • HDL
    • M: < 40 mg/dL
    • F: < 50 mg/dL
  • Triglycerides
    • > or equal to 150 mg/dL
53
Q

What are the black box warnings of clozapine?

A
  • Severe neutropenia (REMS)
  • Seizure
  • Myocarditis
  • Orthostatic hypotension, bradycardia, syncope
  • Increased mortality in elderly patients with dementia-related psychosis
54
Q

What is the starting dose of clozapine?

A

12.5 mg once or twice daily

55
Q

How do you monitor clozapine?

A
  • Clozapine level: 350-500 ng/mL
  • Clozapine:norclozapine ratio
  • Measured as trough
56
Q

What are some REMS monitoring factors of Clozapine?

A
  • Absolute Neutrophil Count (ANC) ≥ 1500/uL before initiating
  • ≥ 1000/uL with benign ethnic neutropenia (BEN)/Duffy-null associated neutrophil count
  • Monitoring schedule: Weekly x 6 months; biweekly x 6 months; monthly
57
Q

Recommendation for mild neutropenia (1000- 1499) in clozapine

A
  • Monitor 3x/week
  • Resume normal schedule once ANC > 1500/uL
58
Q

Recommendation for moderate neutropenia (500-999) in clozapine

A
  • Interrupt therapy
  • Daily ANC until > 1000/uL (may resume), then 3x week until ANC ≥ 1500/uL
  • Return to previous monitoring interval when ANC > 1500/uL
59
Q

Recommendation for severe neutropenia (<500) in clozapine

A
  • Interrupt therapy
  • Daily ANC until > 1000/uL, then 3x week until ANC ≥ 1500/uL
  • Do NOT rechallenge unless prescriber determines benefit outweighs the risks
  • If rechallenged, resume treatment as new patient under ‘normal range’ monitoring once ANC ≥ 1500/uL
60
Q

What are some titration-dependent adverse effects of clozapine?

A
  • Orthostatic
  • Tachycardia
  • Sedation
  • Myocarditis
61
Q

What is the level/dose-dependent adverse effect?

A

Seizures

62
Q

What is the dose-independent adverse effects?

A
  • Sialorrhea
  • Constipation
  • Urinary incontinence
  • Seizures
63
Q

What is the treatment for sialorrhea?

A
  • Atropine eye drops SL
  • Ipratropium nasal spray SL
  • Glycopyrrolate, benztropine, clonidine
64
Q

What is the treatment of constipation?

A
  • Osmotic laxatives (Miralax)
  • Stimulant laxatives (Senna)
  • Stool softeners (Colace)
65
Q

What are the symptoms of Neuroleptic Malignant Syndrome (NMS)?

A
  • Fever
  • Lead-pipe rigidity
  • Mental status changes
  • Leukocytosis, elevated creatinine kinase, AST/ALT
66
Q

How do you manage Neuroleptic Malignant Syndrome?

A

Discontinue antipsychotic (for at least 2 weeks) –> No other psychotropic during 2-week time period (except benzodiazepines) –> Bromocriptine (Cycloset®) and dantrolene (Dantrium®)

67
Q

How do you treat psychotic agitation?

A
  • Haloperidol
  • Fluphenazine
  • Chlorpromazine
  • Olanzapine
  • Ziprasidone
68
Q

What are the pros of long-acting injectable antipsychotics (LAIA)?

A
  • Fewer medications to take daily
  • Fewer Cmax related events
  • Aware of nonadherence
  • Longer interventions windows
  • Continuous coverage
  • Closer follow-up
69
Q

What are the cons of long-acting injectable antipsychotics?

A
  • Limited dose titration
  • Time, logistics, cost
  • Fear of needles
  • Inability to change course
  • Concerns about side effects
70
Q

Haloperidol

A
  • Schizophrenia
  • Dose Frequency: every 4 weeks
  • Oral overlap/load:Decrease ½ daily dose every 3 weeks
    -NOT required if loaded
71
Q

Fluphenazine Decanoate (Prolixin)

A
  • Psychotic disorder
  • Dose frequency: Every 2-3 weeks
  • Dose Overlap/load: decrease 1/2 daily dose every 2 weeks

Neurology (21 decks)

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