Schizophrenia and Psychotic Disorders Flashcards
Schizophrenia
Essentially, schizophrenia can be described as a debilitating disease of neuronal connectivity and function in which patients experience and interpret reality abnormally
What are some positive symptoms?
- Hallucinations
- Delusions
- Disorganized
What are some negative symptoms?
- Affective flattening: lack of emotional expression
- Anhedonia: lack of pleasure
- Avolition: inability to start or follow through with activities
- Alogia: poverty of speech and lack of speech content
- Attentional impairment
Cognitive symptoms
- Impaired memory
- Learning
- Verbal fluency
- Motor speed
What are the therapeutic goals of the acute phase?
Reduce acute sx and reduce threat to self or others
What are the therapeutic goals of the stabilization phase?
- Minimize/prevent sx relapse
- Optimize therapeutic dose; minimize side effects
What are the therapeutic goals of the maintenance phase?
- Improve functioning and quality of life
- Monitor for prodrome and adverse effects
- Promote medication compliance
Schizoaffective Disorder
Sx of schizophrenia and a mood disorder (e.g., mania, depression, mixed)
Schizophreniform Disorder
Schizophrenic symptoms for greater than one month but less than 6 months
Brief Psychotic Disorder
Significant stress may have led to psychotic episode
When was the first antipsychotic discovered?
1952
What are the classical (typical or first generation) antipsychotic?
- Phenothiazines
- Thioxanthenes
- Butyrophenones
Chlorpromazepine (Thorazine)
- FGA
- Significant central and peripheral alpha 1 adrenergic blockade –> sedation and hypotension
- Significant extrapyramidal side effects due to dopamine D2 receptor blockade in basal ganglia
What is the dose of Chlorpromazine?
200-900 mg/day
Haldol
- Butyrophenones
- Significant extrapyramidal side effects
What is the dose of the haloperidol?
5-40 mg/day (high potency)
Hallucinogens
- LSD and mescaline
- Serotonin receptor (i.e., 5-HT 2A receptor) agonists
T/F: Some atypical antipsychotics like clozapine are inverse agonists at the 5-HT2A receptor
T
SGA
- Block more than one type of receptor
- Greater affinity for serotonin receptors than dopamine receptors
- Alleviates more negative symptoms
- Less movement disorders with these agents
Abilify
- Third generation
- Acts as a partial agonist at D2 receptors rather than an antagonist
- Partial agonist at 5HT1A receptors and antagonist at 5HT-2A receptors
What are the side effects of antipsychotics?
- EPS (Parkinsonism, distonias, TD)
- Metabolic (weight gain, hyperglycemia, DM)
- Cardiac (QT prolongation)
- Endocrine (Hyperprolactinemia)
- Adrenergic (Orthostatic hypotension)
- Anticholinergic
- Antihistaminergic (sedation, weight gain)
- Akathisia (Feeling of internal restlessness)
- Neuroleptic Malignant Syndrome (muscular rigidity, fever, severe EPS)
What are the side effects of chlorpromazine?
- Dyslipidemia
- Weight gain/T2DM
- Anticholinergic effects
- Orthostatic hypotension
- QTC prolongation
What are the side effects of haloperidol?
- EPS/TD
- Elevated prolactin
What are the side effects of fluphenazine?
- EPS/TD
- Elevated prolactin
What are the side effects of Olanzpine?
- Dyslipidemia
- Weight gain/T2DM
What are the side effects of paliperidone?
- EPS/TD
- Weight gain/T2DM
- Elevated prolactin
What are the side effects of Quetiapine?
- Dyslipidemia
- Weight gain/T2DM
What are the side effects of Risperidone?
- EPS/TD
- Weight gain/T2DM
- Elevated prolactin
What are the side effects of the ziprasidone?
- QTC prolongation
What are the side effects of clozapine?
- Dyslipidemia
- Weight gain/T2DM
- Anticholinergic effects
- Orthostatic hypotension
