Schizophrenia and Psychotic Disorders

Question 1

Epidemiology of Schizo

Answer 1

Onset is early adulthood, usually younger in males than in females
No racial differences
Genetic link
Early brain viruses
Autoimmune comorbidities

Question 2

Affected neurotransmitters

Answer 2

DA
SR
Glu
GABA

Question 3

DSM 4 Dx Criteria

Answer 3

2 or more of the following for at least 6 months: hallucinations, delusions, disorganized speech, negative sx
Not explained by drug or comorbidity

Question 4

Brain abnormalities in Schizo

Answer 4

Larger ventricles due to reduction in brain size

Smaller hippocampus

Question 5

Initial presentation

Answer 5

Positive sx and prodrome of negative sx

Question 6

Schizo and Life Expectancy

Answer 6

Reduced by 20-30 years due to high suicide rate, self-medicating/substance abuse and poor hygeine

Question 7

Positive Sx

Answer 7

Hallucinations
Delusions
Disorganized Speech

Question 8

Negative Sx

Answer 8

Asociality
Alogia - poor speech
Avolition
Anhedonia

Question 9

Cognitive Sx

Answer 9

Impaired speech, memory, learning

Question 10

Therapeutic Goals

Answer 10

Acute Phase
Stabilization Phase
Maintenance Phase

Question 11

General Pathology of Psychosis

Answer 11

Hyperstimulation, especially of dopamine receptors

Question 12

First Antipsychotic

Answer 12

Chlorpromazine

Question 13

Typical Antipsychotic Classes

Answer 13

Phenothiazines
Thioxanthenes
Butyrophenones

Question 14

Side Effects of FGAs

Answer 14

DA2 - EPS
Anti-histamine - alpha 1
Anticholinergic - alpha 1
Weight gain
Cadiac arrhythmias

Question 15

Phenothiazines vs Butyrophenones

Answer 15

Haldol&raquo_space;> EPS&raquo_space;>phenothiazenes

Question 16

DA Hypothesis

Answer 16

Too much DA stimulation

Question 17

Antipsychotic and DA receptor block (D1 vs D2)

Answer 17

D1 - cAMP inhibition

D2 - potency and clinical response + EPS

Question 18

Modified DA Hypothesis

Answer 18

Low DA in mesocortical pathway

High DA in mesolimbic pathway

Question 19

Other Neurotransmitter hypotheses

Answer 19

NMDA and Glu

SR

Question 20

SGAs

Answer 20

Block 1+ receptor
Less EPS
Treats + and - sx
>affinity for SR receptors than DA

Question 21

Abilify MOA

Answer 21

Partial DA agonis
Agonist of presynaptic receptors (where DA is low)
Antagonist of postsynaptic receptors (where DA is high)
Partial SR agonist!

Question 22

ADME of Antipsychotics

Answer 22

A: readily, but not completely absorbed
D: High Vd, highly lipophilic and distributed into fat (this affects weaning/transitioning)
M: Extensive first pass (> age = < fx = < dose)
E: Half life 12-2h = QD dosing

Question 23

D2 antagonism

Answer 23

EPS

Question 24

5HT 2a

Answer 24

Attenuate EPS

Question 25

5HT 2c

Answer 25

Attentuate prolactin

Question 26

5HT 3

Answer 26

Anti-emetic

Question 27

Alpha 1

Answer 27

Sedation, hypotension

Question 28

Alpha 2

Answer 28

Depression and negative sx

Question 29

H1

Answer 29

Sedation, anti-histamine

Question 30

m1

Answer 30

Anticholinergic

Question 31

When is sedation most common? With what drugs?

Answer 31

Low potency drugs

Usually due to histamine activity

Question 32

Acute dystonia

Answer 32

Involuntary muscle spasms in neck
High/rapid dose of antipsychotic
Give Benadryl

Question 33

Akathisia

Answer 33

Restless leg

Cogentin or benadryl

Question 34

Parkinsonism

Answer 34

Parkinson-like movements

Cogentin or benadryl

Question 35

Tardive Dyskinesia

Answer 35

Irreversible jerky movements

Reduce or d/c dose

Question 36

Neuroleptic Malignant Syndrome

Answer 36

Rare but occurs more in younger males
Muscular rigidity, fever, SEVERE EPS
Supportive treatment