schizophrenia and schizo-affective disorders Flashcards
schizophrenia definition
a long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.
positive and negative symptoms of schizophrenia
positive symptoms ADD to reality (hallucinations, delusions)
negative symptoms TAKE AWAY from reality (poverty of speech, poor eye contact, lack of interest/ ambivalence, poor grooming, social withdrawal, lack of insight)
hallucinations
auditory
visual
tactile
gustatory
olfactory
schizophrenia: paranoid specifier
Persecutory delusions/Auditory hallucinations
Anxiety
Suspiciousness
Hostility
Violent behavior
Few negative symptoms
Responsive to psychopharm treatment
planning/intervention in schizophrenia
Assess and monitor risk factors (safety)
Reduce stimuli
Provide distractions/ breaks
Discourage false beliefs without direct challenging
Identify precipitating stressors to hallucinations
Reinforce reality-not delusional network
medications for schizophrenia
Injectable antipsychotics
Short-acting
Long-acting
First-generation: haloperidol, fluphenazine decanoate
Second-generation: olanzapine pamoate, paliperidone palmitate
medications for schizophrenia part two Dopamine antagonists
The first-generation antipsychotics work by inhibiting dopaminergic neurotransmission; their effectiveness is best when they block about 72% of the D2 dopamine receptors in the brain. They also have noradrenergic, cholinergic, and histaminergic blocking action.
Target positive symptoms of schizophrenia
Advantage
Less expensive than second generation
Disadvantages
Extrapyramidal side effects (EPS)
Anticholinergic (ACh) side effects
Tardive dyskinesia
Weight gain, sexual dysfunction, endocrine disturbances
First Generation Antipsychotics (Loxapine and Prolixin)
Adasuve (loxapine)
acute treatment of agitation associated with schizophrenia or bipolar I disorder in adults
Inhaled
May cause bronchospasm
Monitor for respiratory distress
Contraindicated: asthma, chronic obstructive pulmonary disease, emphysema, or other pulmonary disease associated with bronchospasm
Fluphenazine (Prolixin)
used for the symptomatic management of psychosis in patients with schizophrenia
acts primarily through antagonism of postsynaptic dopamine-2 receptors in mesolimbic, nigrostriatal, and tuberoinfundibular neural pathways
Available: oral tablets, intramuscular injections for acute symptoms, and long-acting intramuscular or subcutaneous injections
Side effects: anticholinergic, EPS
contraindicated for use in patients with hepatobiliary disease or hepatic insufficiency as it can precipitate or worsen cholestatic jaundice
DC is ANC less than 1000
Black Box- CVA and death in elderly patients
Notable Extrapyramidal Side Effects
Acute dystonia: sudden, sustained contraction
Occurs within 48 hours (50%) or within 5 days (90%)
Akathisia: motor restlessness causing inability to stay still or remain in one place
Pseudoparkinsonism: temporary group of symptoms that resemble Parkinson’s disease
Tardive dyskinesia: involuntary rhythmic movements
Can be persistent
Haldol
Haloperidol (Haldol)- One of most commonly used in the world
used to manage positive symptoms of schizophrenia, such as hallucinations and delusions
exerts its antipsychotic action by blocking dopamine D2 receptors in the brain
noradrenergic, cholinergic, and histaminergic blocking action
Available: tablets and oral concentrate. It is also available in a nasal spray formulation. Haloperidol lactate is available in a short-acting parenteral solution injected intramuscularly. Haloperidol decanoate is available for long-acting intramuscular preparation
Cautious Use
With some SSRIs or benzodiazepines
Side Effects
EPS, anticholinergic, weight gain, tardive dyskinesia, NMS, falls
Contraindications
patients with Parkinson disease, dementia with Lewy body, comatose patients, in any condition with a severely depressed central nervous system (CNS). Since many drugs (barbiturates, benzodiazepines, and opioids) can cause depression in CNS, concurrent use of haloperidol should be avoided or used with great caution
Second Generation Anti-psychotics overview
Serotonin (5-HT2A receptor) and dopamine (D2 receptor) antagonists, e.g., clozapine (Clozaril)
Treat both positive and negative symptoms
Minimal to no EPS or tardive dyskinesia
Disadvantage—tendency to cause significant weight gain; risk of metabolic syndrome
Second generation antipsychotics
ae’s and common ones prescribed, contraindications
adverse effects of weight gain (10lbs over 10 weeks), hyperlipidemia, diabetes mellitus, QTc prolongation, extrapyramidal side effects, myocarditis, agranulocytosis, cataracts, and sexual side effects
metabolic syndrome with high blood sugar, hypertension, abnormal cholesterol, and triglyceride concentrations, posing a patient at risk for stroke, myocardial disease, and diabetes mellitus
common ones prescribed
clozapine (Clozaril)
lurasidone (Latuda)
olanzapine (Zyprexa)
paliperidone (Invega)
quetiapine (Seroquel)
Ziprasidone (Geodon
Contraindications
tardive dyskinesia, parkinsonism, and previous neuroleptic malignant syndrome
Monitor
Weight, ANC, A1C, cardiac hx
third generation antipsychotics overview
Really a subset of the SGAs
Aripiprazole (Abilify), brexpiprazole (Rexulti), and cariprazine (Vraylar)
Dopamine system stabilizers
characterized by an extended receptor profile, including DA and 5-HT receptor subtypes together with a significant partial agonism to D2/D3 and 5-HT1A receptors
May improve positive and negative symptoms and cognitive function
Little risk of EPS or tardive dyskinesia
**know abilify has a long half life, review it’s slide on moodle
Dangerous responses to antipsychotics: anticholinergic toxicity
Anticholinergic toxicity
Reduced or absent peristalsis (can lead to bowel obstruction); urinary retention; mydriasis; hyperpyrexia without diaphoresis (hot dry skin); delirium with tachycardia, unstable vital signs, agitation, disorientation, hallucinations, reduced responsiveness; worsening of psychotic symptoms; seizure; repetitive motor movements
Dangerous responses to antipsychotics: neuroleptic malignant syndrome
primary trigger for NMS is dopamine receptor blockade, most often due to an antipsychotic agent, starting or rapid withdrawal
Most cases in young adults and men
Life threatening
Severe muscle rigidity, dysphasia
Flexor-extensor posturing
Reduced or absent speech and movement
Decreased responsiveness.
Hyperpyrexia: temperature over 103°F
Autonomic dysfunction: hypertension, tachycardia, diaphoresis, incontinence
Delirium, stupor, coma
onset of symptoms is over 24 to 72 hours with increased temperature, severe muscular rigidity, confusion, agitation, elevation in white blood cell count, elevated creatinine phosphokinase concentrations, elevated liver enzymes, myoglobinuria, and acute renal failure
Many problems can mimic NMS
