Schizophrenia - Block 3 Flashcards
What is the dopamine theory of schizo?
Overactive dopaminergic system leads to psychosis
What are the dopamine major pathways that affect the brain?
Mesolimbic: positive symptoms - delusions, hallucinations, paranoia
Mesocortical: negative symptoms - social withdrawal
Nigrostriatal: EPS affecting movement
Tuberoinfundibular: Controls prolactin secretion
Describe the functions of dopamine excess and absense?
What are first gen antipsychotics?
- Haloperidol
- Thioridazine
- Chloropramazine
- Fluphenazine
What are SGA?
- Risperidone
- Clozapine
- Quetiapine
- Aripiprazole
- Ziprasidone
Differentiate the activity of FGA and SGA?
FGA: High potency for D2 antagonism
* Low anti-HAM
SGA: Low potency D2 antagonism
* Seratonin action
* Anti-ham
Differentiate the indication of FGA and SGA?
FGA: Better at treating positive sx than negative
SGA: Better at treating negative sx
Differentiate the ADRs of FGA and SGA?
FGA: EPS, hyperprolacteminemia, NMS< anticholinergic
SGA: weight gain, T2DM, argranulocytosis, sedation
What is the glutamate theory?
Glutamate is responsible for learning, memory, neuronal processing, and brain development
* deficiency -> schizophrenia
Positive sx?
- Hallucinations
- Delusions
- Paranoia/suspiciousness
- Conceptual disorganization
Negative sx?
- Blunted/flat affect
- Social withdrawal
- Lack of personal hygiene
- Prolonged time to respond
Cognitive sx?
- Poor executive function
- Impaired attention
- Impaired working memory (fail to learn from mistakes)
Drugs that causes schizo?
- Anticholinergics
- Dopamine agonist (requip, mirapex, sinemet)
- Dextromethorphan
- Systemic steroids
- AMphetamines
- Bath salts, cocaine, LSD, meth, PCP
Feelings of extreme suspicion, persecution or grandiosity, or a combination of these.
Paranoid schizophrenia
Incoherent thoughts, but no delusions?
Disorganized schizo
Withdrawal, negative affect and isolation and marked psychomotor disturbances?
Catatonic schizo
Delusions or hallucinations may go away, but motivation or interests in life is gone?
Residual schizo
Sx of both schizo and major mood disorder such as depression?
Schizoaffective disorder
How do you diagnose schizo?
DSMV: major sx - ≥2 of the following for at least 1 month (must have one of bolded)
* Delusions
* Hallucinations
* Disorganized speech
* Disorganized/catatonic behavior
* Negative sx
Must affect domains of life for at least 6 months
Describe the phases of schizo?
Prodromal: gradual development of sx that may go unnoticed
Acute: full-blown episode of psychotic behavior
Stabilization: Acute sx begin to decrease and phase may last for months
Stable: Declined sx nut nonpsychotic sx (ax and depression) may be present
What is the diagnostic process for identifiying schizo?
- Physical/lab exams can rule out med condition
- Rule out substance induced psychosis
- Imaging (CT, MRI, PET)
- History and mental status exam (MSE)
- no reliable biomarkers
What can you initiate for acute?
- Haloperidol
- Olanzipine
- Ziprasidone
What do you treat for stable?
- Pharm and CBT
- Adherence check
- Remission is rare (decrease s/s)
- Assess suicide risk
What are the tx options for schizo?
- typical AP
- Atypical
- AP injections
- Talking Treatments/Education/Support Groups/CBT
When would you see better outcomes in schizo tx?
The quicker we begin tx
How affective are the use of antipsychotics?
- Sleep disturbances and agitation in the first 2 days
- 6-8 weeks for full effects
- No sx relief 2-4 weeks use alternative or increase dose
- Multiple AP is not effective but increases the risk of side effects
AP BBW?
Increased mortality in elderly patients with dementia related psychosis
AP ADRs?
Sedation
Hypotension
Extrapyramidal
W eight gain
Anticholinergics
Sexual dysfunction
Metabolic changes
Endocrine (increased prolactin)
DA/5-HT and anti-HAM