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Psych: Schizophrenia > Schizophrenia: Overview & Treatment Options > Flashcards

Schizophrenia: Overview & Treatment Options Flashcards

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1
Q

Theories on pathophysiology of schizophrenia center on these neurotransmiters

A

dopamine

serotonin

glutamate

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2
Q

In addition to the 3 major neurotramsitters, what other imbalances are the focus of other theories?

A

aspartate

glycine

GABA

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3
Q

Dopamine receptor site most associated with schizophrenia symptoms

A

D2

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4
Q

The Four Dopominergic pathways implicated in schizophrenia

A

Mesocortical pathway

Nigrostriatal pathway

Mesolimbic pathway

Tuberoinfundibular pathway

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5
Q

A decrease or blockade of tuberoinfundibular dopamine results in ________, which in turn results in (3 things).

A

elevated prolactin levels

galactorrhea, ammenorrhea, and reduced libido.

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6
Q

nigrostriatal pathway location in the brain

A

originates in the substantia nigra and ends in the caudate nucleus.

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7
Q

Low dopamine in the nigrostriatal pathway are thought to affect….

A

the extrapyramidal system, leading to motor problems

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8
Q

Mesolimbic pathway location in the brain

A

extends from the ventral tegmental area to the limbic areas.

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9
Q

Mesolimbic pathway plays this role in schizophrenia

A

an excess of dopamine plays a role in positive symptomology

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10
Q

Mesocortical pathway location in the brain

A

extends from the VTA to the cortex

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11
Q

Low mesocortical dopamine levels are thought to cause

A

Negative symptoms and cognitive deficits in schizophrenia

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12
Q

tuberoinfundibular pathway location in the brain

A

projects from the hypothalamus to the pituitary gland

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13
Q

LSD stands for ____ and enhances this neurotransmitter in the brain leading to this new hypothesis for the development of schizophrenia

A

Lysergic Acid Diethylamide

Serotonin

Serotonin hypothesis

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14
Q

Compounds that block both Serotonin and Dopamine are effective in alleviating _____

A

both the positive and negative symptoms of schizophrenia

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15
Q

These two noncompetitive NMDA/glutamate antagonists induce schizophrenia like symptoms.

A

phenylciclidine & Ketamine

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16
Q

Phsyical brain changes in schizoprhenia

A

Increase in the size of third & lateral ventricles

smaller medial temporal lobe

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17
Q

Examples of obstetric complications that increase risk of schizoprhenia

A

bleeding during pregnancy
gestational diabetes
emergency C-section
asphyxia
low birth weight

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18
Q

Fetal disturbances during this trimester increase the risk of schizophrenia by how much? Give two examples linked to the risk increase.

A

2nd trimester

Double

Infections & excessive stress levels

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19
Q

Risk of illness in individuals with genetic relatives

A

10% for 1st degree relative

3% for 2nd degree relative

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20
Q

the risk of one twin having schizophrenia: monozygotic vs dizygotic

A

48% increase in monozygotic
12-14% dizygotic

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21
Q

If both parents have schizophrenia, % risk of having child with illness

A

40%

22
Q

Environmental stressors linked to schizophrenia

A

childhood trauma
minority ethnicity
residence in urban area
social isolation

23
Q

Social stressors predisposing individuals to delusional or paranoid thinking

A

discrimination
economic adversity

24
Q

Prevelance

A

0.6 - 1.9% in US population

25
Q

First episode onset (males vs women)

A

Males: early 20’s

Females: late 20’s, early 30’s

26
Q

Differential considerations

A

schizoaffective disorder (or other psychotic disorder)

depressive disorder with psychotic features

bipolar disorder with psychotic features

27
Q

Positive symptoms

A

Hallucinations
Delusions
abnormal motor behaviors

28
Q

Most common negative symptoms

A

diminished social expression (flattened affect)

avolition (decreased initiation of goal-directed behavior)

29
Q

Cognitive symptoms include:

A

disorganized speech, thought, or attention

30
Q

percentage of patients reporting favorable treatment outcomes

A

20%

31
Q

Persons with first-episode schizophrenia typically require (lower/higher dose) and are more sensitive to side effects such as _______ & ______________

A

lower antipsychotic doses

weight gain and extrapyramidal symptoms

32
Q

preferred for treatment of first-episode schizophrenia

A

Second-generation antipsychotics (SGAs)

33
Q

When should First Generation Antipsychotics be included in algorithm stages?

A

after first episode that include SGAs other than clozapine as options

34
Q

The recommended number of trials of other antipsychotics that should precede a clozapine trial is `

A

Two

35
Q

earlier use of clozapine should be considered in the presence of

A

suicidality, comorbid violence, and substance abuse

36
Q

Problem with augmentation agents in response to poor performance on clozapine

A

Reasonable, yet published results on augmenting agents have not identified replicable positive results

37
Q

Approaches for patients with treatment-resistant schizophrenia who are unable to tolerate clozapine or are not interested in pursuing a trial of clozapine

A

no benefit from high doses of antipsychotic medication

a trial of a different antipsychotic medication may be helpful

Augmentation treatment can also be considered,

38
Q

Risk of continuing with high doses of antipsychotic medication

A

treatment-related side effects are likely to be increased

39
Q

Should a trial of clozapine be delayed by multiple attempts at augmentation therapy?

A

No, remember the basic algorithm (1st 2 trials of SGA, then try Clozapine, then potential augmentation)

40
Q

Augmentation option for patients with negative symptoms or comorbid depression

A

Augmentation of antipsychotic therapy with an antidepressant medication

41
Q

Suggested in patients who exhibit catatonia

A

Use of a benzodiazepine, such as lorazepam

42
Q

Preferred response to if a patient experiences an exacerbation of symptoms while on a stable dose of medication

A

a reconsideration of the treatment plan is warranted rather than simply adding medications to the existing regimen

43
Q

The identification of treatment-resistant schizophrenia rests on

A

ONE: a diagnosis of schizophrenia

TWO: the persistence of significant symptoms despite adequate pharmacological treatment

44
Q

In identifying treatment-resistant schizophrenia, persistence of the illness is key: define persistence in this context.

A

symptoms be of at least 12 weeks’ duration in total,

be of at least moderate severity, and

be associated with at least moderate functional impairment as determined by validated rating scales

! If a prospective medication trial of at least 6 weeks at adequate dose has not led to symptom reduction of more than 20%, this provides additional evidence of treatment resistance !

45
Q

What criteria is needed for an “adequate” trial of medication?

A

at least two antipsychotic trials should be conducted
+ with different antipsychotic medications
+ at least 6 weeks at a therapeutic dosage of medication for each
+ adherence of at least 80% of prescribed dosages

46
Q

How may one assess adherence to medications?

A

measure antipsychotic blood level
pill counts, dispensing chart reviews, patient/carer reports

47
Q

If there is no significant improvement after several weeks of treatment this impacts the likelihood of substantial improvement how?

A

The likelihood of substantial improvement (e.g., > 50% improvement in symptoms) is small.

Longer trial of a medication may not be warranted

48
Q

A medication trial cannot be viewed as adequate if

A

Truncated in terms of duration or dosage because of poor tolerability

or

if limited by poor adherence

49
Q

Because treatment resistance is predicated on adherence to medication, experts suggest a trial of ___________before deciding that a patient’s symptoms are treatment-resistant.

A

an LAI antipsychotic medication (which reduces the likelihood an adherence issue)

50
Q

Appropriate moments to introduce Clozapine into treatment

A

After two adequate trials of another anti-psychotic medication

After a patient is identified as having treatment-resistant schizophrenia

If pt shows response to treatment (>20% reduction in symptoms) yet still have significant symptoms or impairments in functioning

[APA believes clozapine is often underused]

Psych: Schizophrenia (3 decks)

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