Schizophrenia/Psychosis Flashcards
What are the POSITIVE symptoms of Schizo?
1) Hallucinations
2) Delusions
3) Disorganized thinking and behavior
What are the NEGATIVE symptoms of Schizo?
1) Flat affect, anhedonia (no interest), avolition (no motivation), alogia (speech deficit)
2) Withdrawal
These symptoms are harder to treat!
Which class of antipsychotics are used as first-line agents?
Second-generation antipsychotics (SGA) since thy have a lower risk of extrapyramidal side effects.
Long Acting Injections (Antipsychotic)
1) Risperdal Consta (q2weeks) - Risperidone
2) Haldol Decanoate (q4weeks) - Haloperidol
3) Invega Sustenna (q4 weeks) - Paliperidone
4) Abilify Maintena (q4weeks) - Aripiprazole
5) Invega Trinza (q3months) - Paliperidone
Fasting-Acting injections (Antipsychotics)
1) Haloperidol
2) Fluphenazine
3) Zyprexa (Olanzapine)
4) Geodon (Ziprasidone)
Orally disintegrating tablets (ODT Antipsychotics)
1) Abilify discmelt
2) Clozapine Fazaclo
3) Risperdal M-Tab
4) Zyprexa Zydis
5) Saphris (sublingual)
What is the boxed warning for Clozapine?
1) Severe Neutropenia (Start only if ANC > 1500, d/c if ANC < 1000) - monitor q6mths
2) Seizures - dose related
3) Myocarditis and Cardiomyopathy
*You can only start clozapine if the patient failed 2 prior antipsychotics
Antipsychotics with the most QT Prolongation risk
Ziprasidone > Haloperidol > Thioridazine
*dose related too
How do first generation antipsychotics work?
First generation antipsychotics work mainly by blocking dopamine receptors and minimal serotonin receptor blockade.
What are the first-generation antipsychotics?
1) Thioridazine
2) Thiothixene
3) Trifluoperazine
4) Fluphenazine
5) Perphenazine
6) Chlorpromazine
7) Loxapine
8) Haloperidol (Haldol)
What are the Extrapyramidal Side Effects (EPS)?
These are a group of side effects related to irregular movements
1) Dyskinesia (Abnormal movements) - main side effects of Levadopa and Parkinsons drugs
2) Dystonia (Parkinson’s disease and first-generation antipsychotics) - this is the prolonged contraction of muscles during drug initiation, including painful muscle spasms.
3) Tardive Dyskinesia - abnormal facial movements, primarily in the tongue or mouth. This can be irreversible. Must stop the drug and replace with a SGA with low EPS risk. (E.g Quetiapine, Clozapine). E.g lip smacking, weird grimaces
4) Akathisia - restlessness with anxiety and an inability to remain still. Treated with benzodiazepines or propanolol.
What are the Warnings of FGA?
1) CV: QT Prolongation, Falls
2) CNS Depression
3) EPS
4) Hyperprolactinemia
What are the main side effects of FGA?
1) Sedation
2) Dizziness
3) Anticholinergic Side Effects (Constipation, Xerostomia, blurred vision, urinary retention)
4) EPS
5) Increase in Prolactin
How do Second Generation Antipsychotics (SGA) work?
These block dopamine (D2) and serotonin receptors.
What are the SGA medications?
1) Aripiprazole (Abilify)
2) Brexpiprazole
3) Clozapine (Clozaril)
4) Lurasidone (Latuda)
5) Olanzapine (Zyprexa)
6) Paliperidone (Invega)
7) Quetiapine (Seroquel)
8) Risperidone (Risperdal)
9) Ziprazidone (Geodon)
10) Asenapine
11) Cariprazine
12) Iloperidone
13) Lumateperone
