Schizophrenia/Psychosis Flashcards
What neurotransmitters are believed to be involved in the cause Schizophrenia/Psychosis?
Dopamine (higher levels in Schizophrenia patients)
Glutamine
What are some Schizophrenia/Psychosis symptoms?
Hallucinations
Delusions
Disorganized thinking/behaviors
At what stage dose Schizophrenia/Psychosis symptoms emerge?
Young adulthood
What diagnosis tool is used?
Diagnostic and Statistical Manual or Mental Disorders, 5th Edition (DSM-5)
Name the 5 Extrapyramidal Side effects (EPS)
1) Dystonias
2) Akathisia
3) Parkinsonism
4) Tardive dyskinesias (TD)
5) Dyskinesias
What is Dystonias
A type of Extrapyramidal Side effects (EPS) symptom where there is a prolonged contraction of muscles
What is Akathisia
A type of Extrapyramidal Side effects (EPS) symptom where there is restlessness with anxiety and an inability to remain still
What is Parkinsonism
A type of Extrapyramidal Side effects (EPS) symptom where there is Parkinson’s like tremors
What is Tardive dyskinesias (TD)
A type of Extrapyramidal Side effects (EPS) symptom where there is abnormal facial movement primarily in the tongue or mouth
Irreversible
Med should be stopped ASAP
What is Dyskinesias
A type of Extrapyramidal Side effects (EPS) symptom where there is abnormal movements more common with dopamine replacements for Parkinson disease
What are some Positive signs and symptoms of Schizophrenia?
Hallucination
Delusions
Disorganized thinking and behaviors
What are some Negative signs and symptoms of Schizophrenia?
Lack of emotion
Social withdrawal
Loss of motivation (Avolition)
Lack of speech (Alogia)
Why does positive symptoms of Psychosis occur in Parkinson’s patient?
Why is it so difficult to treat Psychosis in Parkinson’s patients?
Parkinson’s patient have movement symptoms because of lack of Dopamine in the brain. Parkinson’s treatment drugs therefore increase the Dopamine level in the brain which unfortunately can also cause hallucinations and delusions.
Treatment of psychosis in Parkinson’s patient is difficult because most antipsychotic meds decrease Dopamine
Parkinson’s disease due to low Dopamine
Parkinson’s drugs increase Dopamine
Psychosis due to high Dopamine
Psychosis drugs decrease Dopamine
What drug is approved for the treatment of Psychosis in patients with Parkinson’s disease?
Pimavanserin (Nuplazid)
Antipsychotic BBW
NOT indicated for agitation control in the elderly patients with dementia related psychosis due to risk of death
Increased risk of stroke
First generation Antipsychotic agents
Haloperidol
Fluphenazine
Prochlorperazine (Compazine); Used mostly as antiemetic
Second generation Antipsychotic agents
Aripiprazole (Abilify) Clozapine (Cloraril) Lorasidone (Latuda) Olanzapine (Zyprexa) Paliperidone (Invega) Quetiapine (Seroquel) Risperidone (Risperdal) Ziprasidone (Geodon)
First generation Antipsychotic MOA
Block Dopamine (D2) receptors
Second generation Antipsychotic MOA
Block Dopamine (D2) and Serotonin (5HT2A) receptors
Second generation Antipsychotic ADE
EPS (lower than 1st gens) Metabolic effects (higher than 1st gen)
First generation Antipsychotic ADE
EPS (higher than 1st gens)
Weight gain and Metabolic effects (lower than 1st gens)
Which Antipsychotic has the lowest risk of EPS
Quetiapine
So recommended for patients with Parkinson’s disease
Which Antipsychotic has the highest risk of EPS
Haloperidol
Risperidone
Paliperidone
Which Antipsychotic has the lowest risk of Metabolic side effect
Haloperidol
Aripiprazole
Ziprasidone
Lurasidone
Which Antipsychotic has the highest risk of Metabolic side effect
Clozapine
Olanzapine
Quetiapine
Which Antipsychotic has the highest risk of QTc prolongation
Thioridazine
Haloperidol
Ziprasidone
Which Antipsychotic has the highest risk of bleeding
Clozapine
Which Antipsychotic has the highest risk of Cardiovascular even
Risperidone
Which Antipsychotic has the highest risk of Seizure
Clozapine
When should Clozapine be used
No sooner than 3rd line due to risk of agranulocytosis (low WBC)
What is the REMS criteria to begin and continue taking Clozapine
Baseline ANC must be ≥ 1,500/mm3
ANC check
- weekly for 6 months then
- every 2 week for 6 months then
- monthly
STOP med if ANC is < 1,000/mm3
What is the drug approved for Tardive dyskinesias (TD)
and what is its ADE
Valbenazine (Ingrezza) PO
Somnolence and QTc prolongation
What is Neuroleptic Malignant Syndrome
symptoms
Treatment
It is a rare but highly lethal occurrence most commonly caused by 1st generation antipsychotics due to D2 blockade.
Hyperthermia
Muscle rigidity
Taper off the antipsychotic med fast
Supportive care
Benzos or Dantrolene for muscle relaxation
