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Psychiatric conditions > Schizophrenia/Psychosis > Flashcards

Schizophrenia/Psychosis Flashcards

1
Q

What neurotransmitters are believed to be involved in the cause Schizophrenia/Psychosis?

A

Dopamine (higher levels in Schizophrenia patients)

Glutamine

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2
Q

What are some Schizophrenia/Psychosis symptoms?

A

Hallucinations
Delusions
Disorganized thinking/behaviors

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3
Q

At what stage dose Schizophrenia/Psychosis symptoms emerge?

A

Young adulthood

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4
Q

What diagnosis tool is used?

A

Diagnostic and Statistical Manual or Mental Disorders, 5th Edition (DSM-5)

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5
Q

Name the 5 Extrapyramidal Side effects (EPS)

A

1) Dystonias
2) Akathisia
3) Parkinsonism
4) Tardive dyskinesias (TD)
5) Dyskinesias

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6
Q

What is Dystonias

A

A type of Extrapyramidal Side effects (EPS) symptom where there is a prolonged contraction of muscles

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7
Q

What is Akathisia

A

A type of Extrapyramidal Side effects (EPS) symptom where there is restlessness with anxiety and an inability to remain still

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8
Q

What is Parkinsonism

A

A type of Extrapyramidal Side effects (EPS) symptom where there is Parkinson’s like tremors

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9
Q

What is Tardive dyskinesias (TD)

A

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

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10
Q

What is Dyskinesias

A

A type of Extrapyramidal Side effects (EPS) symptom where there is abnormal movements more common with dopamine replacements for Parkinson disease

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11
Q

What are some Positive signs and symptoms of Schizophrenia?

A

Hallucination
Delusions
Disorganized thinking and behaviors

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12
Q

What are some Negative signs and symptoms of Schizophrenia?

A

Lack of emotion
Social withdrawal
Loss of motivation (Avolition)
Lack of speech (Alogia)

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13
Q

Why does positive symptoms of Psychosis occur in Parkinson’s patient?

Why is it so difficult to treat Psychosis in Parkinson’s patients?

A

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

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14
Q

What drug is approved for the treatment of Psychosis in patients with Parkinson’s disease?

A

Pimavanserin (Nuplazid)

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15
Q

Antipsychotic BBW

A

NOT indicated for agitation control in the elderly patients with dementia related psychosis due to risk of death

Increased risk of stroke

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16
Q

First generation Antipsychotic agents

A

Haloperidol

Fluphenazine
Prochlorperazine (Compazine); Used mostly as antiemetic

17
Q

Second generation Antipsychotic agents

A 
Aripiprazole (Abilify)
Clozapine (Cloraril)
Lorasidone (Latuda)
Olanzapine (Zyprexa)
Paliperidone (Invega)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Ziprasidone (Geodon)
18
Q

First generation Antipsychotic MOA

A

Block Dopamine (D2) receptors

19
Q

Second generation Antipsychotic MOA

A

Block Dopamine (D2) and Serotonin (5HT2A) receptors

20
Q

Second generation Antipsychotic ADE

A 
EPS (lower than 1st gens)
Metabolic effects (higher than 1st gen)
21
Q

First generation Antipsychotic ADE

A

EPS (higher than 1st gens)

Weight gain and Metabolic effects (lower than 1st gens)

22
Q

Which Antipsychotic has the lowest risk of EPS

A

Quetiapine

So recommended for patients with Parkinson’s disease

23
Q

Which Antipsychotic has the highest risk of EPS

A

Haloperidol
Risperidone
Paliperidone

24
Q

Which Antipsychotic has the lowest risk of Metabolic side effect

A

Haloperidol
Aripiprazole
Ziprasidone
Lurasidone

25
Q

Which Antipsychotic has the highest risk of Metabolic side effect

A

Clozapine
Olanzapine
Quetiapine

26
Q

Which Antipsychotic has the highest risk of QTc prolongation

A

Thioridazine
Haloperidol
Ziprasidone

27
Q

Which Antipsychotic has the highest risk of bleeding

A

Clozapine

28
Q

Which Antipsychotic has the highest risk of Cardiovascular even

A

Risperidone

29
Q

Which Antipsychotic has the highest risk of Seizure

A

Clozapine

30
Q

When should Clozapine be used

A

No sooner than 3rd line due to risk of agranulocytosis (low WBC)

31
Q

What is the REMS criteria to begin and continue taking Clozapine

A

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

32
Q

What is the drug approved for Tardive dyskinesias (TD)

and what is its ADE

A

Valbenazine (Ingrezza) PO

Somnolence and QTc prolongation

33
Q

What is Neuroleptic Malignant Syndrome

symptoms

Treatment

A

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

Psychiatric conditions (6 decks)

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