Schizophrenia/Psychosis Flashcards
What are common symptoms of schizophrenia
Hallucinations
Delusions
Disorganized thinking/behavior
What are the DSM-5 criteria for schizophrenia diagnosis
Delusions, hallucinations, or disorganized speech MUST be present
Negative s/sx: loss of interest, emotion, motivation, and ability to plan or carry out activities, poor hygiene, social withdrawal, and lack of speech
Positive s/sx: Hallucinations, delusions, disorganized thinking/behavior
What medications and illicit drugs can cause psychotic symptoms
Anticholinergics Dextromethorphan Dopamine or dopamine agonists Interferons Stimulants Systemic steroids Bath salts Cannabis Cocaine Lysergic acid diethylamide Methamphetamine Phencyclidine (PCP)
Which is preferred for schizophrenia – first or second generation antipsychotics? Why?
Second generation because first generation have a high incidence of EPS
What do extrapyramidal symptoms include?
Dystonias (muscle contractions)
Dyskinesias (abnormal movements)
Tardive dyskinesia (repetitive involuntary movements)
Akathisia (restlessness, inability to remain still)
Why should olanzapine and benzos not be given together?
Risk of excessive sedation and breathing difficulty
What medications are first-generation antipsychotics
Low potency: Chlorpromazine, thioridazine
Mid potency: Loxapine, perphenazine
High potency: haloperidol, fluphenazoine, thiothixene, trifluoperazine
First generation antipsychotics BBW, warnings, SE
BBW: do not use in elderly patients with dementia-related psychosis d/t increased risk of death from antipsychotics
Warnings: QT prolongation, anticholinergic effects, CNS depression, EPS, hyperprolactinemia, neuroleptic malignant syndrome
SE: Sedation, dizziness, anticholinergic effects, EPS
What can be given with first generation antipsychotics to limit/avoid dystonic reactions?
Anticholinergics (benztropine, diphenhydramine)
What medications are second-generation antipsychotics?
Aripiprazole (Abilify)
Clozapine (Clozaril)
Lurasidone (Latuda)
Olanzapine (Zyprexa)
Aripiprazole SE
Akathisia
Clozapine BBW, SE, monitoring
BBW: neutropenia/agranulocytosis (REMS), myocarditis and cardiomyopathy, seizures
SE: Agranulocytosis, seizures, constipation, metabolic syndrome
Monitoring ANC must be 1500 or higher to start and check ANC regularly – stop if <1000
Lurasidone SE
Somnolence, EPS (dystonias), nausea
Weight, lipid, and BG neutral
Olanzapine (Zyprexa) BBW and SE
BBW: monitor for 3 hours post injection
SE: Somnolence, metabolic syndrome
Paliperidone (Invega) SE
SE: increased prolactin, EPS, metabolic syndrome
Quetiapine (Seroquel) SE and notes
SE: somnolence, metabolic syndrome, low EPS risk
Notes: Take at night without food or with a light meal (300 cal or less)
Risperidone (Risperdal) SE
Increased prolactin, EPS, Metabolic syndrome
Ziprasidone (Geodon) CI
QT prolongation; do not use with QT risk
Take with food
Asenapine (Saphris – SL tab) SE and notes
SE: Tongue numbness; metallic taste
No food/drink for 10 mins after dose
What medications should not be chosen in someone with cardiac risk/QT risk?
QT prolonging meds (ziprasidone, haloperidol, thioridazone, chlorpromazine)
What medications should not be used in patients with a history of movement disorders (e.g. Parkinson disease?
Do not choose meds with EPS risk (first gen antipsychotics, risperidone, paliperidone)
Quetiapine is preferred
What medications should not be used in patients who are overweight or have metabolic risk?
Do not choose olanzapine or quetiapine
Lower risk with aripiprazole, ziprasidone, lurasidone, and asenapine – can choose these
What to give if a patient is having an acute psychosis episode and they are refusing oral meds?
Haloperidol IV or IM
Which second generation antipsychotic has a black box warning for QT prolongation?
Thioridazine
