schizophrenia/psychotic do Flashcards
response to EPS fro 1st gen antipsychotic
lower dose, add anticholienergic or antiparkinsonian agent, switch to SGA
amantadine minimizes unpleasant SEs and may improve alliance
brain imaging in schizphrenia
primary auditory cortex involvement
activation of Heschl’s gyrus- PRIMARY AUDITORY CORTEX
overactivion of temporal parietal cortex. (during AHs)
smaller hippocampal volume
reduced vol in prefrontal, thalamic, hippocampal and superior temporal gyrus.
can see reduced blood flow in frontal lobes on MRI.
dopamine hypothesis
hyperdopaminergic in mesolimbic D2
HYPO in prefrontal D1 system
akathesia tx
beta blocker is choice, then anticholinergics, benzos, cyproheptadine
polydipsia is associated with
heavy cigarette use bc nicotine inc ADH, which fuels thirst
neuoleptic malignant syndrome
with antipsychotics, MC in young males
inc temp, BP, tachy, altered consciousness,
inc wbc, renal function
incidence of catatonia in pts hospitalized w schizophrenia
7-17%
better outcome predictors of schizophrenia
better premorbid history / functioning
longer untreated psychosis
negative or deficit state syndrome
Scale used is premorbid adjustment scale
GOOD PROGNOSIS requires two:
- sx within 4 weeks of first changes
- confusion at height of psychotic episode
- good premorbid functioning
- absence of flat affect
hypnogogic vs hypnopompic
gogic: GOING to sleep
pompic: waking up
most likely antipsychotics to cause seizures
clozapine
chlorpromazine
risk of schizophrenia in personal with sibling with dz
10% if sibling
5-6% if one parent has disease= 6X greater risk with parent
1% lifetime risk
monozygotic twin concordance rate: 40-50%
dizygotic twins: 10-15%
schizoaffective DO
mood sx for >50% of illness
hallucinations and delusions for 2 or more weeks in absence of mood episode
risk of post injection sedation syndrom for LA olanzapine`
0.07% per injection
tobacco smoke and clozapine
tobacco smoke induces CYP1A2 which metabolized clozapine
smoking patients need higher doses.
levels increase after quitting
environmental predisposition to schizophrenia
ambient temp
exposure to infectious agents
nutritional deficiencies
infections
maternal rubella
late-winter/early spring
birth
urban birth
irradiaiton in first trimester
prolonged labor
perinatal complications
family and social stressors
developed “paranoid schizoid position”
melanie klein
child views mom as all good or all bad.
can be in a depressive position, viewing mom as ambivalent
she developed childs play interpretative technique
Gene associated with schizophrenia
Chrom 22
microdeletions and velocardiofacial syndrome associated iwth 20-30x inc risk
"CATCH 22" cardiac abnormality (esp tetraology of fallot)
Abnormal facies (microcephaly, micrognathia)
Thymic aplasia
cleft palate
hypocalcemia/hypoparathyroidsm
clozapine MOA
antagonist of serotonin 5Ht2A, dopamine D1, d3, d4
and alpha receptors specifically alpha 1
cohort v crossover study v case control
cohort: follows group of similar individuals (cohort) without a disease over time to determine the risk of developing the disease
crossover study: longitudinal study in which subjects receive different treatments, typically so that all subjects receive the same exposures
case control: analyzes outcome and looks back in time to assess exposure
percentage of schizophrenia pts that relapse even while treated
40%
> 75% relapse after 5 years after discontinuing treatement following initial episode.
Benedict augustin hypothesis on schizophrenia
premature dementia
emil kraepelin helped distinguish schizophrenia from manic depressive
de clerambault syndrome
v
capgras syndrome
erotomania
belief that family member or close friend is not actually the same person and has been replaced by a body double.
antipsychotic associated with lower rates of Tardive dyskinesia
Geodon
waxy flexibility
v
catalepsy
waxy: tendency to remain in immobile posture
catalepsy: spontaneous maintenance of postures without reacting to stimuli ie sitting/standing for long periods of time
