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Board Studying. > schizophrenia/psychotic do > Flashcards

schizophrenia/psychotic do Flashcards

1
Q

response to EPS fro 1st gen antipsychotic

A

lower dose, add anticholienergic or antiparkinsonian agent, switch to SGA

amantadine minimizes unpleasant SEs and may improve alliance

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2
Q

brain imaging in schizphrenia

A

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.

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3
Q

dopamine hypothesis

A

hyperdopaminergic in mesolimbic D2

HYPO in prefrontal D1 system

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4
Q

akathesia tx

A

beta blocker is choice, then anticholinergics, benzos, cyproheptadine

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5
Q

polydipsia is associated with

A

heavy cigarette use bc nicotine inc ADH, which fuels thirst

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6
Q

neuoleptic malignant syndrome

A

with antipsychotics, MC in young males

inc temp, BP, tachy, altered consciousness,
inc wbc, renal function

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7
Q

incidence of catatonia in pts hospitalized w schizophrenia

A

7-17%

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8
Q

better outcome predictors of schizophrenia

A

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
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9
Q

hypnogogic vs hypnopompic

A

gogic: GOING to sleep
pompic: waking up

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10
Q

most likely antipsychotics to cause seizures

A

clozapine

chlorpromazine

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11
Q

risk of schizophrenia in personal with sibling with dz

A

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%

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12
Q

schizoaffective DO

A

mood sx for >50% of illness

hallucinations and delusions for 2 or more weeks in absence of mood episode

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13
Q

risk of post injection sedation syndrom for LA olanzapine`

A

0.07% per injection

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14
Q

tobacco smoke and clozapine

A

tobacco smoke induces CYP1A2 which metabolized clozapine

smoking patients need higher doses.

levels increase after quitting

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15
Q

environmental predisposition to schizophrenia

A

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

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16
Q

developed “paranoid schizoid position”

A

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

17
Q

Gene associated with schizophrenia

A

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

18
Q

clozapine MOA

A

antagonist of serotonin 5Ht2A, dopamine D1, d3, d4

and alpha receptors specifically alpha 1

19
Q

cohort v crossover study v case control

A

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

20
Q

percentage of schizophrenia pts that relapse even while treated

A

40%

> 75% relapse after 5 years after discontinuing treatement following initial episode.

21
Q

Benedict augustin hypothesis on schizophrenia

A

premature dementia

emil kraepelin helped distinguish schizophrenia from manic depressive

22
Q

de clerambault syndrome

v

capgras syndrome

A

erotomania

belief that family member or close friend is not actually the same person and has been replaced by a body double.

23
Q

antipsychotic associated with lower rates of Tardive dyskinesia

A

Geodon

24
Q

waxy flexibility

v

catalepsy

A

waxy: tendency to remain in immobile posture
catalepsy: spontaneous maintenance of postures without reacting to stimuli ie sitting/standing for long periods of time

25
Q

lower risk of TD and EPS compared to other antipsychotics

A

clozapine

26
Q

nicotinic receptors and schizophrenia

A

nicotinic acetylcholine receptors are decreased in hippocampus and neocortex.

cholinergic neurons are imp for attention, learning and memory

people with Alzheimer’s have low level of ACh in cerebral cortex

27
Q

TMS treats what in schizophrenia

A

hallucinations

28
Q

lowest risk of anticholinergic SEs

A

haldol

29
Q

CT of schizophrenia

A

enlarged ventricles

median increase in ventricular vol of 40%

decreased overall vol of brain - including prefrontal and medial temporal structures, lateral temporal cortex, thalamus

30
Q

jacob kasanin

A

schizoaffective DO

31
Q

NMS

A 
fever
muscle rigidity
hyperthermia
AMS
autonomic dysfunction
32
Q

TEOSS study

A

pediatric patients with schizophrenia and schizoaffective

no difference in response liklihood b/w molindone, olanzapine, risperdal

33
Q

CATIE

A

schizophrenia trial

SGAs effectiveness tested against perphenazine (FGA)

74% stopped drug that they were randomized before 18 mo FU, cricial flaw in study

olanzapine had significantly lower rate of discontinuation compared to other meds

olanzapine, perphenazine, quetiapine, risperdal, ziprasidone

perphenazpine was similar in efficacy and time to discontinuation as SGAs

34
Q

prevalence of schizophrenia worldwide

A

0.32% of adults

24 million

1 in 300 people

2-3 more times likely to die due to cardiovascular, metabolic and infectious diseases

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