Schizophrenia Spectrum Disorders II Flashcards
describe pharmacological treatment of schizophrenia
- antipsychotics are the mainstay treatment (aka neuroleptics, major tranquilizers)
- all are dopamine D2 receptor antagonists but some:
- block DA2 receptors more potently
- block additional types of DA receptors
name examples of traditional antipsychotics
- chlorpromazine and haloperidol
- mechanism of action: DA2 antagonist
- effect: improves positive symptoms
- side effects: extrapyramidal syndrome (EPS) due to nigrostriatal DA2 blockade
describe extrapyramidal syndrome (EPS)
- dystonia: sustained muscle contractions (head, neck) often developing within the first week
- parkinsonism: parkinsonian symptoms (tremor, shuffling) often developing in the first few months
- akathisia: excessive movements due to “inner restlessness” often developing in the first few months
- tardive dyskinesia: repetitive, involuntary, purposeless movements, often of the face and extremities, developing as a long-term (years) side effect
describe neuroleptic malignant syndrome (NMS)
- characterized by tachycardia, hypertension, rapid respiration, fever, extreme rigidity, delirium, death
- usually occurs within first 2 weeks of starting medication or increasing dosage
- likely due to a precipitous drop in DA affecting hypothalamic functioning
describe atypical antipsychotics
- examples:
- clozaril (Clozapine): (1-2% agranulocytosis risk, decreased WBCs)
- risperidone (Risperdal)
- olanzapine (Zyprexa)
- MoA: antagonists of DA2,3,4 and 5-HT receptors
- effect: improves positive and negative symptoms
- side effects: decreased risk of EPS
describe supportive interventions to treat schizophrenia
- vocational rehabilitation
- individual psychotherapy
- family education
describe ECT augmentation in treating schizophrenia
- ECT augmentation: used for medication-refractory schizophrenia (esp. catatonic type)
describe schizophreniform disorder
- at least 1 month of active-phase symptoms
- signs of the disturbance last less than 6 months
describe diagnostic criteria for brief psychotic disorder
- at least 1 core psychotic domain symptom
- delusions
- hallucinations
- disorganized speech
- episodes last < 1 month
- person returns to full premorbid functioning
- specify “with marked stressor” or “without marked stressor” (based on trigger of episode)
describe diagnostic criteria for delusional disorder
- the presence of a delusion
- symptom must last ≥ 1 month
- no other psychotic domain symptoms
- no functional impairment aside from the direct impact of the delusion
describe subtypes of delusional disorder
- persecutory type: belief of malevolent treatment
- grandiose type: belief of having some great (but unrecognized) talent or insight or important discovery
- erotomanic type: belief of somebody being in love with the individual
- jealous type: belief of infedility by partner
describe the somatic type subtype of delusional disoder
- somatic type (belief involving bodily functions/sensations):
- parasitosis, malodorous, organ dysfunction
- if delusion is appearance-related, then:
- BDD with absent insight (delusional belief)
contrast bizarre vs. non-bizarre delusion disorder
- non-bizarre delusion: a belief that involves something that could occur in real life. the belief is physically possible
- bizarre delusion: a belief that is clearly implausible and not derived from ordinary life experiences
a delusion may develop in the context of a close relationship with a _____ indiudal
- a delusion may develop in the context of a close relationship with a psychotic indiudal
- the person believes the same delusion as the psychotic individual
- treatment: antipsychotics, trial separation from partner, increasing sources of reality testing
describe the graph explaining schizoaffective disorder
summarize schizophrenia spectrum disorders
