Schizophrenia -Test 2 Flashcards
What is the course of schizophrenia?
Most deterioration in psychosocial fxn occurs within the first 5 years
What are the positive symptoms of schizophrenia?
Added to normal patient’s presentation
Hallucinations, delusions, bizarre behavior, paranoia or suspiciousness, disorganization
What are negative symptoms of schizophrenia?
Taken away from a normal patient’s presentation
Avolition, alogia, affective flattening, asociality, anhedonia, attentional impairment
What are cognitive symptoms of schizo?
Difficulties with concentration, memory, executive functioning, decision-making
What types of hallucinations can ppl with schizo experience?
Auditory Visual Tactile Olfactory Gustatory
What are delusions? What types can ppl with schizo experience?
Fixed, false belief held despite negative evidence, and not consistent with cultural norms Types -Grandiose -Persecutory -Referential -Somatic
What are the types of disorganization?
Normal Loose associations Tangential Circumstantial Flight of ideas
What is the diagnostic criteria for schizo?
Two (or more) of the following characteristic symptoms, each present for a significant portion of time during a 1-month period or less is successfully treated and 1 of the 2 must be *: Delusions *
Hallucinations *
Disorganized speech *
Grossly disorganized or catatonic behavior
Negative symptoms- affective flattening, alogia, or avolition
What is potentially happening to the brain in a pt with schizo?
Volume reductions: whole brain (3%), temporal lobe (6-9.5%); amygdala/hippocampus (5.5-6.5%)
Volume increase in lateral ventricles (36-44%)
Abnormal activation:Increased neuronal density and decreased synapse density in schizophrenia
What are the dopamine pathways?
Nigrostriatal, mesolimbic, mesocortical, tubero-infundibular
What does the nigrostriatal do?
Regulates motor movement
Blockade Extrapyramidal Movements (EPS)
What does the mesolimbic do?
Hyperactivity Positive Symptoms
What does the mesocortical do?
Hypoactivity Negative Symptoms, Cognition Issues
What does the tubero-infundibular do?
Inhibits prolactin, thermoregulation
Blockade hyperprolactinemia
What does dopamine antagonism do in pts with schizo?
Improvement of positive symptoms
Develop EPS
Develop Hyperprolactinemia
Minimal improvement of negative symptoms
What are the tx options for schizo?
Antipsychotics
What are the first generation (typical/conventional) antipsychotics?
Phenothiazines Chlorpromazine (Thorazine®) Thioridazine (Mellaril®) Mesoridazine (Serentil®) Perphenazine (Trilafon®) Trifluoperazine (Stelazine®) Fluphenazine (Prolixin®)
NON-Phenothiazines Thiothixene (Navane®) Haloperidol (Haldol®) Loxapine (Loxitane®) Molindone (Moban®
What are the low potency first gen?
Chlorpromazine, thioridazine, mesoidazine
What are characteristics of the low potency first gens?
Less potent D2 antagonism
More Ach antagonism, alpha-antagonism, sedation
What are the medium potency first gens?
Perphenazine, loxapine, molindone
What are characteristics of the medium potency first gens?
Moderate D2 antagonism as well as receptor selectivity
What are the high potency first gens?
Fluphenazine, haloperidol, thiothixene, trifluoperazine
What are characteristics of the high potency first gens?
More potent D2 antagonism
Less Ach, alpha-antagonism, sedation
What are the second gen (atypical) antipsychotics?
Aripiprazole (Abilify®) Clozapine (Clozaril®) Olanzapine (Zyprexa® Quetiapine (Seroquel®) Risperidone (Risperdal®) Ziprasidone (Geodon®)
What is the MOA of antipsychotics?
Every antipsycholic blocks D2 receptors
1)Typical Antipsychotics
Mesolimbic DA block: reduces Positive Symptoms
Not so good for Negative or Cognitive Symptoms
2)Atypicals: also block 5-HT>DA
Good for Positive Symptoms
Possibly better for Negative and Cognitive Symptoms
5-HT2 antagonists release dopamine from inhibition and decreases EPS
What is D2 occupancy related to?
Clinical response (threshold 65%) Prolactin elevation (threshold 72%) EPS and akathisia (threshold 78%)
What is the deal of olanzapine and 5HT2 occupancy?
Olanzapine saturates 5-HT2 receptors; therefore, at clinical doses, muscarinic M1 and histaminergic H1 also likely saturated
What are the advantages of clozapine over typical antipsychotics?
Lack EPS, lack prolactin elevation, efficacy in refractory pts, greater efficacy on suicidality, efficacy against negative symptoms?
5-HT2 occupancy >80 occupancy