Schizophrenia Treatment Flashcards
DSM-5 Criteria for Schizophrenia
2 or more of the following persisting for at least 1 month: At least one of the symptoms must be (1), (2), or (3): • Delusions • Hallucinations • Disorganized Speech • Disorganized or catatonic behavior • Negative symptoms
Other things to look for when diagnosis Schizo
Level of social and/or occupational functioning has significantly declined
Continuous signs for at least 6 months. May include prodromal or residual symptoms
Schizoaffective or mood disorder has been excluded
Disorder not due to a medical disorder or substance abuse
If a development disorder is present, there must be symptoms of hallucinations/delusions for at least 1 month
Acute Stabilization Treatment
Initiate antipsychotic treatment and titrate the dose every few days
If “cheeking” use liquid or orally disintegrating tablets
For severely agitate patients, consider quick actin antipsychotic by IM injection
Chemical restraining is recommended over physical
During the first 7 days pf acute stabilization, you should see:
decreased agitation, hostility, anxiety, and aggression & sleep and appetite should improve
Define cheeking
When a patient appears to be taking his medication, but instead places the pill inside of his cheek and spit sit out when no one is looking
Stabilization Treatment
Takes 6 weeks or longer
If no improvement is seen within 3-4 weeks or only a partial decrease in positive symptoms is observed within 12 weeks with therapeutic doses then the next treatment algorithm stage should be considered.
Continue increasing the antipsychotic dose gradually for more symptom control if tolerated.
Goal of treatment:
Achieve no or minimal positive symptoms
Negative/cognitive symptoms are less likely to remit even with appropriate treatment
Maintenance Treatment
Continued treatment with antipsychotic therapy is recommended to prevent future relapses
At least 5 years but lifetime for chronically ill
For patients experiencing their first psychotic episode –
A first or second generation antipsychotic other than clozapine or olanzapine is recommended.
• If the first agent is not effective, then switch to another first or second generation antipsychotic other than clozapine. Olanzapine can be considered as an option at this stage.
For patients who have experienced more than 1 psychotic episode but they have been treatment responsive in the past-
- A first or second generation antipsychotic other than clozapine is recommended.
- If the first agent is not effective, then switch to another first or second generation antipsychotic other than clozapine.
For treatment resistant patients
- Clozapine is the recommended antipsychotic for treatment resistant patients.
- Clozapine can be offered sooner for patients with violent behaviors or suicidality.
Define Treatment Resistant
Failing 2 or more antipsychotic trials where the antipsychotic were dosed appropriately and given for an appropriate amount of time
***Class 1 Antipsychotics
Chlorpromazine Thioridazine Loxapine Perphenazine Thiothixene Haloperidol Fluphenazine
Chlorpromazine and Thioridazine have
low EPS and high metabolic side effects (anti-cholinergic, sedation/weight gain, low BP)
Loxapine, perphenazine, thiothixene, haloperidol and fluphenazine all have
HIGH EPS but low metabolic side effects
2nd Generation Antipsychotics
THE “PINES” Clozapine Olanzapine Quetiapine Asenapine THE “DONES” Risperidone Paliperidone Ziprasidone Iloperidone Lurasidone THE D2 PARTIAL AGONISTS (THE “PIPS”) Aripiprazole Brexpiprazole
The Pines all show
Low EPS
Ziprasidone shows
Low side effects overall
Illoperidone shows
Low EPS
Risperidone, Paliperidone, Lurasidone show
High EPS
The PIPs show
Low everything but Aripiprazole has akathisia while brexpiprazole does not
Weight Monitoring
Baseline then every month for 3 months and then every 3 months
