Week 10: Schizophrenia Flashcards
Common antipsych SE (6)
- Orthostatic hyp
- Hyperprolactinemia (especially Risperidone)
- Sedation
- weight gain
- Anticholinergic
- New-onset diabetes
Extrapyramidal antipsych SE (4)*
Parkinsonism
Acute dystonia
Akathisia
Tardive dyskinesia
Serious antispych SE (4) *
NMS
Anticholinergic crisis
Agranulocytosis (with clozapine)
Metabolic syndrome
Second gen antipsychotics
Aripiprazole Asenapine Clozapine Risperidone Olanzapine Quetiapine Ziprasidone Lurasidone
(zole, pine, done)
Treatment for anticholinergic crisis
Discontinuation of meds
Physostigmine – increases AcH
Parkinsonism
Period of onset
Symptoms
5-30 d
Resting tremor, rigidity, bradykinesia or akinesia, mask-like face, shuffling gait, decreased arm swing
Acute dystonia
Period of onset
Symptoms
1-5 d
Intermittent or fixed abnormal postures of the eyes, face, tongue, neck, trunk and limbs
Akathisia
Period of onset
symptoms
1 – 30 d
Obvious motor restlessness evidenced by pacing, rocking, shifting from foot to foot
Tardive dyskinesia
Period of onset
symptoms
Months to years
Abnormal dyskinetic movements of the face, mouth, and jaw
Treatment for EPS***
Reduce Ach – give anticholinergics (reinstate balance between DA and Ach)
Diphenhydramine
Benztropine
Lowest weight gain risk of antipsychs (3)
Aripriprazole
lurasidone
ziprasidone
Most sedating of 2nd gen antipsych
Clozapine
Alternate use for Risperidone
autism, manage irritability
Arapiprazole alternate use
BPD
irratibility with autism
depression
antipsychotic drugs that target both positive and negative symptoms
2nd generation
Benztropine
action/indication
treat EPS by lowering acetylcholine
abrupt discontinuation of benztropine
Cholinergic rebound - bad!
Schizophrenia
Psych domain: assess cognitive impairments
Mini Mental
spell WORLD backwards
3 word recall
How are bike and train similar?
Schizophrenia
Psych domain: intervention
Education about syndrome
Patient edu
family edu
crisis plan
Schizophrenia:
Social domain: assessment
Strength of social skills
Role impact
Family assessment (high emotional reactivity?)
Schizophrenia:
Social domain: interventions
promoting safety
social skills training
vocational support
implementing family interventions
ACT Team
Assertive community treatment: specialty community based care including medication, mgmt, psychotherapy, vocational support, 24 hr support
Other psychotic disorders (4)
schizoaffective disorder
schizophreniform disorder
delusional disorder
brief psych disorder
Schizoaffective disorder (3) factors
- Characterized by periods of intense symptom exacerbation alternating with periods of adequate psychosocial functioning
- At times marked by psychosis, other times by mood disturbance
- Long-term outcome is generally better than that of schizophrenia, but worse than that of mood disorder
Schizophreniform (3 factors)
Identical features of schizophrenia
Duration less than 6 months with symptoms present at least 1 month
Delusional disorder
Delusion:
fixed false beliefs that cannot be changed by conflicting evidence
Delusions
fixed false beliefs that cannot be changed by conflicting evidence*
-situations that could occur in real life and are plausible in the context of the person’s ethnic and cultural background or clearly impossible*
Brief psychotic disorder
- Duration is at least 1 day, but less than 1 month
- Onset is sudden and includes at least one of the positive symptoms of schizophrenia
Schizophrenia 6 criteria
- 2 or more of the following, each present for a significatn portion of time during a 1-month period (delusions, hallucinations, disorg speech, grossly disorg or catatonic behavior) + negative symptoms?
- Level of function reduced
- disturbance for at least 6 months
- not schizoaffective, not depressive or BPD with psych features
- not from drugs
- not autism?
3 delusion types
grandiose
persecutory
somatic
3 Positive symptoms of schizo
- hallucinations
- Delusions
- disorganized thoughts
5 negative symptoms of schizo
- alogia
- affective flattening
- avolition
- anhedonia
- asociality
Alogia
Reduced speech even when encouraged
Lack of emotional and facial expression
Cognitive deficits* (4)
Difficulties with the following aspects of cognition can make it hard to live a normal life
-memory
-attention
-planning
-decision making
(impairment involving memory, vigilance, verbal fluency, executive functions)
Verbigeration
Purposeless repetition of words or phrases
Metonymic speech
Use of words with similar meanings interchangeably
Disorganized behavior
Aggression Agitation Catatonia Catatonic excitement Echopraxia Regressed behavior Stereotypy Hypervigilance Waxy flexibility
Catatonia
Stupor, mutism, posturing, repetitive behavior
Catatonic excitement
Hyperactivity characterized by purposeless activity and abnormal movements, such as grimacing and posturing
Stereotypy
Repetitive purposeless movements that are idiosyncratic to the individual
Waxy flexibility
Posture held in an odd or unusual fixed position
High occurrence of what comorbidities (3)*
Diabetes
Obesity
Psychogenic polydipsia
Psychosis*
State in which person experiences hallucinations, delusions, or disorganized thoughts, speech, or behavior (key diagnostic factor in schizophrenia spectrum disorder)
Phases of schizophrenia (5)*
- Prodromal period
- Acute
- Stabilization
- Maintenance
- Relapse
Prodromal period
Stage of early changes that are precursor to disorder (usually early childhood)
Acute
Disruptive or bizarre behaviors/perceptions that impede function (usually late adolescence or early adulthood)
Stabilization
Adjusting to the prospect of long-term severe mental illness, aim to reduce/eliminate risk factors for relapse
Maintenance
Maintaining healthy lifestyle, managing stresses of life, developing meaningful interpersonal relationships
What is there a high risk of during stabilization phase*
Substance abuse
What are the risk factors for relapse (3)
Stressors
Medication non-adherence
Substance abuse
Schizophrenia Biologic theories (5)
- Neuroanatomic findings
- Familial patterns
- Reduced size and activity in the PFC
- Neurotransmitters, pathways, receptors
- Dopamine hyperactivity ins some areas of the brain
Neuroanatomic findings*
Larger lateral and third ventricles, smaller total brain volume
Psychosocial theories (5)
- Social stressors contributing to changes in brain function*
- Social stigma
- High emotional reactivity in families increases relapse
- Fragmented mental health care delivery system
- Poor family response to disorder
What cog fxs are DA involved in (4)
Action, emotion, motivation, and attention
Assessment: biologic domain
- Current and past physical health status and physical exam (DM II, COPD, Hyperlipidemia)*
- physical functioning (clumsiness, physical awkwardness)
- Nutritional assessment and hydration (psychogenic polydipsia)*
- Substance use (smoking and respiratory problems), alcohol use*
- monitor for side effects EPS, NMS
- Pharm assessment (meds, abnormal motor movements, medication adherence)
Pharmacologic interventions
What is last resort?
- Antipsychotics
- second-generation antipsychotic drug effective in treating negative and positive symptoms
- administration and monitoring for 1-2 weeks to monitor changes in symptoms*
- Clozapine used as last resort
