Schizophrenia Therapeutics (Dr. Salako) flashcards |

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Schizophrenia is more prominent in men or women?

Men

What is generally the age onset for schizophrenia?

Late adolescents to early adulthood

T/F: Schizophrenia is associated with a lower socioeconomic status

True (Downward drift)

T/F: It is believed there is a high genetic component to schizophrenia?

True

The etiology of schizophrenia is _____.

Multi-factorial

Per DSM-V, two or more of the following are required for a diagnosis of schizophrenia:

- Delusions
- Hallucinations
- Disorganized speech
- Disorganized or catatonic behavior
- Negative symptoms

How long must the signs and symptoms of schizophrenia be present for diagnosis?

> 6 months

For a diagnosis of schizophrenia you must be able to exclude:

- Schizoaffective disorder
- Mood disorders
- Medical disorders
- Substance use

Examples of positive symptoms:

- Hallucinations
- Delusions
- Disorganized speech
- Catatonia

What is a delusion?

False beliefs that are firmly and consistently held despite disconfirming evidence, culture or logic

What other individuals may experience delusions?

Individuals with mania or depression

Delusions of persecution

Belief that one is a target of others' mistreatment, evil plots, and/or murderous intent

Delusions of reference

Belief that all happenings revolve around oneself and/or one is always the center of attention

Thought broadcasting

Belief that one's thoughts are being broadcast or transmitted to others

Though withdrawal

Belief that one's thoughts are being removed from one's mind

What are hallucinations?

Sensory experiences in the absence of any stimulation from the environment

What are the most common type of hallucinations in schizophrenia?

Auditory hallucinations

What are some examples of negative symptoms?

- Anhedonia
- Avolition
- Social withdrawal
- Decreased facial expression (blunted)
- Apathy

What are some examples of cognitive symptoms?

- Poor concentration
- Memory disturbances
- Odd language
- Impaired attention

Two standardized rating scales for schizophrenia?

- Brief Psychiatric Rating Scale (BPRS)
- Scales for Assessment of Negative Symptoms (SANS)

T/F: Pharmacological agents for schizophrenia will cure the disease?

False; they only work to reduce symptoms

The first schizophrenic psychotic event is usually triggered by _____.

Some stressful event

T/F: Negative symptoms are the most prominent and noticeable in schizophrenia.

False; often times negative symptoms go unnoticed.

A lot of times in schizophrenia there will be a drop in _____.

IQ (by about 30 points)

For the 1st episode of a psychotic event what pharmacologic treatment is recommended by the treatment guidelines?

A trial of a second generation antipsychotic (SGA)

_____ is reserved for the treatment of refractory patients.

Clozapine

T/F: Psychosocial treatment is not often effective as a sole treatment.

True

Monotherapy or poly therapy is preferred in pharmacologic treatment?

Monotherapy

Which drugs are used for acute agitation?

- Aripiprazole
- Ziprasidone
- Olanzapine
- Haloperidol
- Lorazepam
(HALOZ)

If there is no improvement of symptoms after 3-4 weeks of a therapeutic dose, what should you do?

Switch to a different agent

How long is schizophrenia treatment continued?

From about 12 months to lifetime

Which symptoms usually improve first?

- Agression
- Hostility

Which symptoms improve around 2-3 weeks of treatment?

- Attention span
- Anxiety
- Socialization
- Positive symptoms

Which symptoms improve around 6-8 weeks of treatment?

- Hallucinations
- Delusions (non fixed)
- Associative disturbances

What side effects are associated with High Potency antipsychotics?

- More EPS symptoms
- Less sedation
- Less anticholinergic

What side effects are associated with Low Potency antipsychotics?

- Less EPS symptoms
- More sedation
- More anticholinergic

EPS is mostly seen with which generation of antipsychotics?

1st generation
(Also high dose risperodone)

Dystonias

Involuntary sustained spasm of muscles, notably head and neck

Which agents can be given to help treat EPS dystonias?

- Anticholinergic agents (Cogentin, Benadryl)
Diphenhydramine IM or Benztropine IM or slow IV

Akathisia

Restlessness with anxiety and an inability to remain still

What are treatment options for akathisia?

- Decrease dose or change antipsychotic drug
- Propranolol
- BZDs

Pseudoparkinsonism

Occurs within the 1st month after initiation of antipsychotic therapy
- Mask-like faces
- Muscle rigidity
- Shuffling gait

What are some treatment options for pseudoparkinsonism?

- Benztropine
- Trihexyphenidyl
- Diphenhydramine
- Amantadine
- Propranolol (in patients resistant to anticholinergics or amantadine)

Tardive dyskinesia

Occurs with long term treatment with antipsychotics (IRREVERSIBLE)

What are treatment options of tardive dyskinesia?

- Discontinue antipsychotics
- Switch to clozapine

What are some effects of having increased plasma prolactin levels?

- Galactorrhea
- Amenorrhea
- Infertility
- Increased bone demineralization in post-menopausal women
- Sexual dysfunction
- Weight gain

Blocking alpha-1 receptors causes _____.

Orthostatic hypotension

Blocking alpha-2 receptors causes ____.

Sedation

Which 3 antipsychotics cause the most metabolic side effects?

Clozapine
Olanzapine
Quetiapine

Significant weight gain is defined by the FDA as:

Increase in 7% of weight from baseline.

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