Per DSM-V, two or more of the following are required for a diagnosis of schizophrenia:
- Disorganized speech
- Disorganized or catatonic behavior
- Negative symptoms
For a diagnosis of schizophrenia you must be able to exclude:
- Schizoaffective disorder
- Mood disorders
- Medical disorders
- Substance use
What is a delusion?
False beliefs that are firmly and consistently held despite disconfirming evidence, culture or logic
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
What are some examples of negative symptoms?
- Social withdrawal
- Decreased facial expression (blunted)
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
T/F: Negative symptoms are the most prominent and noticeable in schizophrenia.
False; often times negative symptoms go unnoticed.
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)
Which drugs are used for acute agitation?
If there is no improvement of symptoms after 3-4 weeks of a therapeutic dose, what should you do?
Switch to a different agent
Which symptoms improve around 2-3 weeks of treatment?
- Attention span
- Positive symptoms
Which symptoms improve around 6-8 weeks of treatment?
- 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?
(Also high dose risperodone)
Which agents can be given to help treat EPS dystonias?
- Anticholinergic agents (Cogentin, Benadryl)
Diphenhydramine IM or Benztropine IM or slow IV
What are treatment options for akathisia?
- Decrease dose or change antipsychotic drug
Occurs within the 1st month after initiation of antipsychotic therapy
- Mask-like faces
- Muscle rigidity
- Shuffling gait
What are some treatment options for pseudoparkinsonism?
- Propranolol (in patients resistant to anticholinergics or amantadine)
What are treatment options of tardive dyskinesia?
- Discontinue antipsychotics
- Switch to clozapine
What are some effects of having increased plasma prolactin levels?
- Increased bone demineralization in post-menopausal women
- Sexual dysfunction
- Weight gain