SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS

schizophrenia

syndrome or disease process causing:

• Disturbances in thought processes, perception, and affect

• Severe deterioration in social and occupational function

delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms

What are the 5 key symptoms of psychotic disorders?

schizophreniform disorder

Similar to schizophrenia lasting only 1–6 months.

• Duration: 1-6 months

brief psychotic disorder

Sudden onset psychosis, often after stressor

• Duration: 1 day to <1 month

schizoaffective disorder

psychotic disorder where mood + psychotic symptoms present

• Duration: Varies

substance/medication-induced psychotic disorder

Psychosis resulting from substance use, intoxication, withdrawal, or medications

• Duration: soon after exposure

false belief

A delusion is nothing more than a ________.

psychotic disorder due to another medical condition

symptoms of psychosis lasting depending on medical condition

delusional disorder

Delusions most prominent, does not meet criteria for schizophrenia

• Duration: At least 1 month

1-1-6 Rule

Mnemonic:

• brief psychotic = 1 day to <1 month

• schizophreniform = 1 to 6 months

• schizophrenia = 6+ months

hallucinations, delusions, grossly disorganized thinking, ideas of reference, alterations in speech

What are positive symptoms of schizophrenia?

echolalia

automatic repetition of words, phrases, or sounds that a person hears from someone else.

clang association

a disorganized speech pattern where a person chooses and groups words based on how they sound—such as rhyming or alliteration—rather than their actual meaning or logical connection.

word salad

also known as schizophasia, is a symptom of Schizophrenia where a person speaks in a jumble of random, unrelated words and phrases that have no clear meaning to the listener.

neologisms

newly invented words or phrases that have a clear, specific meaning to the speaker but no understandable meaning to anyone else. They are classified as a positive symptom of psychosis and a form of disorganized speech.

apathy, avolition, anhedonia, flat/blunted affect, social withdrawal, poverty of speech

What are negative symptoms of schizophrenia?

to obtain maximum efficacy with minimal toxicity

What is psychopharmacology’s goal?

apathy

a lack of motivation, interest, or emotional expression, defined as a general absence of goal-directed activity rather than a simple choice or laziness.

avolition

is a psychological symptom defined as a severe, debilitating decrease in the ability to initiate and persist in self-directed, purposeful activities

anhedonia

the inability to feel pleasure or joy from activities that you once found enjoyable.

schizophrenia, acute mania, depression with psychotic features, episodes of psychosis in personality disorders, other psychotic disorders, agitation

What are indications of antipsychotics?

1st generation/typical antipsychotics (haldol, thorazine, prolixin)

Primarily dopamine receptor blocker (D2)

2nd generation/atypical antipsychotics (clozapine, risperdal, zyprexa, geodon)

• Serotonin and dopamine receptor blocker

• Seem more effective in treating (-) symptoms

3rd generation/novel antipsychotics (abilify, rexulti)

partial dopamine agonist

long-acting injectable antipsychotics

• Administered every 2–26 weeks depending on product

• Improve adherence compared with daily oral therapy

• Associated with lower relapse and hospitalization risk

• Support continuity of care in psychotic disorders

  • Risperidone (Risperdal), Aripiprazole (Abilify), Olanzapine pamoate (Zyprexa), Haloperidol decanoate (Haldol), Paliperidone palmitate (Invega)

Akathisia, Dystonia, Akinesia, Permanent Tardive dyskinesia

What is the ADAPT mnemonic of anti-psychotic induced movement disorders?

oculogyric crisis

an acute dystonic reaction causing the involuntary, prolonged upward or sideward deviation of the eyes.

cogentin, benadryl, valbenazine (ingrezza)

what medications can be used to treat antipsychotic-induced movement disorders?

metabolic syndrome, EPS, anticholinergic side effects, low blood pressure, sedation

What is the MEALS mnemonic for antipsychotic side effects?

fever, encephalopathy, vital sign instability, elevated CK level, rigidity

What is the FEVER mnemonic for neuroleptic malignant syndrome?

neuroleptive malignant syndrome

a rare, life-threatening reaction to dopamine-blocking medications like antipsychotics.

stop (causative) medication, provide supportive care, cooling measures, vital signs stabilization, hydration, monitor labs

How to treat neuroleptic malignant syndrome?