Looks like no one added any tags here yet for you.
What are positive symptoms of schizophrenia?
-hallucinations
-delusions
-disorganized speech
-disorganized behavior
What are negative symptoms of schizophrenia?
-alogia
-avolition
-affective blunting
-anhedonia
-asociality
What are cognitive deficits seen with schizophrenia?
-attention
-memory
-executive functions
What are mood symptoms associated with schizophrenia?
-depression
-suicidality
-anxiety
What are hallucinations?
-false sensory perceptions occurring in the absence of relevant external stimuli
-Types:
auditory: hearing voices
visual: seeing things
olfactory
gustatory
tactile
somatic: physical sense within the body
What are delusions?
-false beliefs that are firmly held, despite the facts and despite inconsistency with the culture
-Types:
bizarre
reference
control
religious
grandiose
somatic
persecutory
What are disorganized speech?
-loose associations: unrelated ideas shift from one subject to another
-tangentiality: inability to have goal directed associations of though; never gets from original point to desired goal
-circumstantiality: indirect speech that is delayed in reaching the point but eventually gets from original point to desired goal
What is disorganized behavior?
-silliness
-catatonic behaviors
-unusual dress or grooming
-untriggered swearing or shouting
-inappropriate sexual behavior
Negative symptoms:
alogia: poverty of speech
-avolition: lack of self initiated , goal directed activity ; includes poor hygiene
-affect blunting: lack of interest in pleasurable activites
-asociality: withdrawal, isolation
How do you diagnose schizophrenia?
-two or more of the following, each present for a significant portion of time during a 1 month period:
delusions*
hallucinations*
disorganized speech*
grossly catatonic behaviors
negative symptoms
*at least one of these symptoms must be present
-continuous signs of the disturbance persist for at least 6 months; must include active phase and may include prodromal or residual periods
-exclusion of other causes of psychosis
What can be some medications or conditions that present as psychotic symptoms?
-medical conditions: neurological, endocrine, metabolic, autoimmune
-substance induced: amphetamines, cocaine, PSP, LSD
-other psychotic disorders: schizoaffective disorders, schizophreniform
-mood disorders: mania or depression
-personality disorders: schizotypal , schizoid, paranoid
True/False: most patients experience at least 1 relapse within 5 years
-true
What is the class of medications used to treat schizophrenia?
-antiphyscotics
Which antipsychotics act at D2 receptor antagonism?
-All FGAs: block D2 receptors
-Almost all SGAs
Which antipsychotics have D2 receptor partial agonism?
-aripiprazole
-brexpiprazole
-cariprazine
Which antipsychotics have -HT2A receptor antagonism?
-All SGAs
Which antipsychotics have 5-HT1A receptor agonism?
-ziprasidone
What antipsychotics have 5-HT1A receptor partial agonism?
-aripiprazole and brexipiprazole : can’t be used for treatment resistant depression and bipolar depression
-lurasidone
Rexulti ( brexipiprazole):
-MOA: partial D2 and 5-HT1 agonist ; antagonist at 5-ht2A
Vraylar ( Cariprazine):
-MOA: partial agonist at D2 and D3 receptors
-Partial agonist at 5-HT1A receptor
-Antagonist at 5HT2A receptor
Captlyta ( lumateperone):
-MOA: antagonist 5-HT2A and D2 receptors
What happens in the mesolimbic pathway in patients with schizophrenia?
-too much dopamine which causes overactivity and positive symptoms
What happens in the mesocortical system of schizophrenia patients?
-underactivity of this system leads to less dopamine and this causes negative and cognitive symptoms
True/False: D2 antagonism in the mesolimbic pathway leads to the antipsychotic effects
-true
What is the effect of blocking D2 receptors in the tuberoinfundibular pathway?
-can increase prolactin levels
In this pathway when you block D2 you can cause EPS:
-nigrostriatal pathway
Blocking D2 receptors in this pathway can lead to negative symptoms becoming worse in the schizophrenic patient:
-Mesocortical
What is the effects of blocking 5-HT2A receptors in the meocortical tract?
-you can see an improvement in cognitive and negative symptoms
Blocking this receptor can lead to orthostatic hypotension:
-alpha-1 antagonism
Blocking this receptor causes somnolence and weight gain:
-histamine 1 antagonism
Blocking this receptor causes increased appetite:
-5-HT2C
What are the effects of blocking muscarinic receptors?
-cause anticholinergic side effects
Which antipsychotics must be given with food?
-ziprasidone and lurasidone ( take with > 350 calories)
Which medication should not be taken with food?
-asenapine bioavailability is much lower when swallowed or given with food
What antipsychotics must be dosed twice a day due to shorter half life?
-quetiapine and ziprasidone
What is the black boxed warning for all antipsychotics?
-increased mortality in elderly patients with dementia related psychosis
-elderly patients with dementia related related psychosis treated with antipsychotics drugs are at an increased risk of death.
EPs symptom: Acute dystonia:
-prolonged tonic contractions
-onset: happens within hours to days of therapy initiation or dosage increases
-drug related risk factors: FGAs have high potency ; high dosage
-Patient related risk factors: younger age, male gender, previous history of dystonia
-complications: can be painful
-prevention; anticholinergics
-management: treat with parenteral agent , anticholinergic or diphenhydramine, BZD
EPS symptoms: Akathisia
-inner restlessness + motor restlessness ( ants in my pants)
-onset: within days to weeks of therapy initiation or dosage increases
-drug-related risk factors: FGAs, high potency, high dosage
-Patient related risk factors: advanced age , female
-complications: misdiagnosis of psychotic agitation ; can lead to impulsivity or aggression
-Management: switch to SGA, decrease dosage, 1st line: beta blockers, 2nd line: BZDs
Pseudoparkinsonism EPS effect:
-tremor, rigidity, bradykinesia, postural abnormalities
-Onset: within weeks to months of initiation or dosage increase
-drug-related risk factors: FGAs, especially high potency , high dosage
-Patient related factors: older age, AIDS, female gender
-Complications: misdiagnosis of depression, misdiagnosis of negative symptoms, can lead to falls/injuries
-Management: switch to SGA ; decrease dosage, treat with anticholinergic , treat with amantadine
Tardive dyskinesia EPS effects:
-abnormal , involuntary movements
-Onset: after months to years of therapy
-Drug-related risk factors: FGAs, Higher mean daily dosage, Longer duration ,Total cumulative dosage ,Concomitant anticholinergic med
-Patient related risk factors: older age, female gender, mood disorder, diabetes mellitus, organic brain disease, occurrence of acute EPS
-Complications: possible interference with ADLs, can become irreversible
-Prevention: lowest and shortest duration possible, preferential use of SGAs, routine screening
-Management: decrease dosage or discontinue drug; Switch to SGA
What can be some metabolic side effects of antipsychotics?
-weight gain, glucose dysregulation, lipid changes
Which antipsychotics cause low weight gain?
-aripiprazole , ziprasidone, lurasidone
What antipsychotics cause a lot of weight gain/
-clozapine and olanzapine
What is the average weight gain seen in patients on antipsychotics?
-weight gain at 10 weeks is 0.5-5.0 kg on average
What is the leading cause of death in schizophrenia paients?
-CVD
Which antipsychotic has the highest QTC prolongation?
-Thioridazine (35.8 msec)
What is the side effects of Clozapine?
-sedation, anticholinergic effects, sialorrhea, orthostasis, tachycardia, metabolic abnormalities
What is the black boxed warning for Clozapine?
-agranulocytosis, seizures, myocarditis, orthostasis
Clozapine monitoring:
-REMS program: must monitor ANC levels ( ANC >1500 mcg/mL)
-if ANC is normal: check ANC weekly for 6 months ; check every other week for 6 months, then check monthly then after
What is neuroleptic malignant syndrome?
-potential fatal adverse effect of antipsychotics
-signs: rigidity, elevated temp. , autonomic dysfunction, and altered consciousness
-lower risk with SGAs ; rechallenge: use SGA -wait at least 2 weeks after recovery
BZDs, antihistamines, and ethanol can have what effects when taking with antipsychotics:
-additive sedative effects
When antipsychotics are taking with to cause increase anticholinergic effects?
-benztropine, antidepressants
What medications if taken with antipsychotics can lead to additive hypotensive effects?
-diuretics, beta-blockers, ACE inhibitors
Which medications if taking together can cause hematologic effects/
-clozapine taking with carbamazepine
Which medications if taking together can cause respiratory ffects?
-clozapine and BZDs
Which medication is still given to treat schizophrenia, but it can cause QTC prolongation?
-Ziprasidone
Which antipsychotics should not be taken if the patient smokes?
-olanzapine, asenapine, clozapine
How do you dose antipsychotics in the acute phase?
-initiate therapy and titrate dose over several days to average effective dose
-subsequent titrations may be made every 1-2 weeks based on response and tolerability
How do you dose antipsychotics in maintenance phase?
-lower doses may be needed to maintain remission of symptoms than to treat acute episodes.
-After 1 year of therapy , may attempt a very gradual ( every 3-6 months) dosage reduction while closely monitoring the patient
How do you dose long acting injectables?
-start or convert patient to an oral dosage form of the desired antipsychotic medications
-convert oral dosage form to LAI
What is the black boxed warning for Zyprexa LAI?
-black boxed warning for post-injection delirium/sedation syndrome
Which LAI does not require oral bridge?
-Invega Sustenna
What is the treatment for agitation?
-IM BZDs: Ativan 1-2 mg q2-4 hrs.
-IM FGAs: haloperidol 5 mg ( usually given with benztropine and diphenhydramine)
-IM SGAs: geodon, zyprexa, abilify
-Combo IM BZD + IM FGA or SGA