schizophrenia/psychosis

Common symptoms of schizophrenia

Hallucinations, delusions, disorganized thinking/behavior

Negative signs and symptoms

1. Loss of interest in everyday activities

2. Lack of emotion (apathy)

3. Inability to plan or carry out activities

4. Poor hygeine

5. Social withdrawal

6. Loss motivation

7. Lack of speech

Positive signs and symptoms

1. Hallucinations

2. Delusions

3. Disorganized thinking/behavior

4. Difficulty paying attention

Can anticholinergics cause psychotic symptoms?

Yes

Can dextromethorphan cause psychotic symptoms?

Yes

Can dopamine or dopamine agonist cause psychotic symptoms?

Yes

Can interferons cause psychotic symptoms?

Yes

Can stimulants cause psychotic symptoms?

Yes

Can systemic steroids cause psychotic symptoms?

Yes

Can illicit/recreational substances cause psychotic symptoms?

Yes

Dystonia

Prolonged contraction of muscles during drug initiation, including painful muscle spasms/contractions

Treatment/prophylaxis of dystonias

Centrally-acting anti-cholinergics, diphenhydramine and benztropine

Akathisia

Restlessness with anxiety and an inability to remain still

Akathisia treatment

Benzodiazepines or propranolol

Treatment of Parkinsonism if tremor is the main symptom

Anticholinergics, Propranolol

Tardive Dyskinesias

Abnormal facial movements, primarily in the tongue or mouth

Tardive dyskinesia has a higher risk in which patient population?

Elderly females

Can tardive dyskinesia be reversible?

No

Dyskinesias

Abnormal movements

Extrapyramidal Side Effects (EPS)

Dystonia, akathisia, Parkinsonism, tardive dyskinesia, dyskinesias

Haldol Cocktail

Haloperidol, Lorazepam, Diphenhydramine

Which antipsychotic should never be given with benzodiazepines

Olanzapine

Antipsychotic boxed warnings

Avoid use in elderly patients for agitation with dementia-related psychosis (increased risk of mortality)

Several antipsychotics have a warning for an increased risk of ______ in patients with dementia.

stroke

All antipsychotics carry a warning for ____.

Falls

MOA of FGAs

Block D2)receptors with minimal serotonin (5-HT2A) receptor blockade

FGA with the highest QT prolongation risk

Thioridazine

Warnings associated with all FGAs (7)

1. QT prolongation

2. Orthostasis/falls

3. Anticholinergic effects

4. CNS depression

5. EPS

6. Hyperprolactinemia

7. NMS

Adasuve side effect

Dysgeusia