Schizophrenia patho IPT 6 exam 2

Psychotic disorder aspects

psychosis (reality loss), functional decline, mood sx may occur, chronic

Mood disorders

Disturbance in mood, psychosis may appear during episodes, episodic

Loss of reality

delusion, hallucination, thinking/speech disorganisation, social withdrawal

Primary psychotic disorders

Psychosis not caused by substances or other medical conditions. Ex schizophrenia

Secondary psychotic disorders

Psychosis due to external/medical cause. Treating may resolve. Ex LSD, lupus

Schizophrenia definition

chronic psychotic disorder w/ persistent hallucinations, negative sx lasting > 6 months w/ functional impairment

Schizophrenia etiology

genetic predisposition, neurodevelopmental abnormalities, further brain dyfxn, neurodegeneration

Schizophrenia progression

prodromal -> psychotic (acute) -> residual (chronic)

schizophrenia neurobiology

-Dopamine dysregulation: striatal hyperdominergia causes unusual thoughts

-Glutamate/GABA dysfxn

Cortical Da pathway

Low Da levels -> negative sxs

mesolimbic DA pathway

Excessive D2 activation -> positive sxs

Striatal DA pathway

Low DA levels -> motor sxs

Glutamate and GABA in the brain

Glutamate: excitatory

GABA: inhibitory

General schizophrenia pharm tx

1st gen antipsychotics: block D2 r's

2nd gen (atypicals): block D2 and 5HT2a r's

Non-pharm schizophrenia tx

Therapy, social skills, rehab, family education, CBT, adherence therapy

1st gen antipsychotic drugs

haloperidol, fluphenazine, trifluoperazine, loxapine, chlorpromazine

FGA high potency leads to

more ADE

FGA low potency leads to

more sedation/anticholinergic

FGA metabolism and elimination

Hepatic metabolism via CYP450

Renal elimination

FGA ADE

extrapyramidal symptoms (EPS)

High potency: more EPS

Types of EPS

acute dystonia, akathisia, parkinsons, tardive dyskinesia

Acute dystonia tx

anticholinergic: benztropine, diphenhydramine

Akathisia tx

B-blockers (propranolol, benzo, anticholinergic)

Parkinsonism tx

anticholinergic (benzotropine), amantadine (avoid levodopa)

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