schizophrenia

Positive SXS (3)

• Hallucinations

• Delusions

• Disorganized speech/behavior

Must be present for diagnosis**

Negative SXS (4)

• Lack of emotion (apathy)

• Social withdrawal

• Loss of motivation (avolition)

• Lack of speech (alogia)

Medications causing psychotic SXS (10)

• Anticholinergics

• Dextromethorphan

• DA or DA agonists

• Efavirenz

• Interferons

• Ketamine

• Levetiracetam

• Quinolones

• Stimulants

• Steroids

EPS (4)

• Akathisia (days to weeks): BZD, propranolol

• Dystonia (24-96 hrs): Benztropine, diphenhydramine

• Parkinsonism (days to weeks): Anticholinergics, amantadine

• Tardive dyskinesia (months to yrs): VMAT2 inhibitors

First generation antipysh (FGA) (1)

• Haloperidol

Only one bolded

Antipsychotics BW

Increased risk of death in elders with dementia

FGA adverse effects (7)

• QT prolongation

• Orthostasis

• Anticholinergics

• CNS depression

• EPS (increased risk with injectables)

• Hyperprolactinemia

• NMS

SGA MOA

Block D2 and 5HT2A

SGA examples

• Aripiprazole (Abilify)

• Clozapine (Clozaril)

• Lurasidone (Latuda)

• Olanzapine (Zyprexa)

• Paliperidone (Invega)

• Quetiapine (Seroquel)

• Risperidone (Risperdal)

• Ziprasidone (Geodon)

Clozapine indication

TX resistant schizo (resistance ≥2 options)

Clozapine BW (3)

• Neutropenia/arganulocytosis

• Myocarditis/cardiomyopathy

• Seizures

Clozapine and ANC

• BL ANC must be ≥1,500 to start

• Stop TX if ANC <1,000

Olanzapine (Zyprexa Relprevv injection) REMS

Must be administered in a registered healthcare facility & monitor pts for 3 hours post-injection due to sedation/coma following injection

Paliperidone Invega Trinza taken every __ months and Invega Hafyera every ___ months

3, 6

Antipyschotic must be taken for at least ___ weeks before giving up

6

Antipsychs with QT risk (4)

• Ziprasidone

• Haloperidol

• Thioridazine

• Chlorpromazine

Antipsychs with lowest & highest metabolic risk (2)

Highest: Clozapine, Olanzapine

Lowest: Aripip, Asenapine, Lurasidone, Ziprasidone

Acute psychosis medications

Haloperidol or olanzapine +/- diphenhydramine and lorazepam

Abilify Asimtufi IM is taken every __ months

2

Psychosis with parkinsons disease (2)

• Quetiapine (low EPS risk)

• Pimavanserin

What antipsychotic has BW for QT prolongation?

Thioridazine

Which antipsychs have highest risk of elevated prolactin levels? (2)

Risperidone, Paliperidone

T/F: A medguide is required for all antipsychotics

True

Tardive dyskinesia & TX

Occurs with dopamine blockade and can be irreversible

VMAT2 inhibitors:

• Valbenazine

• Deutetrabenazine

NMS & TX

Rare but lethal & occurs with D2 blockade

• SXS: hyperthermia, muscle rigidity

• Increased CPK and WBC

• TX: stop the antipsychotic, cool the patient

- Relax the muscles with benzos, dantrolene, or bromoriptine

What is the main NT in schizophrenia?

Dopamine

Psych