Schizophrenia

Goals of therapy for psychotic disorders

long-term: remission, prevent recurrence

acute: decrease severity and duration of symptoms, increase function

at all times: decrease ADRs, increase adherence to treatment

Non-pharmacologic treatments for psychotic disorders

CBT, psychoeducation, avoidance of stimulants (caffeine, etc.) and alcohol, and avoid any other substance (illicit or other potentially drug inducing)

which drugs can induce/mimic psychotic disorders?

corticosteroids, stimulants, marijuana, DA-augmenting agents, hallucinogens

which diseases induce/mimic psychotic disorders?

HIV/AIDs, epilepsy, CVA/TBI, infections, Huntington’s Disease

what are the positive schizophrenia symptoms?

hallucinations, delusions, thought disorder, hostility, excitability

what the negative schizophrenia symptoms?

affective flattening, alogia, anhedonia, amotivation, asociality

what is catatonia

agitation, cataplexy, echopraxia, echolalia, grimacing, odd mannerisms, mutism, negativism, posturing, stupor, stereotypy, waxy flexibility

T/F: catatonia can be associated with another mental disorder, be a disorder due to another medical condition, or be unspecified catatonia

true

what is schizoaffective disorder’s similarity to schizophrenia?

must have delusions or hallucinations at least 2 weeks in absence of mood symptoms

what is schizophreniform disorder’s similarity to schizophrenia?

must meet the same criteria for the same symptoms

how does schizoaffective disorder differ from schizophrenia?

Impaired social or job dysfunction not required. Symptoms meeting criteria for mood episode are not present for substantial portion of illness duration Must have uninterrupted period of illness either a major depressive or manic episode along with symptoms meeting the criteria for schizophrenia (at
some point).

how does schizophreniform disorder differ from schizophrenia?

Impaired social or job dysfunction not required. Shorter duration (1-6 months)

what is aripiprazole (Abilify) FDA approved for?

schizophrenia, bipolar disorder, MDD, symptoms of autism, and symptoms of Tourette’s

what is asenapine SL (Saphris) FDA approved for?

schizophrenia and bipolar disorder

what is asenapine patch (Secuado) FDA approved for?

schizophrenia

what is brexipiprazole (Rexulti) FDA approved for?

schizophrenia, MDD, and agitation associated with Alzheimer’s

what is cariprazine (Vryalar) FDA approved for?

schizophrenia, bipolar disorder, MDD

what is clozapine (Clozaril, Fazaclo) FDA approved for?

schizophrenia and schizoaffective

what is Iloperidone (Fanapt) FDA indicated for?

schizophrenia and bipolar disorder

what is lumateperone (Caplyta) FDA approved for?

schizophrenia, bipolar disorder depression

what is lurasidone (Latuda) FDA approved for?

schizophrenia, bipolar disorder

what is olanzapine (Zyprexa) FDA approved for?

schizophrenia, bipolar disorder, MDD (with fluoxetine)

what is olanzapine + samidorphan (Lybalvi) FDA approved for?

schizophrenia and bipolar disorder

what is paliperidone (Invega) FDA approved for?

schizophrenia and schizoaffective

what is pimavanserin (Nuplazid) FDA approved for?

Parkinson’s Disease Psychosis

what is quetiapine (Seroquel) FDA approved for?

schizophrenia, bipolar disorder, and MDD

what is risperidone (Risperdal) FDA approved for?

schizophrenia, bipolar disorder, symptoms associated with autism

what is xanomeline and trospium (Cobenfy) FDA approved for?

schizophrenia

what is ziprasidone (Geodon) FDA approved for?

schizophrenia and bipolar disorder

T/F: all second-generation antipsychotics have a BBW for suicidal thoughts

true

what are the general pharmacotherapy recommendations for antipsychotics?

must monitor for effectiveness and side effects, continuation of medication for those whose symptoms have improved, give clozapine for patients with treatment-resistant schizophrenia or those with substantial risk of suicide or suicide attempts, long-acting injectable antipsychotics for those who prefer them

what is the general approach for long-acting injectable antipsychotics?

all require an oral challenge, some require an oral overlap, all have different duration of action and dose schedules, all have different indications for use, all have unique administration instructions (IM, SQ), many have unique needle requirement (patient weight, admin location), none are administered for STAT use or via IV (short acting can be STAT or PRN), none require a concurrent oral dose beyond overlap, be vigilant for unintended concomitant PO and IM, they have different reconstitution directions, storage may differ, and should confirm renal dose eligibility

which antipsychotic needs dose adjustments for CrCl < 80 mL/min

paliperidone

which antipsychotics are available as long-acting injectables?

aripiprazole, olanzapine, paliperidone, and risperidone

which aripiprazole LAI are FDA approved for schizophrenia and bipolar?

Abilify Maintena and Abilify Asimtufii

which aririprazole LAI is indicated for just schizophrenia?

Aristada

what is olanzapine’s LAI (Relprevv) FDA approved for?

schizophrenia

which paliperidone LAI’s are FDA approved for schizophrenia and schizoaffective disorder?

Erzofri, Invefa Sustenna

which paliperidone LAI’s are FDA approved for only schizophrenia?

Invega Trinza and Invega Hafyera

which risperidone LAI’s are FDA approved for schizophrenia and as mono or adjunctive therapy to lithium or VPA for maintenance BP-I?

Risperdal Consta and Rykindo

which risperidone LAI’s are FDA approved for only schizophrenia?

Risvan and Uzedy

what is treatment resistance?

considered as lack of improvement in symptoms despite receiving 2 optimized monotherapy trials of APS of different classes at a duration for at least 2-8 weeks

how do you treat treatment resistance to antipsychotics?

consider clozapine earlier for patients with suicidal, violent, or persistent aggression, clozapine has demonstrated superiority over other agents given these conditions

when can polypharmacy be used for psychotic disorders?

when 3 or more failed trials of monotherapy have been documented, during cross titration of APS, or augmentation of clozapine