Schizophrenia

Describe the symptoms of psychosis:

• What are hallucinations? Ex?

• What are Delusions?

  • Themes?

  • Examples?

• List the symptoms of Disorganization of language and communication (7)

• Describe what these motor symptoms are:

  • Catatonic stupor: 

  • Catatonic excitement: 

  • Stereotypy: 

  • Mannerisms: 

  • Echopraxia: 

  • Automatic obedience: 

  • Negativism: 

Hallucinations: 

• perceptions experienced w/o external stimulus 

• Ex:

  • Auditory (MC), tactile, gustatory, olfactory or combo

  • Formication: 

    • sensation that insects are crawling under the skin

---

Delusions: 

• Disturbance in thought 

  • Firmly held beliefs that are ;

    • Untrue

    • Contrary to pts education/culture

• Themes:

  • somatic, grandiose, religious, nihilistic, sexual, or persecutory (MC) themes

• Type and frequency may vary by culture

• Examples:

  • Delusions of reference

  • Delusions of being controlled

  • Delusions of mind reading

  • Thought broadcasting

  • Thought insertion

  • Thought withdrawal

---

Disorganization of language and communication

• Derailment (loose associations)

• Poverty of 

  • Speech/Content

• Perseveration

  • unintentional, continuous repetition of a word, phrase, or sound long after the initial stimulus or context has ended

• Clanging: 

  • conceptual connections between words and thoughts are replaced by sound associations

• Neologisms: 

• Echolalia

• Thought blocking

---

Abnormal motor behaviors

• Catatonic stupor: 

  • immobile, mute, and unresponsive, yet fully conscious

• Catatonic excitement: 

  • uncontrolled and aimless motor activity; 

  • sometimes bizarre and uncomfortable postures maintained for long periods

• Stereotypy: 

  • repeated but non-goal-directed movement, such as rocking

• Mannerisms: 

  • goal-directed activities that are odd or out of context, 

  • EX: grimacing

• Echopraxia: 

  • imitates movements or gestures 

• Automatic obedience: 

  • carries out simple commands in a robot-like fashion

• Negativism: 

  • refuses to cooperate with simple requests for no apparent reason

What are the medical conditions associated w/ Psychosis?

Drugs Associated w/ Psychosis?

List the Prenatal and Perinatal Risk for Later Psychosis for Offspring

• Maternal/Paternal (2)

• Maternal only (5)

• Problems w/ preg (4)

• Others? (2)

Prenatal and Perinatal Risk for Later Psychosis for Offspring

• Maternal/Paternal:

  • Age <20

  • psychopathology

• Maternal:

  • stress; famine; nutritional deficits

  • hypertension; hypoxia

• Problems w/ preg:

  • >3 = increases risk; nulliparity lower

  • Suboptimal number of antenatal visits

  • Ruptured membrane

  • Polyhydramnios

• Maternal herpes simplex 2 infection

• Small for gestational age 1.4x

Describe Schizophrenia 

• Describe its course:

  • What happens after psychotic break(s)

  • During this time? (2)

  • Describe noncompliance

  • Describe the monthly relapse rate

• List the CV Disorders associated w/ Schizophrenia (5)

Schizophrenia 

Course

• Psychotic Breaks:

  • After first: course of accruing morbidity during first ten years

  • W/ each additional break: pt fail to return to previous level of functioning

• During this time, 

  • cortical grey matter loss and third/lateral ventricles enlargement

• High incidence of Tx noncompliance 

  • rates as high as 74 % have been reported

• Monthly relapse rate

  • – 3.5% per month on maintenance medication

  • – 12% per month for patients who have discontinued antipsychotic therapy

---

Risk factors for cardiovascular disease

• Smoking: 70%

• Obesity: 42-55%

• Hypertension: 14-20%

• Elevated cholesterol: >18%

• Sedentary lifestyle: 72%

1. List the Dx Criteria for Schizophrenia

2. Theories on Causes of Positive/Negative Symptoms?

3. Cog/Motor Symptoms? (5,3)

Schizophrenia: diagnostic criteria

• At Least Two for At least One Month:

  • Delusions

  • Hallucinations

  • Disorganized speech

  • Grossly disorganized or catatonic behavior

  • Negative symptoms

    • Alogia

      • Diminished Amount/Content of Speech

    • Affective flattening or blunting

    • Avolition

    • Anhedonia

• Social/Occupational Dysfunction

• Continuous signs of the disturbance for at least six months

---

Theories on Causes of Positive/Negative Symptoms:

• +:mesolimbic dopamine tract (excessive stimulation)

• -:mesocortical dopamine tract (decreased stimulation)

---

Cognitive/Motor Symptoms;

• Cog:

  • Difficulty paying attention

  • Working memory dysfunction

  • Impaired 

    • executive functions

    • verbal fluency, 

    • learning and memory

• Mood:

  • Dysphoria

  • Suicidality

  • Hopelessness

1. List and describe what is happening in the 3 stages of schizophrenia (5,1,3)

2. What are factors that predict good outcomes of schizophrenia

Schizophrenia Stages:

• Prodromal phase

  • Onset over months to years

  • Subtle behavior changes: 

    • social withdrawal, 

    • work impairment,

    • Emotional blunting, 

    • avolition, 

    • odd ideas and behavior

• Active phase

  • Development of psychotic symptoms

• Residual phase

  • Active symptoms absent or no longer prominent

  • Role impairment, negative symptoms, attenuated positive symptoms

---

Factors predicting good outcome for Schizophrenia:

• Acute/later onset

• Shorter prodrome

• Mood symptoms present

• Mild psychotic or negative symptoms

• No obsessions or compulsions

• Female 

• Good premorbid functioning

• Married

• Good psychosexual functioning

• Normal neurological functioning

• No structural brain abnormalities

• High intelligence

• No family history of schizophrenia

Interviewing Guidelines for Schizophrenia

Describe the treatment of Acute Psychosis:

• First line:

• Course:

• Second Line:

• Adjunct:

List some of the first/second generation antipsychotics

Initiating treatment in acute psychosis

• First line:

  • First/Second gen antipsychotic

• Course:

  • Effects start w/in few days of onset; effects are cumulative; trial = 4-6 weeks 

• Second Line:

  • Clozapine 

    • Increased risk of agranulocytosis

• Adjunct:

  • benzodiazepine for anxiety or agitation

  • anticholinergic to prevent EPS

Describe Clozapine:

• Clinical Usage:

• MOA Theories:

• AE:

Describe the “pines”

• Members

• MOA

• AE

Describe the Dones

• Members

• MOA

• Caution

Describe the “Prazole/Prazines”

• Members

• MOA

Describe Xanomeline/trospium

• MOA

• Clinical Usage

• AE

Clozapine

• Clinical Usage:

  • Refractory 

  • Preventing Violence

• MOA Theories:

  • Antagonism:

    • Serotonin 2A and Dopamine 4 receptor

    • Weak: Dopamine 2 receptor 

• AE:

  • Agranulocytosis

    • Needs CBC monitoring

---

“Pines”

• Members:

  • Olanzapine, quetiapine, asenapine

• MOA:

  • More potent at H1 receptor than the D2 receptor

• Side Effects:

  • OLZ and QTP = anticholinergic 

---

“Dones”

• Members:

  • Risperidone, paliperidone, ziprasidone, lurasidone, iloperidone

• MOA:

  • D2 receptor antagonists

    • Potent

  • serotonin receptors

    • Variable

  • noradrenergic alpha 1

    • Some activity 

• Caution

  • Some needs to be taken w/ food for absorption

---

“Prazole/Prazines”

• Members

  • Aripiprazole, brexipiprazole, cariprazine

• MOA:

  • Very potent D2 antagonism

  • Partial agonism at D2

---

Xanomeline/trospium

• MOA:

  • Vanomeline: M1/M4 agonist

  • Trospium: Muscarinic antagonist (peripheral tissues) 

• Clinical Usage:

  • Schizophrenia in adults

• Side Effects:

  • GI Symptoms

  • Hypertension

• NOTE:

  • First new class of antipsychotic in 3 decades

Describe the Tx Principles:

• Better Long term outcome?

• Difference in tx for first episode vs multiple episode?

• When to stop?

• When to initiate maintenance management?

• Non Vs compliance?

• Monitoring?

• Education?

Describe management:

• Psychosocial interventions (4)

• When to hospitalize? (6)

Treatment Principles

• Long Term outcome: 

  • Better the sooner Tx occurs

• First Episode vs Multiple Episodes:

  • First Episodes Pts: fewer doses + more responsive 

• When to stop?

  • For at least a year after full remission

• When to initiate maintenance management?

  • Pts who had two psychotic episodes in five years or multiple psychotic episodes

• Non vs Compliance:

  • Compliant: Oral meds is good

  • Noncompliant: long-acting depot medication

• Monitoring:

  • Glucose, Lipids, BMI, Weight, Abnormal movements

• Education:

  • Metabolic syndrome, diabetes, weight gain and obesity, dyslipidemia, extrapyramidal symptoms, tardive dyskinesia, neuroleptic malignant syndrome

---

Management of Schizophrenia

• Psychosocial interventions

  • Family therapy

  • Cognitive/Psychosocial rehabilitation

  • Social skills training

  • Case management

• When to Hospitalize

  • New onset (for diagnosis and stabilization medication)

  • For special procedures (ECT)

  • When aggressive or assaultive behavior =  dangerous

  • Suicidal

  • Unable to care for self

  • When medication side effects = disabling or potentially life threatening

Describe Schizophreniform Disorder

• Dx criteria

• Good Prognostic Factors (4)

Describe SchizoAffective Disorder:

• Dx Criteria

• Types

Schizophreniform Disorder

• Dx Criteria;

  • at least two of the following for at least one month

    • Delusions

    • Hallucinations

    • Disorganized speech

    • Grossly disorganized or catatonic behavior

    • Negative symptoms

  • Less than 6 months 

• Good prognostic factors

  • Psychotic symptoms onset  w/in four weeks of noticeable behavior change 

  • Confusion or perplexity @ height of psychotic episode

  • Good premorbid social and occupational functioning

  • Absence of blunted or flat affect

---

Schizoaffective Disorder

• Dx Criteria:

  • Core symptoms of Schizophrenia + Major Depressive or Manic or Mixed episode

  • During Course: at least 2 weeks w/o prominent mood symptoms

• Types:

  • Bipolar type

    • Manic or Mixed Episode

  • Depressive type

    • Only Major Depressive Episodes

Describe Delusional Disorder:

• Dx criteria (4)

• List and explain the different types (7)

• Management:

  • How to build relationship

  • Help pts understand what?

  • Meds?

Delusional Disorder

• Dx Criteria:

  • One or more delusions of at least one month’s duration

  • Do not have at least two of the core symptoms of schizophrenia

  • Function/Behavior = not obviously bizarre

  • Mood episodes = relatively brief 

---

Types

• Persecutory Type: 

  • delusions that the person (or someone to whom the person is close) is being malevolently treated in some way

• Somatic Type: 

  • delusions that the person has some physical defect or general medical condition

• Erotomanic Type: 

  • delusions that another person, usually of higher status, is in love with the individual

• Grandiose Type:

  •  delusions of inflated, worth, power, knowledge, identity, or special relationship to a deity or famous person

• Jealous type: 

  • delusions that the individual’s sexual partner is unfaithful

• Mixed type: 

• Unspecified type

---

Management

• Attempt to build relationship

  • Patience

  • Ensure confidentiality

  • Neither condemn nor collude with delusions

• Help patient understand how symptoms interfere w/ functioning

• Medication

  • Antipsychotics: Should be tried, but often ineffective

  • Pimozide may work for somatic delusions

  • SSRI’s occasionally help

Describe Brief Psychotic Disorder

• Dx criteria

• Subtypes

• Management (2)

Brief Psychotic Disorder

Dx Criteria:

• One or more of symptoms:

  • Delusions

  • Hallucinations

  • Disorganized speech

  • Grossly disorganized or catatonic behavior

• Duration of Episode: 1 day - <1 month; eventual return to normal

---

Subtypes

• With marked stressors

• Without marked stressors

• With postpartum onset

---

Management

• Supportive therapy in hospital milieu

• Antipsychotic if agitation or emotional distress

What is Catatonia? 12)

Catatonia

Dx Criteria: 

• 3 or more:

  • Stupor

  • Catalepsy

    • prolonged muscular rigidity, a fixed body or limb posture, decreased sensitivity to pain, and a reduced response to external stimuli

  • Waxy flexibility

    • person's limbs offer slight, even resistance to being moved by an examiner

  • Mutism

  • Negativism

  • Posturing

  • Mannerism

  • Stereotypy

  • Agitation, (not influenced by external stimuli)

  • Grimacing

  • Echolalia

  • Echopraxia

Describe Charles Bonnet Syndrome

• Pt Profile

• What is it

Describe Capgras Syndrome:

• Pt Profile

• What is it?

  • MEMTIP

Charles Bonnet Syndrome

• Pt Profile:

  • w/ visual impairment

• What is it?

  • Complex recurrent visual hallucinations

    • Most commonly faces

    • Patients know they are not real

---

Capgras Syndrome

• Pt Profile:

  • w/ schizophrenia, brain injury and dementia

• What is it? MEMTIP: u Capping; Grass his ass

  • Delusion that friend, spouse, parent or close family member has been replaced by imposter

What are the uses of antipsychotics

Uses

• Schizophrenia/schizoaffective disorder

• Acute mania

• Bipolar maintenance

• Bipolar depression

• Treatment resistant depression

• Autism

• Agitation

• Tic disorders/Tourette’s disorder

• Personality disorders

• Delusional disorder

• Refractory insomnia

• OCD

• PTSD

• Anxiety (especially in addicts)

• Stuttering

• Intractable singultis

• Huntington’s chorea

• Other conditions causing psychosis (other medical illness, substances)

Describe Antipsychotics 

• Potency

• MOA (a vs typical)?

• A/typical difference in D2 binding and effect of that?:

• Function of 5-H2

Antipsychotics 

• Potency:

  • correlates closely w/ affinity for dopamine 2 receptor

• MOA:

  • Typical: predominant D2 binding

  • Atypical: weaker affinity for D2 + 5-HT 2A antagonism

    • broaden therapeutic effects + reduce EPS

    • Also: significant anticholinergic, antihistaminic, anti noradrenergic 

• A/typical difference in D2 binding:

  • Typical: Tight binding to D2:

    • Symptom relief

    • EPS

    • Hyperprolactinemia

  • Atypical: Looser binding to D2

    • Symptom relief

    • Lower liability for EPS and hyperprolactinemia

• Function of 5-H2:

  • 5HT2 receptors inhibit release of dopamine. 

  • Blockade =  enhances release of dopamine.

What is the Dopamine hypothesis for Schizophrenia

Describe the Mesolimbic and Mesocortical Tracts:

• What is it?

• Fx

• Clinical Importance

Describe the Nigrostriatal tract

• Fx

• effects of blockade of:

  • D2

  • 5HT2A

Mesolimbic tract

• What is it?

  • Projects from midbrain VTA -> nucleus accumbens

• Fx:

  • regulation of emotional behaviors 

  • Cause of Positive symptoms of schizophrenia

    • Increased Dopamine Hyperactivity

• Clinical Importance:

  • Blockade of D2 receptors -> reduction in positive symptoms

    • Equal efficacy in a vs typicals

    • Clozarapine may have greatest efficacy

---

Mesocortical tract

• What is it?

  • VTA -> prefrontal

• Fx:

  • Dopamine deficiency = negative/cog/mood symptoms 

• Clinical Importance:

  • May have more 5HT2A receptors then D2

    • Thus antagonism = help w/ negative symptoms

---

Nigrostriatal tract

• Fx:

  • Part of EPS

  • Controls Motor movement:

    • Modulate in/direct basal ganglia pathways 

• Blockade:

  • Of D2:

    • Deficiency in dopamine -> Parkinsonism

    • Hyperkinetic movement (tardive dyskinesia)

  • Of 5HT2A 

    • Increases dopamine in pathway

      • Thus; atypical = lesser propensity for EPS

Describe EPS:

• Onset of symptoms of EPS

  • Dystonia

  • Akathisia

  • Parkinsonism

  • Tardive dyskinesia

• Describe Acute dystonia:

  • Pt profile

  • Symptoms (3;4)

  • Tx

• Describe Parkinsonism

  • Pt profile

  • Symptoms

  • Tx (2)

• Describe Akathisia

  • Symptoms

  • Importance

  • Tx (3)

Onset of Symptoms of EPS

•  Acute

  • Dystonia: 

    • first hours - first 3 days (90% occurring)

  • Akathisia:

    •  2-3 -> 5 days 

  • Parkinsonism: 

    • first 5 - 30 days 

• Long-term

  • tardive dyskinesia: 

    • months -> years

---

Acute dystonia

• Pt Profile:

  • <40 y/o male

  • Pts on high potency First gen

    • (haloperidol, fluphenazine)

• Symptoms:

  • Muscular rigidity/cramping

    • Neck, Tongue, Face, Back

  • Tongue Thickness + dysphagia

  • Oculogyric crisis 

    • sustained, involuntary upward or lateral deviation of the eyes

• Tx:

  • anticholinergic drugs

    • Benztropine 2 mg IM or IV, diphenhydramine 50 mg IM or IV

---

Parkinsonism

• Pt Profile:

  • Elderly;

  • On high potency 

• Symptoms:

  • bradykinesia, rigidity, cogwheeling, tremor, masked facies, stooped posture, festinating gait, and drooling

• Tx:

  • Switch to second gen or lower dose

  • Antiparkinson drugs

    • Use cautiously in elderly

---

Akathisia

• Symptoms:

  • sensation of restlessness and need to move (especially legs)

  • Anxiety or agitations

• Importance:

  • Leading cause of noncompliance + refusal

  • Increase risk of suicide

• Tx:

  • beta blocker (propranolol 10-30 mg tid) 

  • benzodiazepine (lorazepam 1 mg tid)

  • anticholinergic (benztropine 1-2 mg bid

Describe the treatment of EPS:

• Anticholinergics

  • Why?

  • Drug Name?

  • AE

• Dopamine facilitator

  • Drug Name

  • MOA

  • Clinical Usage

  • AE (3)

• 2 other drug classes? Particular uses?

Anticholinergics:

• Why?

  • Dopamine and acetylcholine = reciprocal relationship in striatum

• Specifically:

  • Benztropine (Cogentin), 

  • Diphenhydramine (Benadryl), 

  • trihexyphenidyl (Artane)

• AE:

  • constipation, dry mouth, blurry vision, urinary retention

---

Dopamine facilitator: 

• Drug name:

  • Amantadine (Symmetrel)

• MOA:

  • Blocking reuptake + increase presynaptic release 

    • Restore Dopa/AcH balance in striatum

• Clinical Usage;

  • Treat symptoms of pseudoparkinsonism

• AE:

  • orthostatic hypotension, 

  • Ankle edema, 

  • GI upset

---

Beta-blockers

• Propranolol

• Works well for akathisia

---

Alpha-agonists

• Clonidine

• Useful in akathisia

• May cause orthostatic hypotension or sedation

Describe Tardive Dyskinesia:

• Symptoms (5)

• Pt Profile

• Tx

  • MEMTIP:

Tardive dyskinesia (TD)

• Symptoms:

  • involuntary athetoid movements

    • tongue, facial/neck, upper/lower extremities, truncal musculature, muscle of breathing/swallowing

• Pt Profile:

  • Rare in pt w/ 3-6 months of antipsychotic exposure

  • > 50 y/o increases risk 

  • 20% of pts taking first gen develops TD

• Tx: MEMTIP: Benazine

  • VMAT2 inhibitors'

    • Deutetrabenzine

    • Valbenazine

      
      

Differentiate the difference in the effects of antipsychotics on the Mesolimbic vs Nigrostriatal pathway:

• Untreated symptoms

• Treated symptoms

Mesolimbic vs Nigrostriatal pathway:

• Untreated:

  • Mesolimbic: Hyperthermia + Positive Symptoms

  • Nigrostriatal: Normal

• Treated ( D2R blockade)

  • Mesolimbic: Normal Temp + Decreased Positive symptoms 

  • Nigrostriatal: 

    • Acute exposure: Hypothemia + EPS

    • Chronic exposure: Hyperthermia + Td

What is AIMS

for TD scoring

Describe the Tuberoinfundibular tract

• Effect of DA and 5HT2A

• Consequences of Prolactin elevation (6)

Effects of DA and 5HT2A on Tuberoinfundibular tract

• DA:

  • Blocks Prolactin Release

• 5HT2A:

  • Causes Prolactin Release 

• NOTE:

  • Increased neuronal Activity in this pathway = inhibits release of prolactin

---

Consequences of Prolactin elevation

• Sexual dysfunction

• Impotence

• Amenorrhea (absence of menstrual periods)

• Galactorrhea 

• Osteopenia (decreased bone density)

• Gynecomastia

List the other side effects of antipsychotics (9)

• MEMTIP

• black box?

Black Box Warnings

• Mortality in dementia

• Suicide

Other Potential Side Effects: 3 Ho’s CNS’ Be Wild/Poor

• Hyperglycemia/diabetes/hyperlipidemia

• Hematologic effects

• Heat intolerance

• Cardiac toxicity

• Neuroleptic malignant syndrome

• Sedation

• Bowel complications (clozapine)

• Weight gain

• Postural hypotension

Describe Neuroleptic Malignant Syndrome

• Symptoms (6)

  • MEMTIP

• Course

• Tx

Neuroleptic Malignant Syndrome

• Symptoms: MEMTIP; MAD? FS (for sure); E

  • Muscle rigidity, 

  • Autonomic instability, 

  • Delirium

  • Fever, 

  • Seizures/Coma

  • Elevated:

    • CK

    • WBC

    • Hepatic enzymes

• Course:

  • Occurs over hours - days

    • Rigidity typically occurs first

• Tx:

  • Stop antipsychotic

  • Supportive care

  • Consider dantrolene

• Note:

  • Less common with second generation drugs

Describe antipsychotics’ effect on:

• Cardiac toxicity:

  • MOA

  • Specific Drugs

• Sedation:

  • Specific Drugs

Cardiac toxicity

• MOA:

  • Potentiate QTc prolongation -> torsades de pointes and sudden death

• Specific Drugs:

  • Pimozide + thioridazine = greatest risk

  • Ziprasidone has FDA caution

---

Sedation

• Can occur w/ all antipsychotics

• Specifically:

  • Chlorpromazine and thioridazine > haloperidol and fluphenazine

  • Clozapine > quetiapine > olanzapine > risperidone > ziprasidone and aripiprazole

Describe antipsychotics’ effect on:

• Postural hypotension

  • Possible Cause:

  • Specific Drugs:

  • Tx:

• Weight gain

  • Possible Cause

  • Specific Drug

Postural hypotension

• Possible Cause:

  • alpha-adrenergic receptor blockade

  • reflex tachycardia

• Specific Drugs:

  • Chlorpromazine, thioridazine, clozapine,

  • can occur with others

• Tx:

  • Get up from recumbency slowly

  • Switching agents to higher potency med

  • Supine = improves hypotension

---

Weight gain

• Possible Cause

  • activation of adenosine monophosphate – dependent protein kinase

• Specific Drugs:

  • All antipsychotics can cause

  •  clozapine and olanzapine = most, followed by quetiapine and risperidone

  • Ziprasidone has the least

Describe antipsychotics’ effect on:

• Diabetes/Hyperglycemia/Hyperlipidemia

  • Specific drugs

• Hematologic effects

  • Specific Drugs

Diabetes/Hyperglycemia/Hyperlipidemia

• Ziprasidone = least risk; 

• Olanzapine = most

• NOTE:

  • Schizo pts in general have risk factors for these diseases; antipsychotics add on

---

Hematologic effects

• Effects:

  • Neutropenia, leukopenia and agranulocytosis

• Clozapine = 1-3 % incidence of agranulocytosis

Describe Abnormal thermoregulation in schizophrenia

• Why?

• Interaction w/ drugs:

  • Anticholinergic 

  • Antidopaminergic 

  • Antipsychotic 

Abnormal thermoregulation in schizophrenia

Why?

• Impaired heat loss via peripheral vasodilation b/c niacin and prostaglandin E1 abnormalities

• Disruption of mesolimbic system 

  • responsible for temperature regulation and psychosis

---

Interactions w/ drugs:

• Anticholinergic 

  • Inhibits sweating

• Antidopaminergic 

  • Increase set point of temperature regulation

• Antipsychotic 

  • Reduces compensatory behaviors (drinking more water)

Describe the Pharmacokinetics of Antipsychotics

Describe the Use of Antipsychotics in Bipolar Disorder

• Bipolar mania and mixed episodes

• Bipolar depression

• Maintenance

Use of Antipsychotics in Bipolar Disorder

• Bipolar mania and mixed episodes

  • Second generation = better tolerated

  • First generation meds also effective

• Bipolar depression

  • Olanzapine + quetiapine = best efficacy

• Maintenance

  • second gen +  lithium or valproate reduces risk of relapse

Describe the Use of Cannabidiol (CBD) in Schizophrenia

Benefits:

• Not dependent on dopamine receptor antagonism

• May reduce positive symptoms

• May improve cog. performance

NOTE:

• While THC has psychotomimetic effects, CBD may have opposing properties